Management of Childhood Functional Constipation: Consensus Practice Guidelines of Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition and Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics

• Published in: Indian pediatrics 2018-10, Vol.55 (10), p.885-892
• Main Authors: Yachha, Surender Kumar, Srivastava, Anshu, Mohan, Neelam, Bharadia, Lalit, Sarma, Moinak Sen
• Format: Article
• Language: English
• Subjects: Maternal and Child Health; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Recommendations
• ISSN: 0019-6061; 0974-7559
• DOI: 10.1007/s13312-018-1402-5

Justification Management practices of functional constipation are far from satisfactory in developing countries like India; available guidelines do not comprehensively address the problems pertinent to our country. Process A questionnaire-based survey was conducted among selected practising pediatricians and pediatric gastroenterologists in India, and the respondents agreed on the need for an Indian guideline on the topic. A group of experts were invited to present the published literature under 12 different headings, and a consensus was developed to formulate the practice guidelines, keeping in view the needs in Indian children. Objective To formulate practice guidelines for the management of childhood functional constipation that are relevant to Indian children. Recommendations Functional constipation should be diagnosed only in the absence of red flags on history and examination. Those with impaction and/or retentive incontinence should be disimpacted with polyethylene glycol (hospital or home-based). Osmotic laxatives (polyethylene glycol more than 1 year of age and lactulose/lactitol less than 1 year of age) are the first line of maintenance therapy. Stimulant laxatives should be reserved only for rescue therapy. Combination therapies of two osmotics, two stimulants or two classes of laxatives are not recommended. Laxatives as maintenance therapy should be given for a prolonged period and should be tapered off gradually, only after a successful outcome. Essential components of therapy for a successful outcome include counselling, dietary changes, toilet-training and regular follow-up.