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Davis TA, Turner A, Wilson C, Wang J, Joerger S, Utterson EC, Shakhsheer BA. Botulinum Toxin Improves Quality of Life and Clinical Outcomes in Pediatric Defecation Disorders. Neurogastroenterol Motil 2025; 37:e70005. [PMID: 39962765 DOI: 10.1111/nmo.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 01/06/2025] [Accepted: 02/04/2025] [Indexed: 05/15/2025]
Abstract
OBJECTIVE To elucidate the effect of internal anal sphincter (IAS) botox as an adjunct to standard treatment for disordered defecation (DD), defined by the inability to effectively evacuate stool from the rectum resulting in constipation, on patient/caregiver quality of life (QoL) metrics in association with corresponding clinical outcomes. METHODS Consecutive children undergoing IAS botox for DD completed surveys at baseline, two weeks, and three months post-procedure. Time points included assessment of clinical symptoms (Rome IV Questionnaire), QoL (Pediatric Quality of Life Inventory [PedsQL]), and caregiver well-being/family functioning (PedsQL-Family Impact Module [PedsQL-FIM]). RESULTS Of 60 participants, the median age was 7 years (IQR 4-10), with 34 (56.7%) males and 32 (53.3%) first-time Botox recipients. The median onset of positive effect after Botox was 6 days (IQR 3-14), while the median loss of effect was 70 days (IQR 39-83). Compared to baseline, by 3 months there was a lower chance of meeting Rome IV criteria for functional constipation in first-time recipients (RR 0.73, 95% CI: 0.58-0.91; p = 0.005). This remained significant after adjusting for any bowel regimen change during the 3-month period following Botox (OR 0.33, 95% CI: 0.13-0.74; p = 0.012). Regarding QoL, there was significant improvement in total PedsQL score at both 2-weeks (11.79 point improvement, 95% CI: 6.36-17.22; p < 0.0001) and 3 months (13.97 point improvement, 95% CI: 8.47-19.47; p < 0.0001) from baseline for first-time recipients, while improvement was only observed at 2 weeks for prior recipients (6.67 point improvement, 95% CI: 0.65-12.69; p = 0.030). First-time recipients demonstrated significant improvements in total PedsQL-FIM score at both 2 weeks (9.33 point improvement, 95% CI: 3.77-14.89; p = 0.001) and 3 months (11.57 point improvement, 95% CI: 5.94-17.20; p < 0.0001) from baseline. CONCLUSION Our findings establish far-reaching benefits of IAS botox primarily for first-time recipients, both clinically and psychosocially, suggesting that appropriate incorporation into the treatment paradigm may globally enhance outcomes in children with DD.
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Affiliation(s)
- Trevor A Davis
- Division of Gastroenterology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ashlyn Turner
- Division of Gastroenterology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carrie Wilson
- Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jinli Wang
- Center for Biostatistics and Data Science, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shannon Joerger
- Division of Gastroenterology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Elizabeth C Utterson
- Division of Gastroenterology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Baddr A Shakhsheer
- Department of Surgery, Section of Pediatric Surgery, University of Chicago, Chicago, Illinois, USA
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McCague Y, Hill K, Furlong E, Somanadhan S. The psychosocial impact of childhood constipation on the children and family: A scoping review. J Pediatr Nurs 2025; 82:e142-e163. [PMID: 40253271 DOI: 10.1016/j.pedn.2025.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 04/09/2025] [Accepted: 04/09/2025] [Indexed: 04/21/2025]
Abstract
BACKGROUND Constipation is a common and complex health issue among children that negatively affects multiple domains of children's and families' lives. Emotional, psychological, and behavioural problems in children, as well as anxiety, distress and frustration in parents, are some of the reported effects. AIM This manuscript presents a systematic scoping review synthesising current evidence on the psychosocial impact of childhood constipation on children and their families. METHODS This review was guided by Arksey and O'Malley's five-stage framework, updated by Levac, Colquhoun and O'Brien and the Joanna Briggs Institute. Five databases were systematically searched: PUBMED, CINAHL, ASSIA, PsycINFO and Google Scholar, which yielded 2836 records. Following a systematic screening process, 32 articles met the inclusion criteria. Results were analysed, discussed and presented using the PAGER framework. RESULTS The four key patterns that emerged were the psychosocial impact of childhood constipation on children, their parents, and school and academic life, and parental factors associated with childhood constipation. CONCLUSION Childhood constipation significantly impacts the quality of life for both children and their parents, as well as the school life and academic performance. Various parental factors are linked to a higher prevalence of constipation in children. IMPLICATIONS Neglecting to assess and address psychosocial issues in children with constipation can prolong the condition and significantly reduce their overall quality of life, contributing to multimorbidity. Adopting a holistic approach to managing constipation in children and their families is essential for promoting overall well-being.
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Affiliation(s)
- Yvonne McCague
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland. Regional Hospital Mullingar, Co. Westmeath, Ireland..
| | - Katie Hill
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eileen Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Suja Somanadhan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Patel D, Saikumar P, Jayaraman M, Desai C, Rosen J, Rodriguez L. Efficacy of anal botulinum toxin injection in children with functional constipation. J Pediatr Gastroenterol Nutr 2025. [PMID: 40123476 DOI: 10.1002/jpn3.70040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 02/24/2025] [Accepted: 03/05/2025] [Indexed: 03/25/2025]
Abstract
OBJECTIVES Functional constipation (FC) is a common diagnosis in the pediatric age group. In addition to laxative regimens and behavioral interventions, some have reported the use of anal botulinum toxin (BTX) injections to treat FC, with limited data regarding its efficacy. METHODS This is a retrospective, multicenter study including patients who received BTX for FC refractory to medical therapy. Demographic data, results of anorectal manometry, and BTX data (number of sessions, dose, and side effects) were collected. Patients were divided into three groups based on the indication for BTX: group 1 (FC with FI [fecal incontinence]), group 2 (FC without FI), and group 3 (FI alone). Response to therapy was assessed for whole cohort and for each group based on improvement in weekly frequency of BM (bowel movements) to 3 or more per week and/or resolution of FI. We also compared the response to therapy to the parental and provider report. RESULTS A total of 63 patients were included in the study. Median age was 6.4 years and 32 (51%) were female. The median dose of BTX was 100 units, and most patients (55/63) received a single BTX injection. Medical therapy was continued after BTX injections in most patients (60/63 or 95%). After BTX, the frequency of BM increased to >3/week in 29/56 (52%) and FI improved in 8/47 (17%) for the whole cohort. We observed a response rate of 10% in group 1, 50% in group 2 and 14% in group 3. No factors (age, gender, anal resting pressure) were associated with BTX response except for prolonged time of therapy before BTX and shorter median follow up after BTX. Parents/primary provider reported improvement in 44/63 (70%) after BTX, which was significantly higher than the actual observed response to therapy (70% vs. 21%, p = 0.003, kappa = 0.202). We found no association between response to BTX and presence of developmental delay and/or behavioral disorders (p = 0.531). Side effects were minimal and noted in seven (11%) patients, mainly FI. No factors were associated with the development of side effects. CONCLUSIONS Anal BTX injections improved BM frequency with minimal effect on FI with an overall symptom resolution in 21% of patients. BTX does not seem to have a notable effect in patients with FC and developmental delay and/or behavioral disorders. Provider and parental reported success were significantly higher than the actual observed response.
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Affiliation(s)
- Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Pavithra Saikumar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Mayuri Jayaraman
- Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Chaitri Desai
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - John Rosen
- Division of Gastroenterology and Hepatology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Leonel Rodriguez
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, New Haven Children's Hospital, Yale University, New Haven, Connecticut, USA
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Beaudry-Bellefeuille I, Ramos-Polo E. Improving Participation in Toileting Routines in a Child with Functional Constipation: A Case Study Using the Integrated Sensory Toileting® Approach. Occup Ther Health Care 2024:1-12. [PMID: 39177311 DOI: 10.1080/07380577.2024.2394947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 08/18/2024] [Indexed: 08/24/2024]
Abstract
This article presents a case report of a three and half year-old boy with functional constipation and sensory hyperreactivity. The Integrated Sensory Toileting® approach was used to guide clinical reasoning and identify the sensory underlying factors that were impacting the child's ability to acquire age-appropriate toileting habits and gastrointestinal health. The six months of treatment in occupational therapy and gastroenterology, as well as six months of follow-up are described. Improvements in sensory reactivity are documented using the Sensory Processing Measure-2 and the Toileting Habit Profile Questionnaire-Revised and corroborate with improvements in the child's ability to participate in toileting routines and improved gastrointestinal health.
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Papadopoulos M, Mutalib M, Nikaki K, Volonaki E, Rybak A, Thapar N, Lindley K, Borrelli O, Das A, Crespi D, Cleeve S, Athanasakos E. Radiopaque marker colonic transit study in the pediatric population BSPGHAN Motility Working Group consensus statement. Neurogastroenterol Motil 2024; 36:e14776. [PMID: 38454312 DOI: 10.1111/nmo.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
Functional constipation (FC) is a common condition in childhood in the United Kingdom and worldwide. Various radiological approaches have been established for diagnostic purposes. The radiopaque marker study (ROMS) is universally accepted and used to assess colonic transit time (CTT) in children with FC. Despite being widely used, there is a lack of standardization with various technical protocols, reproducibility of different populations, the purpose for using investigation, variance in the number of markers used, the amount of study days and calculations, the need to empty the colon before performing the test, and whether to perform on medication or off, or the use of specific diets. As part of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) motility working group (MWG), we decided to explore further into the evidence, in order to provide guidance regarding the use of ROMS in dealing with FC in the pediatric population.
