Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2018; 7(1): 56-61
Published online Feb 8, 2018. doi: 10.5409/wjcp.v7.i1.56
Pediatricians lack knowledge for the diagnosis and management of functional constipation in children over 6 mo of age
Ariani Widodo, Badriul Hegar, Yvan Vandenplas
Ariani Widodo, Badriul Hegar, Department of Child Health, Universitas Indonesia, Jakarta 10430, Indonesia
Yvan Vandenplas, Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Larbeeeklan, Brussels 1090, Belgium
Author contributions: Widodo A and Hegar B developed the questionnaire and collected and analysed the data of the research; Widodo A and Vandenplas Y wrote the manuscript, which was corrected and approved by Hegar B.
Institutional review board statement: The Universitas Indonesia in Jakarta approved the study protocol.
Conflict-of-interest statement: The authors report no potential conflict of interest related to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Yvan Vandenplas, MD, PhD, Department of Pediatrics, UZ Brussels, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels 1090, Belgium.
Telephone: +32-2-4775794 Fax: +32-2-4775783
Received: December 30, 2016
Peer-review started: January 4, 2017
First decision: March 13, 2017
Revised: August 3, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: February 8, 2018

To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.


A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.


Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements (according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools (83%), blood in the stools (36%), fecal incontinence (33%), and/or difficulty in defecating (47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly (according to 68%) The preferred nonpharmacologic treatment are high-fiber diet (96%), increased fluid intake (90%), toilet training (74%), and abdominal massage (49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used (87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment (85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians (69%) expect a positive response during the first week with a mean (± SD) of 4.1 (± 2.56) d. Most participants (86%) treat during one month or even less. And the majority (67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.


These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.

Keywords: Functional constipation, Guideline lactulose, Rectal treatment, Polyethylene glycol

Core tip: Diagnosis and management of functional constipation in children by general paediatricians is suboptimal because of a lack of knowledge of published guidelines. Our data confirm that efforts should be made to improve distribution of existing guidelines to primary health care.