MDCalc

Rome IV Diagnostic Criteria for Child Functional Constipation

Official Rome IV criteria for the diagnosis of child functional constipation.

Use in children (> 4 years) and adolescents with symptoms suggestive of constipation such as passing hard, painful stools, fecal incontinence and/or showing withholding behaviors for at least 1 month.

Patients with any of the following features must be evaluated clinically for other diagnoses even though functional constipation may be present:

  • Constipation onset extremely early in life (<1 mo).

  • Passage of meconium >48 hours after delivery.

  • Family history of Hirschsprung disease. 

  • Ribbon stools. 

  • Blood in the stools in the absence of anal fissures. 

  • Failure to thrive or unintentional weight loss.

  • Fever. 

  • Bilious vomiting. 

  • Severe abdominal distension. 

  • Fecal incontinence in the absence of rectal impaction.

  • Abnormal physical exam findings. 

  • Simultaneous urinary retention or incontinence.

Must have ≥2 of the following:

Occurring ≥1 time per week for a minimum of 1 month with insufficient criteria for a diagnosis of IBS

Diagnostic Result

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Advice

If diagnosis not met (negative):

Symptoms unlikely to be caused by functional constipation. Consider further assessment as clinically indicated.

If meets diagnosis (positive):

Likely diagnosis of functional constipation. Consider initiating treatment.

Management

Management of functional constipation may include:

  • Education.

  • Regular toilet sitting. 

  • Dietary fiber.

  • If fecal impaction is present, disimpaction is indicated, followed by a maintenance regimen.

  • Use of laxatives to ensure painless defecation.

  • Osmotic laxatives (e.g. PEG-3350, lactulose, magnesium hydroxide) 

  • Stimulant laxatives (e.g. Senna, bisacodyl).

  • The following newer treatments are available with limited experience in children: 

    • Secretagogues (e.g. Lubiprostone, linaclotide, plecanatide).

    • 5-HT4 receptor agonist (e.g. Prucalopride).

  • Treatment is typically necessary for months to years, premature discontinuation of treatment can result in recurrence of constipation and/or overflow fecal incontinence. 

The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Some of the pharmacologic interventions have not been studied in children and/or adolescents and should only be used off-label and in the most severely affected children.

Critical Actions

This calculator should only be used in children and adolescents who do not have signs or symptoms suggestive of an anatomic, structural, metabolic or neurologic causes of constipation based on a detailed clinical history and physical exam.

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