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Affiliation(s)
- M Papadopoulos
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - M Mutalib
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - K Nikaki
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - E Volonaki
- Department of Paediatric Gastroenterology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Rybak
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - N Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Queensland, Australia
- Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
| | - K Lindley
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - O Borrelli
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - A Das
- Paediatric Department, Broomfield Hospital, Broomfield, UK
| | - D Crespi
- Department of Paediatric Surgery, The Royal London Hospital, Barts Health NHS, London, UK
| | - S Cleeve
- Department of Paediatric Surgery, The Royal London Hospital, Barts Health NHS, London, UK
| | - E Athanasakos
- Department of Paediatric Surgery, The Royal London Hospital, Barts Health NHS, London, UK
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Bautista-Casasnovas A, Argüelles-Martín F, Martín-Martínez B, Domínguez-Otero MJ, Tavares M, Amil-Dias J. Multicentre Study Into the Use of Polyethylene Glycol With Electrolytes Over at Least 6 Months to Treat Constipation in Paediatric Populations. JPGN REPORTS 2023; 4:e353. [PMID: 38034437 PMCID: PMC10684192 DOI: 10.1097/pg9.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 12/02/2023]
Abstract
Background Constipation is a common clinical problem in children, for which the first-line therapeutic options are osmotic laxatives, mainly polyethylene glycol (PEG). These treatments are often prescribed for short or limited periods, with progressive treatment withdrawal often resulting in relapses. However, there are a few studies into the long-term use (≥6 months) of PEG 3350 with electrolytes (PEG+E) in terms of the patients' clinical evolution. Objectives To assess bowel movement and other relevant symptoms in children with constipation receiving PEG+E (≥6 months), as well as parent/caregiver satisfaction with this treatment. Methods A retrospective, observational, descriptive, longitudinal, and multicentre study was carried out on 74 children diagnosed with functional constipation (ROME IV criteria) who had received PEG+E (≥6 months). Bowel control was assessed using the Bristol stool scale, and the parent's/caregiver's perception of the treatment was also evaluated employing a nonvalidated questionnaire. Results Children with an average duration of constipation >1 year experienced a significant improvement in bowel movements and stool consistency when using PEG+E. The mean duration of use was 18.6 (±13.4) months, without the need to adjust the dose for weight. All clinical symptoms improved significantly except bloating, and all the parents/caregivers confirmed these clinical improvements. Conclusions Children treated with PEG+E (≥6 months) normalised their bowel movements, improving the clinical symptoms related to constipation in the absence of serious advert events or the need for dosage adjustments due to weight gain. Parents/caregivers reported good satisfaction with PEG+E treatment.
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Affiliation(s)
| | | | | | | | - Marta Tavares
- Pediatric Gastroenterology Unit, Centro Infantil do Norte, Oporto
| | - Jorge Amil-Dias
- Pediatric Gastroenterology Department, Hospital Sao Joao, Oporto
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Domínguez-Muñoz A, Bischoff A, Wehrli LA, Judd-Glossy L, Schneider L, Merritt A, Wickham M, Ketzer J, Rodriguez V, Peña A, De La Torre L. Radiologically supervised bowel management program outcome in patients with chronic idiopathic constipation. Pediatr Surg Int 2023; 39:229. [PMID: 37428259 DOI: 10.1007/s00383-023-05508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE This study aimed to analyze our radiologically supervised bowel management program (RS-BMP) outcomes in patients with chronic idiopathic constipation (CIC). METHODS A retrospective study was conducted. We included all patients with CIC who participated in our RS-BMP at Children´s Hospital Colorado from July 2016 to October 2022. RESULTS Eighty patients were included. The average time with constipation was 5.6 years. Before our RS-BMP, 95% had received non-radiologically supervised treatments, and 71% had attempted two or more treatments. Overall, 90% had tried Polyethylene Glycol and 43% Senna. Nine patients had a history of Botox injections. Five underwent anterograde continence procedure, and one a sigmoidectomy. Behavioral disorders (BD) were found in 23%. At the end of the RS-BMP, 96% of patients had successful outcomes, 73% were on Senna, and 27% were on enemas. Megarectum was detected in 93% of patients with successful outcomes and 100% with unsuccessful outcomes (p = 0.210). Of the patients with BD, 89% had successful outcomes, and 11% had unsuccessful. CONCLUSION Our RS-BMP has been proven to be effective in treating CIC. The radiologically supervised use of Senna and enemas was the appropriate treatment in 96% of the patients. BD and megarectum were associated with unsuccessful outcomes.
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Affiliation(s)
- Alfredo Domínguez-Muñoz
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Andrea Bischoff
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Lea A Wehrli
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Laura Judd-Glossy
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Lauren Schneider
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Anne Merritt
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Maura Wickham
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Jill Ketzer
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Víctor Rodriguez
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Alberto Peña
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA
| | - Luis De La Torre
- Department of Surgery, Division of Pediatric Surgery, International Center for Colorectal and Urogenital Care at Children's Hospital Colorado, Universtity of Colorado, 13213 E 16th Ave, Anschutz Medical Campus, Box 323, Aurora, CO, 80045, USA.
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Bokova E, Svetanoff WJ, Rosen JM, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Functional Constipation. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1078. [PMID: 37371309 DOI: 10.3390/children10061078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Functional constipation (FC) affects up to 32% of the pediatric population, and some of these patients are referred to pediatric surgery units to manage their constipation and/or fecal incontinence. The aim of the current paper is to report the recent updates on the evaluation and management of children with FC as a part of a manuscript series on bowel management in patients with anorectal malformations, Hirschsprung disease, spinal anomalies, and FC. METHODS A literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published within the last 5-10 years. RESULTS The first step of management of children with FC is to exclude Hirschsprung disease with a contrast study, examination under anesthesia, anorectal manometry (AMAN). If AMAN shows absent rectoanal inhibitory reflex, a rectal biopsy is performed. Internal sphincter achalasia or high resting pressures indicate botulinum toxin injection. Medical management options include laxatives, rectal enemas, transanal irrigations, and antegrade flushes. Those who fail conservative treatment require further assessment of colonic motility and can be candidates for colonic resection. The type of resection (subtotal colonic resection vs. Deloyer's procedure) can be guided with a balloon expulsion test. CONCLUSION Most of the patients with FC referred for surgical evaluation can be managed conservatively. Further studies are required to determine an optimal strategy of surgical resection in children unresponsive to medical treatment.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Medical Center, Washington, DC 20001, USA
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Rajindrajith S, Devanarayana NM, Thapar N, Benninga MA. Myths and misconceptions about childhood constipation. Eur J Pediatr 2023; 182:1447-1458. [PMID: 36689003 DOI: 10.1007/s00431-023-04821-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/09/2023] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
Many widely held beliefs and assumptions concerning childhood constipation continue to interfere with rational management of childhood constipation. Although many still believe that constipation is not a common disease, about 9.5% of the world's children suffer from chronic constipation. Most of these children live in non-Western countries. There are major misconceptions about the etiology of constipation as a significant proportion of clinicians still believe that constipation is caused by some form an organic pathology, whereas in reality, the majority have functional constipation. Contrary to a commonly held belief that children outgrow constipation without long-term problems, there is evidence that constipation leads to significant bowel and psychological consequences and has a major impact on the quality of life which detrimentally affects future health and education. Finally, ineffective management strategies such as increasing fiber and water in the diet, and short duration of treatment owing to the fear that long-term laxative treatment leads to colonic dysfunction, interfere with effective therapeutic strategies. Conclusions: It is apparent that myths and misconception often lead to wrong assumptions regarding the distribution of the disease, its etiology, pathophysiology, and management leading to ordering incorrect investigations and ineffective therapeutic strategies while spending large sums of public funds unnecessarily. Poorly treated constipation leads to deleterious psychological consequences predisposing children to develop significant psychological damage and bowel dysfunctions. This review aims to challenge these myths about various elements of constipation by exploring the existing literature and encouraging clinicians to have a fresh look at old concepts that could interfere with the well-being of children with constipation. What is Known: • Childhood constipation is a growing problem in the world leading to significant suffering and high healthcare expenditure • Myths and misconceptions lead to poor management strategies causing psychological and bowel damage What is New: • Organic, systemic, and bowel disorders leading to constipation are uncommon, and in the majority, it arises due to deliberate fecal withholding and most investigations ordered by clinicians are not very helpful in the management • Most non-pharmacological interventions are not effective in the day-to-day management of childhood constipation. The use of laxatives is considered to be the first-line management strategy.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka.
| | | | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
| | - Marc Alexander Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University, of Amsterdam, Amsterdam, The Netherlands
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Meng Y, Zhou Y, Li H, Chen Y, Dominik G, Dong J, Tang Y, Saavedra JM, Liu J. Effectiveness of Growing-Up Milk Containing Only A2 β-Casein on Digestive Comfort in Toddlers: A Randomized Controlled Trial in China. Nutrients 2023; 15:nu15061313. [PMID: 36986042 PMCID: PMC10058316 DOI: 10.3390/nu15061313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Emerging clinical evidence indicates the potential gastrointestinal (GI) benefits of milk containing only A2 β-casein, but data from randomized controlled trials is sparse among pediatric populations. We aimed to evaluate the effectiveness of growing-up milk (GUM) containing only A2 β-casein on GI tolerance in toddlers. METHODS A total of 387 toddlers aged 12-36 months were recruited in Beijing, China, and randomized in a 1:1:1 ratio to consume one of two commercially available A2 GUMs (combined in the analysis as A2 GUM) or continue their current feeding regimen of conventional milk for 14 days. The primary outcome was the total Gut Comfort Score (GCS) (range: 10-60; higher values indicate greater GI distress) derived from a 10-item (score range: 1-6 per item) parent-reported questionnaire, reflecting GI tolerance. RESULTS The GCS (mean ± SD) was comparable between the A2 GUM and conventional milk groups on day 7 (14.7 ± 5.0 vs. 15.0 ± 6.1, p = 0.54) and day 14 (14.0 ± 4.5 vs. 14.3 ± 5.5, p = 0.51). Parents reported less constipation in those consuming A2 GUM vs. conventional milk on day 14 (1.3 ± 0.6 vs. 1.4 ± 0.9, p = 0.020). Among 124 participants with minor GI distress at baseline (GCS ≥ 17, top tertile range 17-35), GCS was significantly lower in those consuming A2 GUM on day 7 (18.2 ± 5.1 vs. 21.2 ± 6.8, p = 0.004) and day 14 (17.1 ± 5.3 vs. 19.6 ± 6.3, p = 0.026), as were individual GI symptoms (all p < 0.05). In the toddlers without GI issues at baseline (GCS < 17), a low GCS was maintained throughout the study period after switching to A2 GUM (mean values range 10-13). CONCLUSIONS Growing-up milk containing only A2 β-casein were well-tolerated and associated with lower parent-reported constipation scores after two weeks when compared to conventional milks. In healthy toddlers with minor GI distress, A2 GUM improved overall digestive comfort and GI-related symptoms within one week.
