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    Rome IV Diagnostic Criteria for Infant Dyschezia

    Official Rome IV criteria for the diagnosis of infant dyschezia.


    Use in an otherwise healthy infant <9 months with symptoms of infant dyschezia such as crying, turning red and straining for several minutes before successfully or unsuccessfully having a bowel movement. 

    Infants with any of the following alarm features must be evaluated further:

    • Constipation.

    • Failure to thrive.

    • Bloody stools.

    • Vomiting.

    • Excessive irritability or crying.

    • Symptoms after 9 months of age.

    • Abdominal distension.

    • Abnormal physical exam.

    • Fever or illness.

    When to Use
    Why Use

    Infants presenting with symptoms suggestive of infant dyschezia. The diagnosis of infant dyschezia should be made by clinical history, positive symptom criteria and a thorough physical examination. Laboratory or imaging studies are not needed to make the diagnosis in the absence of any alarm features.

    • Infant dyschezia refers to infant’s attempts to coordinate defecation. Crying, for example, is the infant’s way of increasing intra-abdominal pressure and relaxing the pelvic floor simultaneously. 

    • Eventually over the course of several weeks, defecation coordination is learned. 

    • Symptoms usually start in the first months of life and resolve spontaneously after 3-4 weeks. 

    Despite straining, infants with infant dyschezia defecate normally. They are not constipated. Laxative and/or rectal stimulation are not necessary.

    • Used to establish the diagnosis of infant dyschezia in babies who present with crying, screaming, straining and/or turning red associated with defecation or defecation attempts.

    • Making a diagnosis will allow the physician to provide reassurance to parents, help avoid doctor visits and unnecessary testing and treatments.

    Must have the following:

    For patients <9 months of age

    Diagnostic Result:

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    Next Steps
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH