Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Gastroenterological Association and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Diagnosis and Management of Pediatric Functional Constipation

American Gastroenterological Association

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

Publication Date: Apr 1, 2026

Page Last Updated: Apr 23, 2026

Recommendations for Transitioning Process From Pediatric to Adult Gastroenterology

1. Selection of patients who may benefit from transition of care

16 years of age and above
Intractable constipation considered to require long-term care into adulthood
Fecal incontinence
Patients with anterograde continence enema catheters, sacral nerve stimulation in place (even if not currently using)
HD or anorectal malformations with active symptoms
Spinal cord abnormalities with constipation/fecal incontinence
Constipation in the setting of connective tissue diseases, cystic fibrosis, diabetes, myasthenia gravis, intestinal pseudo-obstruction, etc.

2. Assessment of patient's transition readiness and education of the patient and family by the pediatric team

Assessment must be personalized and based on the maturity of the patient and presumed ability to master skills for responsible management of own health care
Caretaker involvement in the transition process

3. Key health care professionals

Pediatric team

Primary care or pediatric gastroenterologist
Nutritionist
Psychologist
Social worker
Nurse
Transition coordinator
Pediatric surgeon and/or neurosurgeon (when appropriate)
Another specialist on as needed basis

Adult team

Adult neurogastroenterology/motility expert
Nurse (nurse coordinator)
Dietician
Adult surgeon (when appropriate)
Another specialist on as needed basis

4. Role of transition coordinator

Assessment and education of patients and families on skills related to self-management and self-advocacy.
Logistics of transfer (education and coordination)
Education on self-advocacy and basic skills (eg, understanding insurance coverage, scheduling appointments/following up on referrals), and self-management (eg, filling/reordering prescriptions).
Be available to answer questions or concerns from patients and families during transition and at initial stages of transfer

5. Materials

Constipation-specific transition readiness questionnaires to assess pre- and post-transfer health care outcomes
Manuals and educational programs to train health care professionals about transition care in neurogastroenterology and motility
Educational materials and forms for adolescents and young adults on transition

6. Periodic meetings

Discuss complex cases
Reassess program and outcomes evaluating transition effectiveness through patient feedback and health outcomes

7. Legal and ethical considerations

Ensure compliance with legal requirements for transfer of care between pediatric and adult services.
Address privacy and confidentiality concerns.
Educate patients and families on their rights and responsibilities in the health care transition.

8. Financial support

Guidance on insurance coverage transitions, including Medicaid.
Education on cost management and budgeting for ongoing medical needs.

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Document Overview

Document Title: Diagnosis and Management of Pediatric Functional Constipation

Authoring Societies

American Gastroenterological Association

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

Document Publication Date: Apr 1, 2026

Page Last Reviewed/Updated: Apr 23, 2026

Document Type: Consensus

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.cghjournal.org/article/S1542-3565(26)00159-X/fulltext

Source Citation: Rodriguez L, Ambartsumyan L, Baumgartner K, Di Lorenzo C, Fenick AM, Garza JM, Kaul A, Khlevner J, Nurko S, Saps M, Shotwell J, Stoeckel M, Camilleri M. American Gastroenterological Association-North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pediatric Functional Constipation Clinical Care Pathway. Clin Gastroenterol Hepatol. 2026 Apr 2:S1542-3565(26)00159-X. doi: 10.1016/j.cgh.2026.03.003. Epub ahead of print. PMID: 41935596.

Document Scope, Criteria, and Use Cases

Document Objectives: Functional constipation (FC) is a prevalent condition in pediatrics that significantly impacts quality of life and health care utilization. The American Gastroenterological Association (AGA) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) collaborated to develop a clinical care pathway for pediatric primary care providers and pediatric gastroenterologists, based on consensus among content experts, for the diagnosis and management of FC in children. This pathway aims to provide a structured, practical approach to streamline clinical decision-making and improve patient outcomes. The AGA-NASPGHAN Pediatric Functional Constipation Clinical Care Pathway standardizes evaluation and management, ensuring a practical approach for clinicians. Future research should focus on optimizing real-world implementation and evaluating long-term patient outcomes.

Scope: Assessment and Screening, Diagnosis, Management

Keywords: constipation, functional constipation, pediatric constipation

Health Care Settings: Ambulatory, Outpatient

Intended Users: Dietician/Nutritionist, Nurse, Nurse Practitioner, Physician, Physician Assistant

Diagnosis and Management of Pediatric Functional Constipation

Summary of Recommendations

Highlights

Recommendations for Transitioning Process From Pediatric to Adult Gastroenterology

Table 1. Rome IV Diagnostic Criteria for Functional Constipation in Infants/Toddlers

Table 2. Differential Diagnosis of Pediatric functional constipation

Table 3. Summary of Utility of Diagnostic Studies in Children With functional constipation

Table 4. Medication Doses and Frequency Recommended for the Therapy of functional constipation

Figure 1. Timeline summary for transition of care

Figure 2. Evaluation of pediatric functional constipation

Document Overview

Document Scope, Criteria, and Use Cases