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Affiliation(s)
- Ying Meng
- National Health Commission Key Laboratory of Reproductive Health/Institute of Reproductive and Child Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
| | - Yubo Zhou
- National Health Commission Key Laboratory of Reproductive Health/Institute of Reproductive and Child Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
| | - Hongtian Li
- National Health Commission Key Laboratory of Reproductive Health/Institute of Reproductive and Child Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
| | - Yipu Chen
- Nestlé Product Technology Center-Nutrition, 1800 Vevey, Switzerland
| | | | - Jie Dong
- Wyeth Nutrition, Shanghai 200040, China
| | - Youchi Tang
- Information Management Section, Chaoyang District Maternal and Child Health Hospital, Beijing 100021, China
| | - Jose M Saavedra
- Division of Gastroenterology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jianmeng Liu
- National Health Commission Key Laboratory of Reproductive Health/Institute of Reproductive and Child Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd., Beijing 100191, China
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11
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Reeves PT, Jack BO, Rogers PL, Kolasinski NT, Burklow CS, Min SB, Nylund CM. The Uniformed Services Constipation Action Plan: An Effective Tool for the Management of Children with Functional Constipation. J Pediatr 2023; 253:46-54.e1. [PMID: 36115625 DOI: 10.1016/j.jpeds.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To implement and to evaluate the effectiveness of the Uniformed Services Constipation Action Plan (USCAP) in our gastroenterology clinic for children with functional constipation. STUDY DESIGN This implementation science study included toilet-trained subjects aged 4 years and older who met the Rome IV criteria for functional constipation. Children were block randomized to receive either the USCAP or control. All clinic functional constipation plans recommended subjects continue pharmacotherapy for 4 months. Endpoints measured were clinical outcomes (resolution of functional constipation and achievement of a Pediatric Bristol Stool Form Scale [PBSFS] score of 3 or 4), patient-related outcomes (health-related quality of life [HRQoL] total scale score), and health confidence outcomes (Health Confidence Score [HCS]). RESULTS Fifty-seven treatment group subjects (44%) received a USCAP (52% male; mean age, 10.9 [4.9] years) compared with 73 controls (56%; 48% male; mean age,10.9 [5.3] years). A PBSFS score of 3 or 4 was achieved by 77% of the treatment group compared with 59% of controls (P = .03). Subjects from the treatment group were more likely than the controls to endorse adherence to the 4-month course of pharmacotherapy (P < .001). Subjects who received a USCAP had greater improvements in HRQoL total scale score by the end of the project (P = .04). CONCLUSIONS The USCAP is a simple, inexpensive tool that has the potential to improve global outcomes for functional constipation in children and should be recommended as standard clinical practice.
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Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX.
| | - Benjamin O Jack
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD
| | - Philip L Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Nathan T Kolasinski
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carolyn Sullivan Burklow
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Steve B Min
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cade M Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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12
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Kostekci YE, Baskan S, Topcu S, Kose SK, Ozgur EG, Orhon F. Evaluation of the effects of the toilet training process on the children's quality of life. Pediatr Int 2023; 65:e15508. [PMID: 36799016 DOI: 10.1111/ped.15508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Toilet training is a significant developmental milestone for children. During the process of toilet training, voiding and defecation problems may develop, which have a major adverse impact on the child's quality of life (QoL). The aim of this study was to assess voiding and defecation problems in the process of toilet training and evaluate how these issues influenced the children's QoL. METHODS The children included in the study were followed up at the Department of Social Pediatrics, Ankara University School of Medicine. Participants were surveyed via a questionnaire that included sociodemographic features, the toilet training process, and the Pediatric Quality of Life Inventory. RESULTS The study included 177 children and their parents. There was no correlation between the parents' age, sociodemographic features, or the timing of the start of toilet training. Voiding problems were found in 55.6% and defecation problems in 23.6% of the children included in the study. Urinary retention during play and nocturnal enuresis were more frequent in the children toilet trained at 25-36 months of age. The self-reported QoL scores in children with voiding problems and with both voiding and defecation problems were lower than those in children did not have any problems. CONCLUSIONS Even if a child has been toilet trained, it is essential to investigate daily urination and defecation habits at every follow-up visit and to discuss with families when a physician should be consulted.
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Affiliation(s)
| | - Sevgi Baskan
- Division of Social Pediatrics, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Seda Topcu
- Division of Social Pediatrics, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serdal Kenan Kose
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gokay Ozgur
- Department of Biostatistics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Filiz Orhon
- Division of Social Pediatrics, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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13
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Smith CA, Kwon EG, Nicassio L, Glazer D, Avansino J, Durham MM, Frischer J, Calkins C, Rentea RM, Ralls M, Saadai P, Badillo A, Fuller M, Wood RJ, Rollins MD, Van Leeuwen K, Reeder RW, Lewis KE, Rice-Townsend SE. Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery. J Pediatr Surg 2023; 58:56-63. [PMID: 36283846 DOI: 10.1016/j.jpedsurg.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Fecal continence is a concern for many patients with idiopathic constipation and can significantly impact quality of life. It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal continence and associated demographic characteristics in children with idiopathic constipation referred for surgical evaluation. METHODS A multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients >3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests. RESULTS 458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p<0.001). Patients with developmental delay were also more likely to have lower continence levels (p = 0.009) while diagnoses such as anxiety, ADD/ADHD, autism, depression, obsessive-compulsive disorder were not associated. Approximately 30% of patients had an ACE operation (antegrade continence enema) at a median age of 9.2 years at operation. Black patients were significantly less likely to undergo ACE operation (p = 0.016) when compared to white patients. CONCLUSION We observed data that suggest differences in fecal incontinence rates based on payor status. Further investigation is needed to characterize these potential areas of disparate care. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Eustina G Kwon
- Seattle Children's Hospital, Seattle, WA, United States.
| | | | - Deb Glazer
- Seattle Children's Hospital, Seattle, WA, United States
| | | | - Megan M Durham
- Emory + Children's Pediatric Institute, Atlanta, GA, United States
| | - Jason Frischer
- Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Casey Calkins
- Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | | | - Matthew Ralls
- C.S. Mott Children's Michigan, Ann Arbor, MI, United States
| | | | | | - Megan Fuller
- Boys Town National Research Hospital, Boys Town, NE, United States
| | - Richard J Wood
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Michael D Rollins
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States
| | | | - Ron W Reeder
- University of Utah, Salt Lake City, UT, United States
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14
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Ahmed S, Alam S, Alsabri M. Health-Related Quality of Life in Pediatric Inflammatory Bowel Disease Patients: A Narrative Review. Cureus 2022; 14:e29282. [PMID: 36277571 PMCID: PMC9578282 DOI: 10.7759/cureus.29282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 12/02/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic autoimmune condition that can have a wide range of symptoms among pediatric patients. Although clinical symptoms like hematochezia, diarrhea, and abdominal pain are commonly addressed, health-related quality of life (HRQOL) is often overlooked in patients with IBD and pediatric patients with chronic disease in general. Examining HRQOL can help improve patient outcomes, but it has been studied sparingly. In this review, we aim to compare HRQOL between pediatric patients suffering from IBD and healthy children, as well as those suffering from other illnesses. We searched through peer-reviewed primary literature related to IBD and HRQOL and selected 10 articles from the PubMed database to be reviewed. Our inclusion criteria included articles published after the year 2000 in English, primary studies, and those that corresponded to the aim of this review. Case reports and secondary and tertiary articles were excluded from our review. We found that patients with IBD reported worse HRQOL in terms of overall health and in various subdomains, including physical health and fatigue, compared to their healthy counterparts. However, children with IBD demonstrated a comparable HRQOL with children suffering from functional abdominal pain (FAP) and obesity. Additionally, children with IBD displayed a greater HRQOL than pediatric patients with gastroesophageal reflux disease (GERD) and chronic constipation. In addressing the aim of this review, we found that children with IBD had a lower HRQOL when compared to healthy children, but a comparable or greater HRQOL than other sick children. Some factors associated with a reduced HRQOL include disease activity, age, fatigue, gender, psychological variables, and associated symptoms. Going forward, HRQOL should be considered by practitioners when caring for pediatric IBD patients in a clinical setting as it can help improve patient care. More studies need to be conducted to further explore HRQOL in pediatric patients. This can help implement early psychosocial interventions in children to reduce the disease burden.
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15
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Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11:385-404. [PMID: 36185096 PMCID: PMC9516492 DOI: 10.5409/wjcp.v11.i5.385] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/24/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 00800, Sri Lanka
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam 1105AZ, The Netherlands
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16
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Peña-Vélez R, Toro-Monjaraz E, Avelar-Rodríguez D, Zárate-Mondragón F, Ramírez-Mayans J. Alterations in the Rectal Sensitivity of Children With Chronic Constipation Evaluated by High-Resolution Anorectal Manometry. Cureus 2022; 14:e28835. [PMID: 36225479 PMCID: PMC9536238 DOI: 10.7759/cureus.28835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Constipation is one of the most frequent chronic disorders in children and is almost always of functional etiology. Manometric alterations in anorectal sensitivity in children with chronic constipation are described in the literature; nevertheless, the impact of the duration of constipation on the parameters of anorectal manometry sensitivity is unknown. Objective To compare the parameters of sensitivity of high-resolution anorectal manometry (first sensation, threshold volume for urgency, and maximal tolerability) in children with chronic constipation, related to the time of evolution from the beginning of the symptoms. Methods This was a retrospective observational analytic study. The data of 39 children with functional constipation who were subjected to high-resolution anorectal manometry were included to evaluate constipation. The patients were divided into three groups according to the duration of constipation: <1 year; from 1 to 2 years; and >2 years. The parameters of sensitivity of the anorectal manometry were compared between the three groups and correlation tests were performed with the duration in months from the beginning of the symptoms of constipation. Results There was no difference between the sensitivity parameters of high-resolution anorectal manometry of the three groups; no correlation of these parameters with the time of evolution of the symptoms was found. Conclusions Alterations in the anorectal distensibility could develop early in the course of the disease, even from the first year of the beginning of the symptoms.
