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    Rome IV Diagnostic Criteria for Child Functional Constipation

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

    INSTRUCTIONS

    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.

    When to Use
    Pearls/Pitfalls
    Why Use

    Children (>4 years) and adolescents presenting with symptoms suggestive of constipation for at least 1 month. The diagnosis of functional constipation should be made by clinical history, physical examination, and minimal laboratory tests.

    • Functional constipation (FC) is diagnosed based on typical history and physical examination. In the absence of alarm symptoms, no further diagnostic testing is routinely needed.

    • The triggering event for FC in children is frequently the instinct to avoid defecation because of pain or for social reasons.

    • Children with constipation can present with diarrhea, resulting from overflow fecal incontinence.

    • There is no role for the routine use of abdominal radiographs to diagnose pediatric FC. It should be reserved for patients with suspected fecal impaction in whom a digital rectal exam is not possible. 

    • In the presence of alarm features or in the case of failure to respond to appropriate conventional therapy, further testing for celiac or thyroid disease, Hirschspung’s disease, anorectal and spinal malformation, neurenteric abnormalities or cow milk protein allergy can be considered based on clinical judgement.

    • Early initiation of appropriate treatment is important and prognostically relevant. 

    • If fecal impaction is present, it should be treated. There is evidence that oral medications and rectal interventions such as enemas are equally effective for its treatment. 

    • Rectal interventions such as enemas or suppositories can be traumatizing for children and should be avoided if possible.

    • If abdominal pain persists despite adequate treatment of constipation, a diagnosis of constipation-predominant irritable bowel syndrome (IBS-C) should be considered.

    • Used to diagnose functional constipation in children and adolescents in the absence of any alarm features.

    • Making a diagnosis of functional constipation helps guide the need for further work-up and allows early initiation of treatment.

    • Can be used to discuss the diagnosis with patients and their family.

    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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    Next Steps
    Evidence
    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