Nonpharmacologic Treatment for Children with Functional Constipation: A Systematic Review and Meta-analysis

Wegh, Carrie A.M.; Baaleman, Desiree F.; Tabbers, Merit M.; Smidt, Hauke; Benninga, Marc A.

doi:10.1016/j.jpeds.2021.09.010

Cited by 41 publications

(40 citation statements)

References 102 publications

(145 reference statements)

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“…Moreover, there is a lack of systematic data for the fibre types that may be beneficial in terms of addressing the functional component of this disorder in children. A meta-analysis of 10 studies in a total of 690 children with functional constipation and a further follow-up study in 80 children evaluated the effect of seven different fibre mixtures with or without prebiotics compared with placebo or a control treatment 58. While the fibre types used in the studies perhaps did not reflect those most likely to offer a benefit for relief of constipation (ie, bulking fibre), a number of the prebiotic fibre combinations provided promising results 59.…”

Section: Role Of Fibre In the Management Of Children With Constipationmentioning

confidence: 99%

Benefits of dietary fibre for children in health and disease

Hojsak

Benninga

Hauser³

et al. 2022

Arch Dis Child

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Fibre is an essential nutrient in the human diet that is crucial for human health. It provides a range of functional benefits, including stool bulking, and physiological benefits through fermentation of diverse fibre types by the gut microbiome including cholesterol lowering, glycaemic control and weight control. The by-products of the fermentation of fibre in the gut confer health benefits that extend beyond the gut to the immune system and organs such as the liver, kidneys and the brain. A lack of fibre in the diet has been associated with several disorders in children including constipation, irritable bowel syndrome, allergies and immune-related disorders. In paediatric practice, concerns exist over tolerance of dietary fibre which may lead to unnecessary restrictions, especially for children receiving nutritional support. One reason for this may be the terminology which has historically been used. Fibre is often described in terms of its physico-chemical properties (solubility, viscosity), rather than its physiological effects/functionality (fermentability, bulking effects). To describe fibre in these latter terms represents more clearly the important role it plays. Most international guidelines recommend a daily quantity of fibre, failing to mention the quality aspect of the fibre required for health. Here we consider the evidence base for the current recommendations for daily fibre intakes for healthy children, those requiring nutritional support and those with functional gastrointestinal disorders. We also consider the importance of the gut microbiome and the role of fibre in maintaining gut microbial health and its role in health beyond the gut.

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Section: Role Of Fibre In the Management Of Children With Constipationmentioning

confidence: 99%

Benefits of dietary fibre for children in health and disease

Hojsak

Benninga

Hauser³

et al. 2022

Arch Dis Child

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“…A number of new prebiotic-fiber combinations provide some promising results. Further well-designed high-quality RCTs are needed before additional fiber intake can be recommended ( 9 ). Adding certain fibers to the diet may increase abdominal pain and flatulence, but the symptoms often decrease after several days.…”

Section: Functional Constipationmentioning

confidence: 99%

“…Adding certain fibers to the diet may increase abdominal pain and flatulence, but the symptoms often decrease after several days. Sometimes gaseousness can be reduced by switching to another fiber supplement ( 9 ).…”

Section: Functional Constipationmentioning

confidence: 99%

Pediatric Aspects of Nutrition Interventions for Disorders of Gut-Brain Interaction

et al. 2022

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Dietary factors may play an important role in the generation of symptoms in children with disorders of gut-brain interaction (DGBIs). Although dietary modification may provide successful treatment, there is a relative paucity of controlled trials that have shown the effectiveness of dietary interventions. This study is a narrative review that explores the existing literature on food and pediatric DGBIs. The following have been shown to be beneficial: (i) in infants with colic, removing cow's milk from the infant's diet or from the maternal diet in those who are breastfed; (ii) in infants with regurgitation, adding thickeners to the formula or removing cow's milk protein from the infant's diet or the maternal diet in those who are breastfed; and (iii) in children with pain-predominant DGBIs, using soluble fiber supplementation or a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet. In children with functional constipation, there is no evidence that adding fiber is beneficial. Given that most dietary interventions include restriction of different foods in children, a thoughtful approach and close follow-up are needed.

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“…In this study, treatment success rates and defecation frequency were not significantly different between groups. Therefore, there is currently no evidence for the routine addition of behavioral therapy in the treatment of childhood FC ( 32 , 34 ). On the other hand, FC has been reported to be more common in children with specific behavioral disorders such as autism and attention deficit disorders ( 35 , 36 ).…”

Section: Additional Non-pharmacological Treatment Optionsmentioning

confidence: 99%

“…One study compared biofeedback at home and in the clinical setting—both as add-on treatment to laxative treatment ( 40 ). A recent meta-analysis, including the three studies comparing add-on treatment with biofeedback to conventional treatment, detected considerable levels of heterogeneity and found no evidence for benefit of the addition of biofeedback in children with FC ( 34 ). Interestingly, there is evidence that biofeedback training is beneficial in adult patients with FC and dyssynergic defecation ( 41 , 42 ).…”

Section: Additional Non-pharmacological Treatment Optionsmentioning

confidence: 99%

Functional Constipation and Dyssynergic Defecation in Children

Koppen

Benninga

2022

Front. Pediatr.

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Defecation is a complex physiological process, which relies on intricate mechanisms involving the autonomic and somatic nervous system, the pelvic floor muscles, and the anal sphincter complex. Anorectal dysfunction may result in constipation, a bothersome defecation disorder that can severely affect daily lives of children and their families. In this review, we focus on different mechanisms underlying anorectal dysfunction and specific treatment options aimed at improving defecation dynamics in children with functional constipation.

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Nonpharmacologic Treatment for Children with Functional Constipation: A Systematic Review and Meta-analysis

Cited by 41 publications

References 102 publications

Benefits of dietary fibre for children in health and disease

Benefits of dietary fibre for children in health and disease

Pediatric Aspects of Nutrition Interventions for Disorders of Gut-Brain Interaction

Functional Constipation and Dyssynergic Defecation in Children

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