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17
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van der Doef H, Houwen R. Constipation and cystic fibrosis. Slow movement. J Cyst Fibros 2022; 21:385-386. [DOI: 10.1016/j.jcf.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Liyanarachchi H, Rajindrajith S, Kuruppu C, Chathurangana P, Ranawaka R, Devanarayana NM, Benninga MA. Association between childhood constipation and exposure to stressful life events: a systematic review. Neurogastroenterol Motil 2022; 34:e14231. [PMID: 34415089 DOI: 10.1111/nmo.14231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/23/2021] [Accepted: 07/13/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several cross-sectional studies have reported an association between childhood constipation and exposure to stressful events. We planned to systematically review the literature on constipation and its associated stressful events. METHODS PubMed, Embase, and PsycINFO databases were searched (until February 2021) using standard search terms related to "constipation" and "stress" from 0 to 18 years that describe the association between psychological stressors and constipation. Studies were screened using pre-designed eligibility criteria. Studies that fulfilled the criteria were reviewed in a full-text format. The quality assessment of selected articles was conducted using standard methods. KEY RESULTS Of 2296 titles and abstracts screened, 38 were included in the full-text review. Out of that, 15 articles were included in this systematic review. There were 2954 children with constipation, and the age range was from 6 months to 16 years. Exposure to home-related stressors (divorce or separation of parents, severe illness in family, and parental job loss) school-related stressors (including being bullied at school, change in school, separation from the best friend at school, and failure in an examination), exposure to child maltreatments and exposure to war/civil unrest were associated with childhood constipation. CONCLUSIONS AND INFERENCES Exposure to day-to-day home- and school-related stressors, to child maltreatment, and to civil unrest is associated with constipation in children and adolescents. These factors need to be explored during clinical evaluation of children with constipation.
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Affiliation(s)
- Hasitha Liyanarachchi
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Shaman Rajindrajith
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | | | - Prasad Chathurangana
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Randula Ranawaka
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
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19
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Harris K, Overcash F, Belobrajdic D, Slavin J. Perspective: Utilizing High Amylose Wheat Flour to Increase Dietary Fiber Intake of Children and Adolescents: A Health by Stealth Approach. Front Public Health 2022; 10:817967. [PMID: 35433621 PMCID: PMC9008407 DOI: 10.3389/fpubh.2022.817967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/14/2022] [Indexed: 12/15/2022] Open
Abstract
Children and adolescents have consistently failed to meet recommended levels of dietary fiber consumption, thus making fiber a nutrient of concern. The importance of adequate dietary fiber intake to attain a healthy diet necessitates the identification of fiber-rich and readily consumed food sources by youth. Grain-based foods derived from whole grains represent a strategic initiative to increase dietary fiber consumption and is consistent with the American diet pattern. Increased intake of foods made from whole grains have been positively associated with improved health outcomes but are also less preferred among youth compared to refined grain products, which make up the majority of their carbohydrate intake. Advances in the commercialization and availability of high amylose wheat flour, a source of resistant starch fiber, provides an opportunity to remedy the suggested acceptability issues of whole grain products indicative of sensory factors, without compromising the amount of fiber ingested. Resistant starch fiber consumption has been associated with health benefits including improved blood sugar management, improved markers of digestive and gut health, increased satiety, and a reduced inflammatory response among adults. The limited studies that indicate fiber's direct benefit among youth are largely observational, thereby necessitating the need for more controlled trials for these age groups. Replacing traditional refined wheat flour with refined high amylose wheat flour has the unique ability to increase dietary fiber consumption without compromising desired sensory and finished product characteristics and thus can help increase dietary fiber consumption in children and adolescents who struggle to meet adequate intakes of fiber.
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Affiliation(s)
| | - Francine Overcash
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, United States
| | - Damien Belobrajdic
- Commonwealth Scientific and Industrial Research Organization (CSIRO), Canberra, ACT, Australia
| | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, United States
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20
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Gamarra ACQ, Carvalho MDA, Machado NC. Pediatric Functional Constipation Questionnaire-Parent Report (PedFCQuest-PR): development and validation. J Pediatr (Rio J) 2022; 98:46-52. [PMID: 33991496 PMCID: PMC9432193 DOI: 10.1016/j.jped.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Developing and validating a disease-specific instrument in the Brazilian Portuguese language to assess the Health-Related Quality of Life of children with functional constipation, applied to parents/caregivers. METHODS The process of developing the questionnaire was carried out in the following steps: items generation concerning functional constipation; elaboration of the preliminary questionnaire; assessment by health professionals; identifying problems or inconsistencies by the researchers; improvement of the questions; obtaining a final questionnaire named Pediatric Functional Constipation Questionnaire-Parent Form (PedFCQuest-PR) with 26 questions divided into four domains. Responses options use a Likert scale based on the events of the last four weeks. The process of validation was an observational, cross-sectional study in a sample of 87 parents/caregivers of children from 5 to 15 years of age diagnosed with Functional constipation according to the Rome IV Criteria. The questionnaire was applied simultaneously to the Pediatric Quality of Life Inventory 4.0 (PedsQL TM 4.0) as a control. RESULTS The questionnaire validation included 87 parents/caregivers. The children's median age was 8.2 years, with a long time of constipation symptoms associated with fecal incontinence in approximately two-thirds. Internal consistency reliability for the Total Scale Score of PedFCQuest-PR by Coefficient Alpha of Cronbach score was 0.86. Convergent and divergent validity of PedFCQuest-PR was demonstrated by correlating the domains of both questionnaires. CONCLUSION This study provides evidence that PedFCQuest-PR is a reliable instrument. The results showed a high degree of internal consistency and validity of the instrument for future applications.
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Affiliation(s)
| | - Mary de Assis Carvalho
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Pediatria, Divisão de Gastroenterologia, Hepatlogia e Nutrição Pediátrica, Botucatu, SP, Brazil
| | - Nilton Carlos Machado
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Pediatria, Divisão de Gastroenterologia, Hepatlogia e Nutrição Pediátrica, Botucatu, SP, Brazil.
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21
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Athanasakos E, Cleeve S. Anorectal Manometry, Conventional and High Resolution in Paediatrics. ANO-RECTAL ENDOSONOGRAPHY AND MANOMETRY IN PAEDIATRICS 2022:55-73. [DOI: 10.1007/978-3-030-97668-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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22
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Smyth M, Jacobson K. Pediatric Quality of Life Inventory TM version 4.0 short form generic core scale across pediatric populations review data. Data Brief 2021; 39:107599. [PMID: 34901340 PMCID: PMC8639391 DOI: 10.1016/j.dib.2021.107599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
The Pediatric Quality of Life InventoryTM Version 4.0 Short Form Generic Core Scale (PedsQLTM) is a validated and widely used tool assessing the quality of life (QoL) of children and youth. It has been used extensively across healthy populations as well as those with chronic and acute illnesses, allowing for comparison of the psychosocial impact of chronic illness between pediatric disease cohorts. As part of the QoL initiative undertaken at the British Columbia Children's Hospital (BCCH) Inflammatory Bowel Disease (IBD) program and published in the Journal of Pediatrics titled “Cross-Sectional Analysis of Quality of Life in Pediatric Patients with IBD in British Columbia, Canada,” a limited literature review was conducted using Embasse and Ovid. Studies using the English version of the PedsQLTM short form generic scale (not a disease specific scale) were identified. Studies with populations greater than 50 patients with robust subgroup sample size were included, with an emphasis on studies with well-defined patients with chronic disease. These data were compared to the BCCH population, as discussed in the aforementioned journal article. Analysis within the BCCH cohort is described separately. Comparison between different populations from the existing literature was qualitative only, with no statistical analysis done given the heterogeneity of populations and studies. In a study of patients from the emergency department at BCCH (n=178), the mean (SD) QoL scores of the healthy patients was 89.2 (10.3). In a group of self-identified healthy patients in California (n=5079), their mean QoL score was 83.9 (12.5). Separating the BCCH IBD population by disease activity, those in remission (n=220, 84.4 (12.8)) have similar QoL scores to these healthy cohorts, though their scores remain slightly below the previously published BCCH cohort. For children with any degree of active IBD (n=98, 75.6 (15.8)), their QoL scores are below the healthy means and are lower than other groups with self-identified “chronic illnesses” (n=367, 77.2 (15.5)), diabetes (n=418, 82.3 (13.5)), mild asthma (n=281, 85.5 (13.3)), or Canadian patients 4 weeks post-concussion (n=1157, 80.3). BCCH IBD patients with moderately to severely active disease have QoL scores well below the other disease groups (n=33, 63.1 (18.8)); lower than oncology patients on induction chemotherapy regimens (n=105, 68.9 (16.0)), acute inpatients (n=359, 63.9 (20.3)), and asthmatics with moderate-severe, persistent asthma (n=86, 67.1 (18.6)). This data is useful for clinicians treating pediatric patients looking at how QoL is influenced by chronic illness and by factors such as disease type and severity.
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Affiliation(s)
- Matthew Smyth
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada.,British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kevan Jacobson
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, British Columbia Children's Hospital, University of British Columbia, British Columbia, Canada.,British Columbia Children Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Cross-Sectional Analysis of Quality of Life in Pediatric Patients with Inflammatory Bowel Disease in British Columbia, Canada. J Pediatr 2021; 238:57-65.e2. [PMID: 34293367 DOI: 10.1016/j.jpeds.2021.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate quality of life (QoL) in a large cohort of pediatric patients with inflammatory bowel disease (IBD) and to identify the clinical factors that influence QoL. STUDY DESIGN This cross-sectional study analyzes a quality improvement initiative in 351 pediatric patients with IBD in British Columbia, Canada using the self-reported Pediatric Quality of Life Inventory (PedsQL) 4.0 generic scale. The questionnaire was completed at outpatient clinic and biologic infusion appointments. Statistical analysis included the t test, ANOVA, and multilinear regressions to evaluate the relationships between clinical factors and QoL. RESULTS Mean (SE) QoL scores (79.95 [0.84]) fell between previously described healthy and chronically ill populations. Disease activity was the most significant predictor of QoL, with patients in remission scoring similar (84.42 [0.87]) to well established healthy norms, and those with moderately or severely active disease having some of the lowest published PedsQL scores (63.13 [3.27]), lower than most other chronic pediatric conditions. Twenty-five patients with moderately or severely active disease at the time of survey completion had follow-up surveys identified 1 year later and had a significant improvement of both their disease activity (P < .005) and their PedsQL scores (follow-up survey mean 76.13 [3.11]). Additional clinical factors independently associated with poor QoL were school nonattendance (15.5% decrease in QoL, P < .001), immune-modulator selection (methotrexate conferring a 9.5% lower mean QoL score than azathioprine, P = .005), and female gender (P = .031). CONCLUSION Pediatric patients with IBD experience a QoL significantly impacted by multiple clinical factors including current severity of IBD symptoms.
