Abstract 632 Poster Session II, Sunday, 5/2 (poster 166)

Constipation is a common pediatric problem and the frequency of visits attributable to this problem is increasing. While constipation usually develops before age six, most research has focused on older children. Little is known about what factors contribute to early childhood constipation, how primary care physicians manage this problem, and how effective their management is.

METHODS: Children between two and six years of age who presented to their primary care physician with constipation for the first time were invited to participate. Children were excluded if they had conditions that predisposed to constipation. Controls were recruited from the community. Data were collected using structured interviews, behavioral checklists, and symptom diaries. Following initial evaluation, all constipated children were managed by their primary physician. Two months following initiation of treatment, subjects were reassessed.

RESULTS: Of 129 identified children with new onset constipation, 76 participated in the study. The mean age of participants was 43.3±13.6 months. 36 were boys and 40 were girls. There were 51 controls with a mean age of 52.3±18.4 months. 23 were boys and 28 were girls. Children with constipation passed significantly fewer stools each week than did controls (3.11±2.33 vs 7.94±3.77, p<0.0001). Parents of children with constipation were much more likely to report their child had pain and fear associated with defecation than were controls (p<0.0001 in both cases). There was no significant difference between constipated children and controls as to the age of beginning toilet training (26.8±7.7 vs 26.3±6.7 mos, p=0.702) and the total duration of toilet training (5.23±5.23 vs 4.26±5.13 mos, p=0.446) however parents of children with constipation reported much more difficulty completing toilet training than did parents of control children (p<0.0001). With regards to techniques used to promote toilet training, parents of constipated children were no less likely than non-constipated controls to read stories with their child about toilet training (p=0.8198), to discuss toilet training with their child (p=0.9363), to model toileting behaviors for their child (p=0.1177), or to watch videos about toilet training with their child (p=0.6246). After two months of therapy directed by their primary care providers, 43% of the constipated children were still symptomatic. The age of initiation of toileting training, the total duration of toilet training, and degree of difficulty completing toilet training were not significantly different between children who responded to treatment and those who remained constipated (p>0.5 in all cases).

CONCLUSIONS: Most early childhood constipation appears to be precipitated by painful defecation and the timing and the style of toilet training do not appear to be major contributors to the onset of constipation. After two months of therapy by primary care providers, nearly half of young children remain constipated.