Normal Bowel Pattern in Children and Dietary and other Precipitating Factors in Functional Constipation

INTRODUCTION:In day to day pediatric practice about 10 % of children present with constipation; and 10 % to 25 % of referrals to pediatric gastroenterologist are for constipation1. Although often regarded as a less common and insignificant problem by many physicians, chronic constipation is of great importance to the child and his family. The early and accurate assessment and prompt treatment of constipation is vital to the child’s well being and life style. Delay in management will only exacerbate the problem and perpetuate the child’s lack of self esteem. As there is no published data on childhood constipation from Southern India, we conducted this study from one the largest tertiary referral center for pediatrics from Southern India. AIM OF THE STUDY: 1. To study the normal bowel pattern of children with respect to their food habits and collect data regarding psychosocial aspect of toileting issues. 2. To study the diet pattern, psychosocial aspect and clinical profile of children with habit constipation. DISCUSSION:This descriptive observational study was carried out to study the demographic, clinical profile and dietary and other precipitating factors in functional constipation, as well as to find the normal bowel pattern in Southern Indian children from a large tertiary care centre. The prevalence of functional constipation based on the data from school children in our study were 13.5%, with a slight female preponderance of constipation (54.5%). The prevalence of constipation in school age children from USA was found to be 18% by Lorenzo et al;21 Vera Loening- Baucke et al;28 found that the prevalence of constipation was equal in both boys and girls and it was 0.3% to 8% in pediatric population. Similarly Iacono et al;26 and Ciampo D et al; 46 found the prevalence of constipation to be equal between girls and boys. Ip et al; 39 and Kajiwara et al; 52 found a increased prevalence in girls 32% and 24.2% as compared to boys 21% and 13.2% respectively, similar to our study. Kokkonen et al;53 too showed more prevalence of constipation in girls. Gannikou R et al; 64 found a slight male preponderance of constipation with 6.4% of boys being constipated as against 5.7% in girls. Khanna et al; 37 also showed a male preponderance in functional constipation. SUMMARY AND CONCLUSION : 1. The prevalence of Functional constipation is 13.5% in our study 2. Common age of presentation is 2-4 years with an overall female preponderance 3. Functional constipation is more common in lower socioeconomic group 4. Marital disharmony, sibling rivalry and school phobia have an effect on functional constipation 5. Skipping of breakfast and low intake of vegetables and fruits had a significant influence on functional constipation 6. Early toilet training is associated with development of constipation 7.The average number of stool passed per day by children with normal bowel habit is 1.14 and it is mostly of soft consistenc