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Nakamura M, Matsumura K, Ohnuma Y, Yoshida T, Tsuchida A, Hamazaki K, Inadera H. Association of cesarean birth with prevalence of functional constipation in toddlers at 3 years of age: results from the Japan Environment and Children's Study (JECS). BMC Pediatr 2021; 21:419. [PMID: 34556067 PMCID: PMC8459474 DOI: 10.1186/s12887-021-02885-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between delivery mode and subsequent development of diseases is a growing area of research. Cesarean delivery affects the diversity of the microbiota in the infant gut, which may be associated with gastrointestinal disorders, including functional constipation, in infants. In this study, we investigated the association between delivery mode and prevalence of functional constipation in 3-year-old Japanese toddlers. METHODS This study used data from the Japan Environment and Children's Study, an ongoing nationwide birth cohort study. We analyzed 71,878 toddler-mother pairs. The presence of functional constipation was determined according to the Rome III diagnostic criteria. Odds ratios and 95% confidence intervals were calculated using logistic regression analysis. RESULTS The prevalence of functional constipation in 3-year-old Japanese toddlers was estimated to be 12.3%. Logistic regression analysis revealed that the prevalence of functional constipation was higher in toddlers born by cesarean delivery (13.1%) compared with those born by vaginal delivery (12.1%), independent of 22 confounders (adjusted odds ratios = 1.064, 95% confidence interval = 1.004-1.128). CONCLUSIONS We determined the prevalence of functional constipation in 3-year-old Japanese toddlers and found that delivery mode was associated with the prevalence of functional constipation in Japanese toddlers.
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Affiliation(s)
- Mari Nakamura
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan.,Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-8555, Japan
| | - Yoshiko Ohnuma
- Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-8555, Japan
| | - Taketoshi Yoshida
- Division of Neonatology, Maternal and Perinatal Center, Toyama University Hospital, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan
| | - Akiko Tsuchida
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan.,Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-8555, Japan
| | - Kei Hamazaki
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan.,Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-8555, Japan.,Department of Public Health, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi City, Gunma, 371-8511, Japan
| | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan. .,Toyama Regional Center for JECS, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-8555, Japan.
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Dos Santos IR, de Abreu GE, Dourado ER, Martinelli Braga AAN, Lobo VA, de Carvalho IWB, Bastos Netto JM, Barroso U. Emotional and behavioural problems in children and adolescents: The role of constipation. J Paediatr Child Health 2021; 57:1003-1008. [PMID: 33565678 DOI: 10.1111/jpc.15368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/29/2022]
Abstract
AIM The functional constipation (FC) is a source of an expressive suffering in children, negatively affecting their emotional, social, and physical well-being. The objective of this study is to describe the clinical and behavioural characteristics of children/adolescents with FC. METHODS A cross-sectional, observational, analytical study was conducted in public places by interviewing parents of children/adolescents about their child's bowel habits and psychological profile. Bowel symptoms were investigated using the Rome IV criteria. The Strengths and Difficulties Questionnaire (SDQ) was used to evaluate the emotional and behavioural problems. RESULTS Of 799 children/adolescents included, 424 (53.1%) were female. Mean age was 9.1 ± 2.7 years. FC prevalence was 20.4%. The most common symptoms in Rome IV criteria were 'painful or hard bowel movements' (n = 110; 67.5%; 95% confidence interval: 60.0-74.3) and 'retentive posturing or excessive volitional stool retention' (n = 89; 54.6%; 95% confidence interval: 46.9-62.1). Median scores for internalising symptoms (7; interquartile range (IQR): 4-9 vs. 5; IQR: 2-7; P < 0.001) and externalising symptoms (7; IQR 4-11 vs. 6; IQR 3-9; P < 0.001) were higher in constipated children compared to non-constipated participants, respectively. The SDQ domains that were associated with FC were emotional symptoms (median 4, P < 0.001) and conduct problems (median 3, P < 0.001). No association was found between faecal incontinence and median scores for the internalising/externalising symptoms. All Rome IV criteria were associated with abnormal overall SDQ scores. CONCLUSION Children and adolescents with FC had more emotional and behavioural problems irrespective of whether faecal incontinence was present or not, with higher scores for internalising and externalising symptoms compared to non-constipated children.
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Affiliation(s)
- Ivana R Dos Santos
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Glícia E de Abreu
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Eneida R Dourado
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ana A N Martinelli Braga
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Victoria A Lobo
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | | | - José M Bastos Netto
- Division of Urology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Ubirajara Barroso
- Center for Children's Urinary Disorders (CEDIMI), Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.,Urology Department, Hospital das Clínicas, Federal University of Bahia, Salvador, Bahia, Brazil
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Evidence-based Standardization of Constipation Management in the Emergency Department: A Quality Improvement Study. Pediatr Qual Saf 2021; 6:e395. [PMID: 33718750 PMCID: PMC7952117 DOI: 10.1097/pq9.0000000000000395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022] Open
Abstract
Supplemental Digital Content is available in the text. Constipation is a common problem in pediatric patients. Abdominal radiographs (AXRs) are frequently obtained in the pediatric emergency department for diagnosis despite their poor reliability to rule out underlying pathology or prognostic ability to determine the degree of constipation. The goal of this quality improvement (QI) initiative was to standardize the diagnosis and management of constipation in the pediatric emergency department and urgent care in patients ages 6 months to 21 years and decrease AXR use by 20% and sustain this reduction for 12 months.
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Thompson AP, Wine E, MacDonald SE, Campbell A, Scott SD. Parents' Experiences and Information Needs While Caring for a Child With Functional Constipation: A Systematic Review. Clin Pediatr (Phila) 2021; 60:154-169. [PMID: 33026251 DOI: 10.1177/0009922820964457] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents' needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.
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Affiliation(s)
| | - Eytan Wine
- University of Alberta, Edmonton, Alberta, Canada
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Reeves PT, Kolasinski NT, Yin HS, Alqurashi W, Echelmeyer S, Chumpitazi BP, Rogers PL, Burklow CS, Nylund CM. Development and Assessment of a Pictographic Pediatric Constipation Action Plan. J Pediatr 2021; 229:118-126.e1. [PMID: 33068567 PMCID: PMC7557278 DOI: 10.1016/j.jpeds.2020.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation. STUDY DESIGN The USCAP facilitates the management functional constipation by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included part 1 (pictogram validation) and part 2 (assessment). For part 1, pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n = 65) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical librarians (n = 3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n = 34) using Doak's Suitability Assessment of Materials (superior ≥70% rating). RESULTS All 12 pictograms demonstrated appropriate transparency, translucency, and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability. CONCLUSIONS The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic functional constipation.
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Affiliation(s)
- Patrick T. Reeves
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD,Reprint requests: Patrick T. Reeves, MD, 8901 Rockville Pike, Bethesda, MD, 20814
| | - Nathan T. Kolasinski
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | | | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Bruno P. Chumpitazi
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX,Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX
| | - Philip L. Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carolyn Sullivan Burklow
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cade M. Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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Lamparyk K, Burkhart K, Buzenski J, van Tilburg MAL. Challenges and opportunities in measuring the pediatric quality of life: exemplified by research in pediatric gastroenterology. Expert Rev Pharmacoecon Outcomes Res 2021; 21:211-219. [PMID: 33478299 DOI: 10.1080/14737167.2021.1879643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Quality of life (QOL) is an important patient-reported outcome measure (PROM). Assessment of QOL in children is challenging particularly because developmental age affects the accuracy of self-reports.Areas covered: This paper gives an overview and expert opinion of the factors impacting quality assessment of pediatric QOL. Given this literature is vast, we focused on QOL measurement in pediatric gastroenterological conditions as an example, but the general principles apply across childhood chronic diseases. Child developmental stage affects self-reports. Younger children are less reliable reporters implicating the need for parental proxies. However, parents may not be as cognizant of their child's internal life especially as the child grows older. Adjustment to disease (QOL initially decreases then improves) as well as the time of year (QOL improves during summer) affects reports of QOL. Furthermore, it is important to acknowledge the impact of the child's disease on caregivers and families' QOL.Expert opinion: The numerous aspects impacting pediatric QOL make assessment and measurement complex. We propose several strategies to guide this process such as assessing both self-report and parent-proxy measures, as well as considering the timing of QOL assessments.
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Affiliation(s)
- Katherine Lamparyk
- Center for Pediatric Behavioral Health, Cleveland, Cleveland Clinic Children's Hospital, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH, USA
| | - Kimberly Burkhart
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jessica Buzenski
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, US
| | - Miranda A L van Tilburg
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA.,University of Washington, School of Social Work, Seattle, WA, USA.,Department of Clinical Research, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, USA
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Thompson AP, MacDonald SE, Wine E, Scott SD. Understanding Parents' Experiences When Caring for a Child With Functional Constipation: Interpretive Description Study. JMIR Pediatr Parent 2021; 4:e24851. [PMID: 33470939 PMCID: PMC7857943 DOI: 10.2196/24851] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pediatric functional constipation (FC) is a common but serious medical condition. Despite significant effects on children, families, and the health care system, the condition is typically undertreated. Parents carry the primary responsibility for complex treatment programs; therefore, understanding their experiences and needs may offer a critical perspective toward improving clinical care. OBJECTIVE The aim of this study is to understand and give voice to parents' experiences and information needs when caring for a child with FC. The ultimate objective is to build an evidence base suitable for creating a digital knowledge translation tool to better support parents caring for a child with FC. METHODS This qualitative design used an interpretive description methodology to generate findings aimed at improving clinical care. One-on-one, in-depth interviews were completed either in person or through web-based teleconferencing to explore parents' perspectives. Data collection and analysis occurred concurrently. RESULTS Analysis of 16 interviews generated 4 major themes: living in the shadows; not taken seriously, with a subtheme of persevering and advocating; missing information and misinformation; and self-doubt and strained relationships. One minor theme of affirmative influences that foster resilience and hope was identified. CONCLUSIONS Parents have unmet needs for support and information related to pediatric FC. To address gaps in current care provision, decision makers may consider interventions for clinicians, resources for parents, and shifting care models to better meet parents' needs.
