Guideline Video

Guideline Resources

  • Diagnosis and Management of Pediatric Functional Constipation
  • American Gastroenterological Association/North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
  • April 1, 2026
  • Summary
  • Full-text

Video Transcription

Just published April 1st, 2026, the American Gastroenterological Association and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition’s newest clinical care pathway on Diagnosis and Management of Pediatric Functional Constipation.

This pathway provides a standardized and evidence-based approach aiming to enhance early identification of functional constipation and improve outcomes while providing a structure for transition to adult care.

In today’s rapid update, we’ll just be going over key highlights, so for the full clinical pathway make sure to check it out on guidelinecentral.com

Let’s get started. 

Starting with the section on Diagnostic Studies 

  • There is no evidence to support routine use of abdominal x-ray in the management and diagnosis of functional constipation, also known as FC. Abdominal X-ray has poor diagnostic accuracy, with no correlation between symptoms and fecal load, low intra- and interobserver reliability, and poor sensitivity and specificity.
  • Colonic transit has limited value in predicting outcomes as most patients with FC have normal transit, routine use is not recommended.
  • Contrast enema has been used to screen for Hirschsprung’s disease, or HD, but a normal study does not rule it out. Evaluation of colonic diameter has not been associated with outcomes.
  • Anorectal manometry allows assessment of anal sphincter function and length. The main indication is to evaluate the presence of the rectoanal inhibitory reflex, to screen for HD or internal anal sphincter achalasia, and in appropriate patients to assess for dyssynergic defecation. In children with FC, anorectal manometry has not been shown to add clinical value.
  • Colonic manometry, or CM, is the test of choice to evaluate colonic motility function. CM can help identify colonic dysmotility and has been helpful in selecting patients for surgical interventions, but not medical therapy. Its use should be limited to patients being considered for surgery. 

On to the section on Treatment

  • Treatment of FC in children begins with changes in diet, lifestyle, and activity and may progress into medications, and then more invasive treatments if necessary. 
  • For behavioral interventions, pelvic floor physical therapy and biofeedback has not been proven to be effective but may be recommended for those with proven dyssynergic defecation. In certain cases, comprehensive treatment may require a multidisciplinary team including a pediatric mental health professional, ideally a gastrointestinal psychologist or other pediatric mental health clinician with expertise in gastrointestinal conditions. Enhanced toilet training is the only behavioral intervention with empirical evidence for toileting and fecal incontinence. 
  • Medical treatment includes three phases: identification and treatment of fecal impaction, maintenance therapy, and eventual withdrawal of medical treatment. Despite the lack of a clear and accepted definition of fecal impaction, it is important to evaluate and treat fecal impactions prior to maintenance therapy as this leads to better outcomes. 
  • Surgical interventions are reserved for pediatric patients who fail adequate medical and behavioral therapy, and a multidisciplinary evaluation is recommended for those considered for surgery. 

And now the section on Transition of Care

Scientific societies recommend education on transition of care from children into adulthood into the training of pediatric and adult gastroenterologists. The following are recommended steps to support the management approach to achieve a successful transition process:

  • Educating health care administrators of the importance of transition of care.
  • Establishing current procedural terminology that reflects the complexity of the process.
  • Educating pediatric and adult gastroenterologists on the mutually applicable diagnostic criteria, testing and management approaches.
  • Familiarizing adult providers with the care of young adults and their parents.
  • Harmonizing diagnostic criteria and treatment in pediatric and adult patients.
  • Common diagnostic criteria for FC would allow combined meta-analysis, systematic reviews, and clinical trials with participants of different age groups as well as longitudinal studies.

And there you have it. Make sure to check out the full pathway from the American Gastroenterological Association and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and other related clinical decision support tools at guidelinecentral.com.

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