CONSTIPATION IN EARLY-CHILDHOOD - PATIENT CHARACTERISTICS, TREATMENT,AND LONG-TERM FOLLOW-UP

Little is known about chronic constipation in infants, toddlers, and p reschool children and longterm outcome after treatment. The symptoms o f 174 children less-than-or-equal-to 4 years of age, who were evaluate d for chronic constipation, are reported in this study together with t he longterm outcome in 90 of them. Initial symptoms were infrequent bo wel movements in 58%, painful bowel movements in 77% often with scream ing, and severe stool withholding manoeuvres in 97%. The treatment of chronic idiopathic constipation consisted of education, faecal disimpa ction, prevention of future impaction, and promotion of regular bowel habits with dietary fibre and milk of magnesia, and finally toilet tra ining of the preschool child. Longterm outcome could be evaluated in 9 0 patients (52%) (mean (SD) 6.9 (2.7)) years after initial evaluation. Fifty seven children (63%) had recovered, defined as no soiling with greater-than-or-equal-to 3 bowel movements per week, while not receivi ng treatment. The recovery rate of children less-than-or-equal-to 2 ye ars of age was significantly higher than in children >2 to 4 years of age. Thirty three children (37%) had not recovered. Constipation recur red as soon as laxatives were discontinued in 31 (94%) of them. Laxati ves were still used by 33% of the children who had not recovered, 39% had <3 bowel movements per week, 48% had faecal soiling, 45% had stool withholding, 27% complained of abdominal pain, 73% passed large stool s, and 45% still on occasions clogged the toilet with their large stoo ls. Symptoms of chronic constipation persisted in one third of our pat ients, 3-12 years after initial evaluation and treatment. Children who had not recovered deserve continued follow up, to reinforce and adjus t treatment and to prevent faecal soiling.