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Affiliation(s)
| | | | - Eytan Wine
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Intrarectal Electromotive Botulinum Toxin Type A Administration in Children With Intractable Constipation: A Randomized Clinical Trial. Am J Gastroenterol 2020; 115:2060-2067. [PMID: 33009066 DOI: 10.14309/ajg.0000000000000940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection. METHODS From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire. RESULTS After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively). DISCUSSION BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia.
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Erdur B, Ayar M. The treatment of functional constipation significantly increased quality of life in children aged 4-17 years. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2020; 31:814-818. [PMID: 33361045 PMCID: PMC7759230 DOI: 10.5152/tjg.2020.19509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND/AIMS In this study, it was aimed to investigate the effect of 6-week treatment on quality of life in 4-17-year-old children with functional constipation. MATERIALS AND METHODS The children 4-17 years old diagnosed as functional constipation according to Rome IV criteria, between June and December 2018 were included in the study. KINDL scales were applied to patients and their parents before starting treatment for 6 weeks and after the end of the treatment. RESULTS The study was completed with 42 patients. The majority of the patients (54,8%) were female cases and the general part of them (45,2%) were between 4-6 years old. The age at onset of constipation was found to be 5,19±3,658 years. Total KINDL scores of both children and parents were lower before the treatment. Significant improvement was observed in the symptoms of constipation after 6 weeks of treatment. There was a statistically significant (p<0,05) increase in children's subgroup and total KINDL scores after treatment. Parental subgroup and total KINDL scores also showed a statistically significant (p<0,05) increase after treatment. The treatment of functional constipation was found to be highly effective with the eyes of both children and parents in improving the quality of life. (Eta value, η2. >0,25) Conclusion: A significant increase was observed in all areas of life quality and total score in children with functional constipation after a regular treatment. We think that the treatment of children with functional constipation will significantly improve their quality of life.
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Affiliation(s)
- Barış Erdur
- Department of Pediatric Gastroenterology, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, İzmir, Turkey
| | - Murat Ayar
- Department of Pediatrics, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, İzmir, Turkey
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Yıldırım A, Biçer Ş, Hacıhasanoğlu-Aşılar R, Özdamar MY, Şahin H, Gül V. The Effect of Education Given to Children with Functional Constipation and Fecal Incontinence and Their Mothers on Anxiety and Constipation Management. Florence Nightingale Hemsire Derg 2020; 28:321-332. [PMID: 34263211 PMCID: PMC8134022 DOI: 10.5152/fnjn.2020.19134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022] Open
Abstract
AIM This study aimed to determine the effect of multidimensional training program on children with constipation and fecal incontinence and their mothers on anxiety and their constipation management. METHOD The study had an experimental design with a pretest-posttest control group. The intervention group consisted of children diagnosed with functional constipation (n=20) and fecal incontinence (n=21) and their mothers in the Pediatric Surgery Clinic. The control group consisted of healthy (n=20) children who applied to two different Family Health Centers for any reason. Data were collected between February 2016 and June 2017 using a descriptive questionnaire, a nutrient consumption frequency form, the Rome III diagnostic criteria form, and the Trait Anxiety Scale for Children. RESULTS After the training program, the mean score of the Trait Anxiety Scale for Children decreased in both intervention groups (p<0.01) and increased in the control group (p<0.05). In addition, the frequency of the consumption of milk, caffeinated drinks, and white bread was reduced in the children of both intervention groups after the training program. The consumption of dried legumes, vegetables, and whole wheat bread increased. According to the Rome III diagnostic criteria, it was determined that constipation symptoms were not observed in 50% of the children. CONCLUSION The training program had a significant influence on the prevention and management of constipation and anxiety. Given that constipation is associated with both physical and mental health outcomes, the approach for the treatment should be holistic in nature, involving a multidisciplinary team.
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Affiliation(s)
- Arzu Yıldırım
- Department of Psychiatric Nursing, Yalova University Faculty of Health Sciences, Yalova, Turkey
| | - Şenol Biçer
- Department of Pediatric Surgery, Erzincan Binali Yildirim University School of Medicine, General Surgery, Erzincan, Turkey
| | | | - Mustafa Yaşar Özdamar
- Department of Pediatric Surgery, Erzincan Binali Yildirim University School of Medicine, General Surgery, Erzincan, Turkey
| | - Hilal Şahin
- Division of Dietetics, Department of Nutrition and Dietetics, Erzincan Binali Yildirim University Faculty of Health Sciences, Erzincan, Turkey
| | - Vahdet Gül
- Division of Medical Biochemistry / Internal Medicine, Department of Mental Health and Diseases, Erzincan Binali Yildirim University School of Medicine, Basic Medical Sciences, Erzincan, Turkey
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Flankegård G, Mörelius E, Duchen K, Rytterström P. Experiences of parents who give pharmacological treatment to children with functional constipation at home. J Adv Nurs 2020; 76:3519-3527. [PMID: 33043491 PMCID: PMC7702076 DOI: 10.1111/jan.14539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Aim The aim was to explore the lived experiences of parents who give oral and rectal pharmacological treatment to their children with functional constipation at home. Design A phenomenological design with a reflective lifeworld research approach that describes phenomena as they are experienced by individuals. Methods From January–May 2019, 15 interviews were conducted with parents of children with functional constipation with home‐based oral and rectal treatment. Parents were recruited from three different healthcare levels. Open‐ended questions were used starting from the description of a normal day with constipation treatment. Analyses were made with an open and reflective ‘bridling’ attitude. Findings Constipation treatment causes parents to question their parental identity and what it means to be a good parent. Forced treatment makes them feel abusive and acting against their will as parents. There is a conflict between doubt and second thoughts about the treatment, the urge to treat based on the child's needs and encouragement from healthcare professionals to give treatment. Conclusion As pharmacological constipation treatment can be experienced as challenging, it is important to help parents make an informed decision about how such treatment should be carried out at home. The findings reveal a medical treatment situation where parents hesitate and children resist, resulting in insecure parents who question their parental identity. Impact The findings point to the importance of supporting parents in treatment situations. Healthcare providers need to treat children with constipation with greater focus and more prompt management to prevent these families from lingering longer than necessary in the healthcare system.
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Affiliation(s)
- Gunilla Flankegård
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden
| | - Evalotte Mörelius
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Karel Duchen
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Patrik Rytterström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrkoping, Sweden
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Abstract
Constipation in otherwise healthy infants and children is a common problem despite confusion about how to precisely define constipation and constipation-related disorders. Constipation may, rarely, be a sign or symptom of a more serious disease or a diagnosis defined only by its symptoms and without any structural or biochemical findings. In the latter case it is classified as a functional gastrointestinal disorder (FGID). FGIDs are defined as disorders that cannot be explained by structural or biochemical findings. The Rome Foundation has standardized diagnostic criteria for all FGIDs. The Rome criteria are based on the available research as well as the clinical experience of the Foundation's assembled experts. The most recent report, Rome IV, described clinical criteria and diagnostic tools and encouraged more rigorous research in the area of FGIDs. The true incidence and prevalence of constipation is difficult to know because it may be treated at home using home remedies or diagnosed at a visit to a primary care provider or to a subspecialist pediatric gastroenterologist. The most recent attempts to define the prevalence of all pediatric FGIDs have been made using the Rome IV criteria. The defined FGID entities that may be associated with the complaint of constipation are infant dyschezia, functional constipation, and nonretentive fecal incontinence. The term encopresis, omitted from Rome IV, is defined by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition The 3 Rome-defined (constipation-related) entities and the APA entity of encopresis are the focus of this review.
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Affiliation(s)
| | - Sarah Mayer-Brown
- Department of Psychiatry and Human Behavior, Hasbro Children's Hospital/Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI
| | | | - Wendy Plante
- Department of Psychiatry and Human Behavior, Hasbro Children's Hospital/Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI
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Athanasakos E, Cleeve S, Thapar N, Lindley K, Perring S, Cronin H, Borrelli O, Mutalib M. Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement. Neurogastroenterol Motil 2020; 32:e13797. [PMID: 31989766 DOI: 10.1111/nmo.13797] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
Defecatory disorders in children, including chronic constipation (CC) and fecal incontinence (FI), are common conditions worldwide and have a significant impact on children, their families, and the healthcare system. Anorectal manometry (ARM) and high-resolution anorectal manometry (HRAM) are relatively novel tools for the assessment of anal sphincter function and rectal sensation and have contributed significantly to improving the understanding of the anorectum as a functional unit. ARM has been recognized as the investigation of choice for adults with symptoms of defecation disorders, including fecal incontinence (FI), evacuation difficulties, and constipation. Although it is the gold standard tool in adults, it has yet to be formally accepted as a standardized diagnostic tool in the pediatric age, with limited knowledge regarding indications, protocol, and normal values. ARM/HRAM is slowly becoming recognized among pediatricians, but given that there are currently no agreed guidelines there is a risk that will lead to diversity in practice. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)-Motility Working Group (MWG) therefore has taken the opportunity to provide guidance on the use of ARM/HRAM in children with CC and/or FI.
