Clinical Review Clinical review

Chronic constipation in children

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39007.760174.47 (Published 16 November 2006) Cite this as: BMJ 2006;333:1051

This article has a correction. Please see:

  1. Greg Rubin, professor of primary care1,
  2. Anne Dale, consultant paediatrician2
  1. 1Centre for Primary and Community Care, University of Sunderland, Sunderland SR1 3PZ
  2. 2Children's Unit, Queen Elizabeth Hospital, Gateshead NE9 6SX
  1. Correspondence to: G RubinGreg.rubin{at}sunderland.ac.uk
  • Accepted 4 October 2006

Difficulty in defecation, with or without soiling, is often encountered in children. It presents a management problem for general practitioners, and parental concern is often high. Constipation accounts for about 25% of a paediatric gastroenterologist's work and is one of the 10 most common problems seen by general paediatricians.1 We outline the epidemiology of chronic constipation in children, review the evidence base for the therapeutic interventions, and suggest strategies for management. We do not deal with the management of childhood constipation that results from an organic cause. This review is intended for general practitioners and hospital doctors who are not specialists in the management of constipation.

Summary points

  • Explicit criteria for the diagnosis of constipation and a defined terminology now exist

  • The evidence for effectiveness of treatments in childhood constipation is weak; management is based largely on clinical experience and consensus

  • Children with constipation and faecal incontinence benefit from regular support and guidance, particularly in establishing a regular and more normal toilet routine

  • Childhood constipation is often a long term problem requiring treatment over months or years

Sources and selection criteria

This review draws on the chapter on constipation in children in Clinical Evidence, search date April 2002,2 supplemented by a search of Medline and the Cochrane database of systematic reviews for randomised controlled trials published in English since then. The search used the following key words: constipation, encopresis, diet therapy, diagnosis, therapy, psychology, stimulant laxatives, dietary fibre, and lactulose; it was limited to infants and children. Trials were selected for inclusion if they focused on the management of constipation or encopresis, or both.

How is constipation defined in children?

Stool frequency reduces progressively in early childhood, from more than four stools a day to 1.2 a day at age 4 years,3 by which age 98% of children are toilet trained. Constipation is typically characterised by infrequent bowel evacuations, …

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