Constipation in Children Follow Up

Monitoring

Since relapses are common and bowel movement difficulty may persist into adolescence follow-up plan of children and their parents should be individualized, tailored based on the child’s treatment response measured by consistency, frequency, and amount of stool. Preventive measures are discussed for relapse of constipation.  

Constipation in children that meet all the below criteria should be categorized as refractory constipation:

• Rome IV criteria for functional constipation met
• Treatment failure after 3 months using conventional therapies which include stimulant laxative (eg Bisacodyl, Linaclotide, Prucalopride, etc), behavioral interventions and biochemical interventions (eg correct position on toilet)
• Persistent symptoms that include ≤2 voluntary defecations per week and/or ≥1 episode of fecal incontinence per week
• Impaired quality of life for the patient or family due to constipation symptoms

Further Studies  

Patients with refractory constipation may undergo further laboratory exams that include serologic screening for celiac disease and screening tests for thyroid disease. Various imaging studies such as abdominal X-ray, colonic transit studies via radiopaque markers, colonic scintigraphy (if radiopaque markers are unavailable or contraindicated), lumbar spine MRI, contrast enema, defecography and transabdominal ultrasound may also be considered, depending on the symptoms of the patient.


Timing  

Parents and guardians of infants <6 months with functional constipation are advised to bring the patient for follow-up after 2-4 weeks, and infants ≥6 months with functional constipation without fecal impaction after 2 weeks for re-evaluation and evaluation of treatment efficacy.

Prognosis

In a recent systematic review, the majority of children with constipation recover within 6-12 months of starting treatment. Recovery rate is not related to age of onset, frequency of bowel movement, positive family history, and presence of fecal incontinence. Another study noted that less than half of affected children continued to be symptomatic beyond puberty with associated several complications. Relapse rate is high as functional constipation is difficult to treat. Lastly, underlying organic disorders exacerbate constipation resulting in difficult long-term management.