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Affiliation(s)
| | | | - Nikhil Thapar
- Gastroenterology, Great Ormond Street Hospital, London, UK.,UCL Great Ormond Street Institute of Child Health Library, London, UK
| | - Keith Lindley
- Department of Paediatric Gastroenterology, Division of Paediatric Neurogastroenterology and Motility, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Steve Perring
- Medical Physics, Poole Hospital NHS Trust, Poole, UK
| | - Hannah Cronin
- Department of Paediatric Gastroenterology, Division of Paediatric Neurogastroenterology and Motility, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Osvaldo Borrelli
- Department of Paediatric Gastroenterology, Division of Paediatric Neurogastroenterology and Motility, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Mohamed Mutalib
- Paediatric Gastroenterology, Evelina London Children's Hospital, London, UK
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Arruda VPD, Bellomo‐Brandão MA, Bustorff‐Silva JM, Lomazi EA. Refractory functional constipation: clinical management or appendicostomy? JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Arruda VPAD, Bellomo-Brandão MA, Bustorff-Silva JM, Lomazi EA. Refractory functional constipation: clinical management or appendicostomy? J Pediatr (Rio J) 2020; 96:210-216. [PMID: 30352206 PMCID: PMC9432165 DOI: 10.1016/j.jped.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/17/2018] [Accepted: 09/04/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare the clinical evolution in patients with refractory functional constipation undergoing different therapeutic regimens: oral laxatives and antegrade enemas via appendicostomy or clinical treatment with oral laxatives and rectal enemas. METHODS Analysis of a series of 28 patients with a mean age of 7.9 years (2.4-11), followed-up in a tertiary outpatient clinic. Refractory functional constipation was defined as continuous retentive fecal incontinence after at least a 12-month period of consensus therapy. After the diagnosis of refractory condition, appendicostomy was proposed and performed in 17 patients. OUTCOMES (1) persistence of retentive fecal incontinence despite the use of enemas, (2) control of retentive fecal incontinence with enemas, and (3) control of retentive fecal incontinence, spontaneous evacuations, with no need for enemas. RESULTS Six and 12 months after the therapeutic option, control of retentive fecal incontinence was observed only in patients who underwent surgery, 11/17 and 14/17, p=0.001 and p=0.001, respectively. At 24 months, control of retentive fecal incontinence was also more frequent in operated patients: 13/17 versus 3/11 with clinical treatment, p=0.005. In the final evaluation, the median follow-up times were 2.6 and 3 years (operated vs. clinical treatment, p=0.40); one patient in each group was lost to follow-up and 9/16 operated patients had spontaneous bowel movements vs. 3/10 in the clinical treatment group, p=0.043. Surgical complications, totaling 42 episodes, were observed 14/17 patients. CONCLUSION Appendicostomy, although associated with a high frequency of complications, controlled retentive fecal incontinence earlier and more frequently than clinical treatment. The choice of one of the methods should be made by the family, after adequate information about the risks and benefits of each alternative.
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Affiliation(s)
- Vanesca P A de Arruda
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Campinas, SP, Brazil
| | - Maria A Bellomo-Brandão
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil
| | - Joaquim M Bustorff-Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brazil
| | - Elizete Aparecida Lomazi
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil.
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Vriesman MH, Koppen IJ, van Dijk M, Benninga MA. Reply. J Pediatr 2020; 217:216-217. [PMID: 31759579 DOI: 10.1016/j.jpeds.2019.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Ilan J Koppen
- Department of Pediatric Gastroenterology and Nutrition
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Trajanovska M, Liew A, Gibb S, Goldfeld S, King SK. Retrospective audit of referral and triage pathways of paediatric patients with constipation and soiling. J Paediatr Child Health 2020; 56:298-303. [PMID: 31436004 DOI: 10.1111/jpc.14601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 12/15/2022]
Abstract
AIM This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder). METHODS We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded. RESULTS Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12-month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments). CONCLUSION Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community-based primary care, need to be explored to improve timely management.
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Affiliation(s)
- Misel Trajanovska
- Centre for Community and Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Policy and Equity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amos Liew
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Gibb
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Centre for Community and Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Policy and Equity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
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Cushman GK, Stolz MG, Shih S, Blount R, Otley A, Talmadge C, Grant A, Reed B. Parent IMPACT-III: Development and Validation of an Inflammatory Bowel Disease-specific Health-related Quality-of-life Measure. J Pediatr Gastroenterol Nutr 2020; 70:205-210. [PMID: 31978018 PMCID: PMC7189420 DOI: 10.1097/mpg.0000000000002540] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The present study aimed to validate the parent-proxy IMPACT-III (IMPACT-III-P) in a sample of youth diagnosed with inflammatory bowel disease (IBD). Parent-proxy report measures are standard for pediatric psychosocial assessment, and the IMPACT-III-P will provide a more comprehensive representation of HRQOL. Reliability and validity analyses were conducted. METHODS Parents (N = 50) of youth 8 to 17 years with IBD reported on their child's HRQOL (IMPACT-III-P and PedsQL-4.0) and depression (BASC-2); youth reported on their HRQOL (child IMPACT-III), pain interference (PROMIS Pain Interference), and disease symptoms; and physicians completed measures of disease activity. RESULTS Criterion validity was established as the IMPACT-III-P was strongly, positively associated with the PedsQL (r = 0.59, P < 0.001). Convergent validity was supported as higher IMPACT-III-P scores were associated with less pain interference (r = -0.41, P < 0.01) and lower depression (r = -0.41, P < 0.01). Discriminant validity was partially supported, as higher IMPACT-III-P scores were associated with lower child-reported symptoms (r = -0.41, P < 0.01), but scores did not differ based on inactive, mild, or moderate/severe disease activity groups as rated by physicians. Internal consistency, parent-child agreement, and item-level analyses revealed strong reliability. CONCLUSIONS The IMPACT-III-P demonstrated strong validity and reliability. Parents and children had similar reports of HRQOL, with parents rating child HRQOL slightly lower. Findings support the use of the IMPACT-III-P for youth 8 to 17 years old to use in accordance with the child IMPACT-III to provide valuable information regarding HRQOL in youth with IBD.
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Affiliation(s)
| | | | | | | | | | | | | | - Bonney Reed
- GI Care for Kids, Atlanta, GA
- Emory University/Children’s Pediatric Institute, Atlanta, GA
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El-Sonbaty MM, Fathy A, Aljohani A, Fathy A. Assessment of Behavioural Disorders in Children with Functional Constipation. Open Access Maced J Med Sci 2019; 7:4019-4022. [PMID: 32165945 PMCID: PMC7061370 DOI: 10.3889/oamjms.2019.677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Functional constipation (FC) is a common health problem in paediatrics that causes significant physical and emotional distress to patients and their families. AIM In the current work, we assessed the presence of behavioural problems in children with functional constipation and their pattern and relation to various demographic and disease-associated factors. METHODS A cross-sectional case-control study was conducted, including 55 consecutive children aged 4-16 years diagnosed with functional constipation and 55 healthy age and sex-matched controls. Psychological assessment was done using the Pediatric Symptom Checklist - 17 (PSC-17). RESULTS Twenty-six (47.3%) patients with FC had positive total PSC-17 scores while none of the controls had positive scores (p-value < 0.001). Positive internalising and externalising behaviours scores and attention problems were found in 36 (65.5%), 15 (27.3%) and 12 (21.8%) of the patients respectively in contrary to controls where only 6 (10.9%) had positive scores in internalising behaviour, and non-showed externalising behaviour and 4 (7.3%) were inattentive. Older age, longer duration of illness, residency in rural areas and presence of encopresis were found to have a significant association with the presence of such problems. CONCLUSION Children with FC have more behavioural disorders compared to healthy controls. Integration of psychosocial aspects and their management is recommended during dealing with patients with FC.
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Affiliation(s)
- Marwa M. El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Ahmed Fathy
- Child Health Department, Medical Research Division, National Research Centre (Affiliation ID: 60014618), Dokki, Cairo, Egypt
| | - Amal Aljohani
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Abeer Fathy
- Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi Arabia
- Department of Pediatrics, College of Medicine, Mansoura University, Mansoura, Egypt
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Vriesman MH, Rajindrajith S, Koppen IJN, van Etten-Jamaludin FS, van Dijk M, Devanarayana NM, Tabbers MM, Benninga MA. Quality of Life in Children with Functional Constipation: A Systematic Review and Meta-Analysis. J Pediatr 2019; 214:141-150. [PMID: 31399248 DOI: 10.1016/j.jpeds.2019.06.059] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically review the literature on health-related quality of life (HRQoL) in children with functional constipation and to identify disease-related factors associated with HRQoL. STUDY DESIGN The Pubmed, Embase, and PsycINFO database were searched. Studies were included if they prospectively assessed HRQoL in children with functional constipation according to the Rome criteria. Articles were excluded if patients had organic causes of constipation and if HRQoL was only assessed after successful therapeutic interventions. A meta-analysis was performed calculating sample size-weighted pooled mean and SD of HRQoL scores. The quality of the studies was also assessed. RESULTS A total of 20 of 2658 studies were included, providing HRQoL data for 2344 children. Quality of evidence was considered to be poor in 9 of the 20 studies (45%); 13 of the 20 studies reported sufficient data to be included in the meta-analysis. Pooled total HRQoL scores of children with functional constipation were found to be lower compared with healthy reference samples (65.6 vs 86.1; P < .01). Similar HRQoL scores were found according to self-report and parent proxy report. Hospital-based studies reported lower HRQoL scores as compared with community-based studies. Two studies reported on HRQoL scores of children with and without fecal incontinence, but no significant difference was found. CONCLUSIONS HRQoL is compromised in children with functional constipation.
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Affiliation(s)
- Mana H Vriesman
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Ilan J N Koppen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marieke van Dijk
- Psychosocial Department, Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Understanding the Constipation Conundrum: Predictors of Obtaining an Abdominal Radiograph During the Emergency Department Evaluation of Pediatric Constipation. Pediatr Emerg Care 2019. [PMID: 28632576 DOI: 10.1097/pec.0000000000001206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Many children with constipation who are evaluated in emergency departments (EDs) receive an abdominal radiograph (AR) despite evidence-based guidelines discouraging imaging. The objectives of this study were to identify predictors associated with obtaining an AR and to determine if ARs were associated with a longer length of stay (LOS) among children with constipation evaluated in the ED. METHODS A review of billing and electronic health records was conducted in an academic pediatric ED for children ages 0 to 17 years who had a primary discharge diagnosis of constipation from July 2013 to June 2014. Logistic regression was used to identify predictors for obtaining an AR. Differences in mean LOS were analyzed using linear regression. RESULTS In total, 326 children met inclusion criteria, and 60% of the children received an AR. In logistic regression, significant predictors included age (odds ratio [OR] = 1.1/year of age, P = 0.004), presenting with abdominal pain as chief complaint compared with constipation (OR = 4.4, P < 0.0001), and history of emesis (OR = 2.8, P = 0.001) after controlling for provider type and previous constipation medication use. In linear regression, the adjusted mean LOS for those with an AR was 163 minutes compared with 117 minutes for those without after controlling for age, provider type, and history of constipation medication use (P < 0.0001). CONCLUSIONS Abdominal radiographs were used frequently in the ED diagnosis and management of constipation, particularly in older children and those with abdominal pain and emesis. Abdominal radiographs were associated with increased LOS.
