Advances in pediatric constipation management

Pediatric constipation is a prevalent issue that significantly affects quality of life and incurs substantial healthcare costs. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends a combination of disimpaction, maintenance laxatives, and lifestyle modifications as initial management strategies. Despite this, many patients and their families are dissatisfied with traditional laxatives due to side effects or ineffectiveness, prompting interest in non-pharmacologic options.
This review evaluates various non-pharmacologic interventions for pediatric constipation, emphasizing dietary, behavioral, and physical therapies. Increased dietary fiber intake is the most advocated measure by pediatricians, yet the actual consumption by American children falls short of recommendations. Specific fibers like psyllium and glucomannan show promising benefits in children, unlike others with scant pediatric data. Behavioral interventions, particularly biofeedback, have demonstrated efficacy in managing constipation, especially in cases involving dyssynergia. Mind-body techniques, including cognitive-behavioral therapy and relaxation exercises, help address the psychological aspects associated with chronic constipation. Physical interventions such as abdominal massage and transcutaneous electrical nerve stimulation are emerging as effective methods. They are particularly useful in children with slow transit constipation, with studies highlighting improvements in stool frequency and consistency.