Constipation in children
INTRODUCTION: Prevalence of chronic constipation has been estimated at 1-5% of children in the UK and USA, most of whom have no obvious aetiological factors. A third of children with chronic constipation continue to have problems beyond puberty. Half of children with chronic faecal impaction and soiling have experienced an episode of painful defecation, and many children with chronic constipation exhibit withholding behaviour. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for children with chronic constipation? What are the effects of treatments for clearing the bowel in children with faecal impaction? We searched: Medline, Embase, The Cochrane Library and other important databases up to June 2005 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: anal dilatation, behavioural treatments (biofeedback, diaries, or toilet training), bulk-forming laxatives, faecal softeners, fiber, oral fluids, osmotic laxatives, stimulant laxatives.
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