Functional constipation in infants & toddlers is a common pediatric gastrointestinal disorder, often causing significant distress for both the child and caregivers. It is characterized by infrequent, difficult, or painful defecation without an identifiable organic cause.
Prevalence
Constipation typically begins early in life and remains prevalent throughout childhood:
- 40% of cases start in the first year of life
- 19.2% of children aged 4–9 years
- 15.2% of those aged 10–18 years 1,2
In the MENA region, 35.2% of the physicians reported a rate of 10–30% of childhood constipation cases seen in clinic.
95% of the cases correspond to functional constipation, with no underlying medical condition.
Common Triggers
- Introduction of solids
- Toilet training
- School start
Pathophysiology: The Vicious Cycle
Painful defecation → voluntary stool withholding → prolonged colonic transit → harder stools → more pain → ongoing retention.
Over time, this cycle can lead to fecal impaction, abdominal distension, and chronic discomfort3.
Symptoms
- Abdominal distension
- Irritability and crying
- Cramping and discomfort
- Decreased appetite
- Painful or infrequent stools
- Stool withholding behavior (e.g., stiffening, crossing legs)
In severe or prolonged cases, complications such as fecal incontinence, loss of rectal sensation, and diminished defecation urge can occur4.
Diagnosis
The Rome IV criteria is the most common and reliable diagnostic tool, with 90.7% of the physicians in the MENA region aware of it.
Infants up to 4 years of age should present at least 2 of the following symptoms for 1 month: 2 or fewer defecations/week, history of excessive stool retention, history of painful or hard bowel movements, history of large-diameter stools, or presence of large fecal mass in the rectum.
In toilet-trained children, the following additional criteria may be used: at least 1 episode/week of incontinence after acquisition of toileting skills, and history of large-diameter stools that obstruct the toilet.
Management in infants & toddlers
- Goal: Soften stools, ensure painless defecation.
- Early intervention prevents chronic issues, improves quality of life and reduces parental anxiety.
- First-line recommendations: Parental education + nutritional changes, e.g., magnesium-rich formula.
1. Vandenplas Y., et al., Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. JPGN 61: 531–537 (2015).
2. Iacono G., et al. Gastrointestinal symptoms in infancy: a population-based prospective study. Dig Liver Dis 37, 432–438 (2005).
3. Constipation Guideline Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Evaluation and treatment of constipation in infants and children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J. Pediatr. Gastroenterol. Nutr. 43, e1-13 (2006).
4. Levy E. I., Lemmens R., Vandenplas Y. & Devreker T. Functional constipation in children: challenges and solutions. Pediatric Health Med Ther 8, 19–27 (2017).
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