Guideline for the management of pediatric idiopathic constipation and soiling

Objective: To develop an evidence-based guideline for the primary pediatric care of children (birth to 18 years old) with idiopathic constipation and soiling. Data Sources: References were identified through a MEDLINE search from Janu ary 1975 through January 1998 to address 3 focus questions: (1) the best pa th to early, accurate diagnosis; (2) best methods for adequate clean-out; a nd (3) best approaches to promote patient and family compliance with manage ment. Data Selection: Twenty-five references were identified. Data Extraction: References were reviewed by a multidisciplinary team and g raded according to the following criteria: randomized controlled trial; con trolled trial, no randomization; observational study; and expert opinion. E vidence tables were developed for each focus question. Data Synthesis: An algorithm and clinical care guideline were developed by consultation and consensus among team members. Emphasis was placed on metho ds to promote early identification of pediatric idiopathic constipation and soiling, to recognize points of referral, and to increase patient and fami ly compliance-with treatment through use of education, developmentally base d interventions, and variables for tracking success of management. Conclusion: An algorithm and guideline for pediatric idiopathic constipatio n and soiling are presented for use by primary care physicians.