Functional Constipation and Soiling in Children
Introduction to this self-study CME activity
Purpose
Constipation, a common medical problem in children worldwide, affects up to 40% of infants and 30% of school age children. Up to 8% of children have symptoms that meet criteria for functional constipation. Constipation with overflow soiling affects at least 4% of preschool-age children and 1 - 2% of school-age children. Earlier diagnosis and effective management generally improve outcome. This CME activity presents methods for accurate and early diagnosis of idiopathic constipation, outlines methods for appropriate clean-out and follow up, and helps clinician promote patient and family education and compliance.
New to the 2008 update of the guideline are:
- Revised infant and child algorithms
- Strength of recommendations added for Key Points
- Rome III diagnostic criteria for similar conditions added for differential diagnosis
- Updated education, diet, behavioral and medication tables
- Expanded dietary information including fiber content in common toddler foods
Key aspects of care include:
Diagnosis:
- Functional constipation often begins during late infant to toddler age.
- Inquiring about stool frequency, character, and painful stool passage may aide earlier diagnosis.
- Symptoms and signs are the best guides for accurate diagnosis.
Treatment:
- Provide education for child and family
- Clean-out impaction if present (applies to age > 1year)
- Prescribe diet modification to increase fiber and clear fluids
- Support positive behavioral training (applies to age > 1 year)
- Medications are often needed to achieve stool frequency ≥ 3 times per week
- Consider consultation with specialist if treatment failure within first month, or thereafter if not making progress
- Wean from medications after about 6 months (if stool frequency ≥ 3 per week)
- Dietary and behavioral components should continue after treatment phase
- Child and family adherence to treatment recommendations is a likely predictor of success
Audience
This self-study activity on constipation and soiling is appropriate for pediatricians, family physicians and other health care providers involved in the diagnosis and treatment of pediatric constipation and soiling.
Authors
| Team Leader | Barbara Felt, MD Behavioral Developmental Pediatrics |
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| Team Members |
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| Consultants | Sheila Marcus, MD Psychiatry Daniel H. Teitelbaum, MD Pediatric Surgery |
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| Author Disclosures | None of the authors or the consultant have relationships with companies whose products are discussed in this activity. |
Other Acknowledgements
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CME Accreditation and Credit Designation
The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The University of Michigan Medical School designates this educational activity for a maximum of 1 AMA/PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This CME activity was prepared for release in September 2008. CME credit may be awarded for a maximum of three years from its release date, specifically from September 2008 through August 1, 2011. Continuation of credit from that date depends on a thorough review of the content currency and accuracy.
Method of Participation
- View the web pages. You may print the self-study text to read off-line.
- Complete the on-line learning assessment test. It will be electronically scored and the correct answers returned immediately for your review.
- Complete the electronic credit request and activity evaluation. An electronic certificate of participation will be provided immediately.
- Print the certificate of participation for your personal records.
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