The University of Michigan Health System recently updated its Guidelines for Clinical Care for "Functional Constipation and Soiling in Children" to present recommended methods for early and accurate diagnosis and treatment of functional constipation (not due to an underlying medical condition) and soiling in children. Objectives also included identification of methods for education, maintenance and follow up, and promotion of adherence to treatment recommendations.

The guidelines for clinical care present a rationale for recommendations stemming from the Rome III criteria for functional constipation in children/adolescents. Functional constipation is defined as constipation occurring at least once per week for at least two months prior to diagnosis in children ages 4 to 18. Diagnostic criteria include two or fewer bowel movements in the toilet per week and a history of painful or hard bowel movement, amongst others.

To successfully treat functional constipation, experts suggest improved outcomes with early diagnosis, such as treatments with laxatives to relieve constipation, followed by behavior and diet modifications for longer term success.

Effective management of constipation requires substantial commitment to positive behavioral training, such as: documenting bowel movements on a chart or calendar; positive bathroom visit techniques; positive reinforcement; and, education about healthy eating, daily exercise and adequate fluid intake.

Long term success also includes diet modifications that include recommended daily fiber intake. Increasing dietary fiber may improve the frequency of bowel movements and also helps to soften stool. Whereas the University of Michigan Health System guidelines for clinical care references the "age plus five" rule to determine the recommended daily fiber intake for children, the American Academy of Pediatrics recently updated the fiber guidelines to a minimum intake of 19 grams of fiber for children ages 2 to 3 (1).

(1) Adapted from: Kleinman RE, editor. Carbohydrate and dietary fiber: current dietary recommendations. In: Pediatric Nutrition Handbook. 6th ed. Elk Grove Village (IL): American Academy of Pediatrics; 2009. p.353.

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