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Morgan KE, Leroy SV, Corbett ST, Shepard JA. Complementary and Integrative Management of Pediatric Lower Urinary Tract Dysfunction Implemented within an Interprofessional Clinic. CHILDREN (BASEL, SWITZERLAND) 2019; 6:children6080088. [PMID: 31366055 PMCID: PMC6721344 DOI: 10.3390/children6080088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/11/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Abstract
Lower urinary tract dysfunction in children is a common multifactorial functional problem that often correlates with bowel dysfunction and behavioral disorders. Ideal management combines integrative therapies that optimize bladder and bowel habits, address behavioral issues, foster mind–body connection, and improve pelvic floor muscle dysfunction. Movement therapies that teach diaphragmatic breathing and relaxation, mind–body awareness, and healthy pelvic floor muscle function are vital for long-term symptom improvement in children. This paper outlines recommendations for integrative management of these patients and discusses a recently developed interprofessional clinic that aims to better meet these patients’ complex needs and to provide patients with an integrated holistic plan of care. Additional work is needed to scientifically assess these treatment models and educate providers across the various disciplines that evaluate and treat these patients.
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Affiliation(s)
- Kathryn E Morgan
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA.
| | - Susan V Leroy
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Sean T Corbett
- Department of Pediatric Urology, University of Virginia, P.O. Box 800422, Charlottesville, VA 22908, USA
| | - Jaclyn A Shepard
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, P.O. Box 800223, Charlottesville, VA 22908, USA
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Parent-child Agreement on Health-Related Quality of Life in Children With Functional Constipation in Primary Care. J Pediatr Gastroenterol Nutr 2018; 67:726-731. [PMID: 30095575 PMCID: PMC6282676 DOI: 10.1097/mpg.0000000000002124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Functional constipation (FC) has a major impact on the health-related quality of life (HRQoL) of children. The aim of this study was to evaluate parent-child agreement on HRQoL in children (8-17 years) with FC in primary care. METHODS Children diagnosed with FC by their clinician were eligible. HRQoL was measured with the Defecation Disorder List (DDL, score 0-100), and the EuroQol-5-Dimension-Youth Visual Analogue Scale (EQ-5D-Y-VAS, scale 0-100). Parent-child agreement was examined with discrepancy scores, intraclass correlation coefficients and Bland-Altman plots. RESULTS Fifty-six children, median age of 10 years (IQR 8-12) and their parents were included. Parent-child agreement at a group level was good, with an intraclass correlation coefficient of 0.80 (95% confidence interval 0.67 to 0.88) for the DDL, and 0.78 (95% confidence interval 0.65 to 0.87) for the EQ-5D-Y-VAS. Mean discrepancy scores for the DDL and EQ-5D-Y-VAS were small: -2.6 and -2.9, implying that parents were slightly more positive about the HRQoL than their children. Bland-Altman plots showed considerable discordance between individual parent-child pairs. Limits of agreement were -19.7 and 14.6 for the DDL and -27.6 and 21.8 for the EQ-5D-Y-VAS. CONCLUSIONS There is good parent-child agreement on HRQoL in children with FC at group level. However, a substantial number of parent-child pairs differed considerably on their rating of the HRQoL of the child. Therefore, we recommend clinicians, if they want to have an impression of the impact of the FC on the HRQoL of the child, to ask both the child and the parent(s).
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Timmerman MEW, Trzpis M, Broens PMA. Using laxatives and/or enemas to accelerate the diagnosis in children presenting with acute abdominal pain: a randomised controlled trial study protocol. BMJ Paediatr Open 2018; 2:e000341. [PMID: 30498795 PMCID: PMC6241996 DOI: 10.1136/bmjpo-2018-000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Many children with acute abdominal pain and suspicion of appendicitis are diagnosed with constipation. Nevertheless, it can be difficult to differentiate between acute constipation and acute appendicitis because of similar symptoms and lack of diagnostic criteria. Consequently, constipation is often missed despite repeated consultations at the emergency department. We hypothesise that the diagnostic process can be improved and adequate treatment accelerated by supporting faecal evacuation in children with acute abdominal pain. METHODS AND ANALYSIS An unblinded randomised controlled trial including children aged between 5 years and 18 years with acute abdominal pain and suspicion of acute appendicitis. Children who do not have a definitive diagnosis after the first consultation and who need to return for a second consultation will be randomised. The intervention group will receive laxatives and enemas, while the control group will receive no medication. If, after the second consultation, still no diagnosis is established, and a third consultation is needed, then the intervention group will receive only laxatives, and the control group will again not receive medication. The primary outcome will be the differences in abdominal pain scores obtained with FACES Pain Rating Scale and the visual analogue scale at first, second and possibly third consultation. The secondary outcome will be the number of consultations needed to reach final diagnosis. ETHICS AND DISSEMINATION Laxatives and enemas have proven to be safe and effective treatments for constipation in children. Adverse events are therefore not expected, however, should they occur, then the child concerned shall be properly followed and treated until the event is over. The local Medical Research Ethics Committee approved of this study and waived the otherwise mandatory insurance for human test subjects. TRIAL REGISTRATION NUMBERS Pre-results: CCMO NL44710.042.12 andEudraCT 2013-000498-56.
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Affiliation(s)
- Marjolijn E W Timmerman
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul M A Broens
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Infant Feeding Practices and the Effect in Reducing Functional Constipation 6 Years Later: A Randomized Field Trial. J Pediatr Gastroenterol Nutr 2018; 67:660-665. [PMID: 29927865 DOI: 10.1097/mpg.0000000000002075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study is to assess the impact of health worker training on infant feeding practices on the prevalence of functional constipation (FC) among children at 6 years of age. METHODS Cluster randomized field trial conducted in Porto Alegre, Brazil. Health centers were randomly allocated into intervention (n = 9) or control (n = 11) groups. In intervention sites, health workers joined training sessions on the "Ten Steps for Healthy Feeding for Children from Birth to Two Years of age". Pregnant women in the last trimester of both groups were identified, invited to participate and enrolled in the study as the potential mothers to receive the dietary counseling provided by the health workers. At 6 years of age, the prevalence of FC was evaluated based on Rome III, defined by 2 or more of the following: infrequent defecation, fecal incontinence, history of retentive posturing, or/and history of painful defecation. RESULTS Among 387 mother-child pairs (206 intervention, 181 control) evaluated at 6 years of age, the prevalence of FC was lower in the intervention group compared with the control group (15.0% vs 23.9%, respectively). The probability of being constipated was 38% lower in the intervention group (PR = 0.62; 95% CI 0.44-0.87; P < 0.01). CONCLUSION The health workers training to promote the "Ten Steps" was an effective way to reduce the prevalence of constipation among children at 6 years of age.
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Yield and Examiner Dependence of Digital Rectal Examination in Detecting Impaction in Pediatric Functional Constipation. J Pediatr Gastroenterol Nutr 2018; 67:570-575. [PMID: 29601443 DOI: 10.1097/mpg.0000000000001969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is doubtful or with a suspicion of organic etiology. The guidelines do not clarify if DRE is mandatory to diagnose impaction. This study aims to determine the frequency of impaction detectable only on DRE among children satisfying Rome III criteria without requiring DRE and also the inter-observer influences on impaction detection by DRE. METHODS Children between 6 months to 13 years of age, presenting with history suggestive of constipation were assessed. After excluding those with suspicion of organic etiology, those who needed DRE for diagnosis of constipation and those who do not satisfy Rome III criteria without DRE, the rest who satisfied Rome III criteria were assessed for impaction by palpable fecoliths or constipation-associated fecal incontinence. Those without such impaction were randomized to 2 examiners for DRE to diagnose impaction, in the absence of contraindications. RESULTS Two hundred and thirty-three children were assessed. One hundred and sixty-nine satisfied Rome III without needing DRE. Forty-eight (28.4%) had impaction detectable without DRE. Among the rest, 28 (30.1%) had impaction by DRE. There was no difference between the frequency of impaction detected by the 2 examiners. Clinical characteristics were similar (P > 0.05) between those with impaction detectable by DRE and those without. CONCLUSIONS DRE does detect cases of impaction not discernible by other means. Such a finding may be comparable between examiners. These children may be identified by other clinical characteristics. The clinical significance of such a finding needs more understanding from the standpoint of therapeutic choices.
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A Randomized Controlled Trial Examining the Effects of Reflexology on Children With Functional Constipation. Gastroenterol Nurs 2018; 40:393-400. [PMID: 28957970 DOI: 10.1097/sga.0000000000000196] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Functional constipation is a common problem in Turkey that affects up to 10% of children. Reflexologists claim that reflexology can be beneficial in the treatment of constipation. The aim of this randomized controlled study was to determine the effectiveness of reflexology in treating functional constipation in children. Thirty-seven children who were referred to a pediatrician with functional constipation as defined by the Rome III criteria were recruited to the study. After the physician's diagnosis, two groups (intervention/control) were created. The intervention and control groups comprised 17 and 20 children, respectively. Each child in the intervention group was given a foot massage for 10 minutes five times a week, and toilet/diet/motivation training was given to their parents. The test period lasted for 4 weeks. Toilet/diet/motivation training was undertaken for 30 minutes once per week (for a total of 4 weeks) in an interactive manner. The parents of children in the control group received equivalent toilet/diet/motivation training only. No significant differences in terms of feces frequency and feces consistency were noted between the intervention and control groups (p > .05). This study sample showed that only toilet/diet/motivation training had potential benefit for treating functional constipation in children. Further larger randomized trials are required to establish whether there are benefits to foot message in the treatment of functional constipation in children.
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