Evaluation And Treatment Of Functional Constipation In Infants And Children
Publication Date: November 13, 2013
Last Updated: March 14, 2022
Recommendations
Diagnosis
The Rome III criteria are recommended for the definition of functional constipation for all age groups.
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The diagnosis of functional constipation is based on history and physical examination.
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We recommend using alarm signs and symptoms and diagnostic clues to identify an underlying disease responsible for the constipation.
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If only 1 of the Rome III criteria is present and the diagnosis of functional constipation is uncertain, a digital examination of the anorectum is recommended.
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In the presence of alarm signs or symptoms or in children with intractable constipation, a digital examination of the anorectum is recommended to exclude underlying medical conditions.
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The routine use of an abdominal radiograph has no role to diagnose functional constipation.
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A plain abdominal radiography may be used in a child in whom fecal impaction is suspected but in whom physical examination is unreliable/not possible.
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Colonic transit studies are not recommended to diagnose functional constipation.
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A colonic transit study may be useful to discriminate between functional constipation and functional nonretentive fecal incontinence and in situations in which the diagnosis is not clear.
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Rectal ultrasound is not recommended to diagnose functional constipation.
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Routine allergy testing to diagnose cow’s-milk allergy is not recommended in children with constipation in the absence of alarm symptoms.
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Based on expert opinion, a 2- to 4-week trial of avoidance of CMP may be indicated in the child with intractable constipation.
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Routine laboratory testing to screen for hypothyroidism, celiac disease, and hypercalcemia is not recommended in children with constipation in the absence of alarm symptoms.
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Based on expert opinion, the main indication to perform ARM in the evaluation of intractable constipation is to assess the presence of the RAIR.
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Rectal biopsy is the gold standard for diagnosing HD.
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We do not recommend performing barium enema as an initial diagnostic tool for the evaluation of children with constipation.
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Colonic manometry may be indicated in patients with intractable constipation before considering surgical intervention.
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The routine use of MRI of the spine is not recommended in patients with intractable constipation without other neurologic abnormalities.
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We do not recommend obtaining full-thickness colonic biopsies to diagnose colonic neuromuscular disorders in children with intractable constipation.
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We do not recommend the routine use of colonic scintigraphy studies in children with intractable constipation.
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Overview
Title
Evaluation And Treatment Of Functional Constipation In Infants And Children
Authoring Organization
Consensus and Physician Experts