<< The Evaluation And Management Of Constipation In The Pediatric Emergency Department


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study, will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, will be noted by an asterisk (*) next to the number of the reference.*

  1. Diamanti A, Bracci F, Reale A, et al. Incidence, clinical presentation, and management of constipation in a pediatric ED. Am J Emer Med. 2010;28:189-194. (Retrospective study; 202 subjects)
  2. * Liem O, Harman J, Benninga M, et al. Health utilization and cost impact of childhood constipation in the United States. J Pediatr. 2009;154:258-262. (Database review; 21,778 subjects)
  3. Pijpers MA, Bongers ME, Benninga MA, et al. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr. 2010;50:256-258. (Review article)
  4. * Pijpers MA, Tabbers MM, Benninga MA, et al. Currently recommended treatments of childhood constipation are not evidence based: a systematic literature review on the effect of laxative treatment and dietary measures. Arch Dis Child. 2009;94:117-131. (Review article)
  5. * van den Berg MM, Benninga MA, DiLorenzo C. Epidemiology of childhood constipation: a systematic review. Am J Gastroenterol. 2006;101:2401-2409. (Review article)
  6. * Constipation Committee of the North American Society for Pediatric Gastroenterology, Hepatology, And Nutrition. Evaluation and treatment of constipation in children: recommendations of the north american society for pediatric gastroenterology, hepatology, and nutrition. J Pediatr Gastroenterol Nutr. 2006;43:e1-e13. (Review article)
  7. * Pirie J. Management of constipation in the emergency department. Clin Pediatr Emerg Med. 2010;11:182-188. (Review article)
  8. Iacono G, Francesca C, Montalto G, et al. Intolerance of cow’s milk and chronic constipation in children. N Engl J Med. 1998;339:1100-1114. (Double-blind crossover study; 65 subjects)
  9. * Bekkali NL, van den Berg MM, Dijkgraaf MG, et al. Rectal fecal impaction treatment in childhood constipation: enemas versus high doses oral PEG. Pediatrics. 2009;124:e1108-1115. (Randomized controlled trial; 90 subjects)
  10. Benninga M, Candy DC, Catto-Smith AG, et al. The Paris Consensus on Childhood Constipation Terminology (PACCT) Group. J Pediatr Gastroenterol Nutr. 2005;40:273-275. (Consensus definition)
  11. Longstreth GF, Thompson WG, Chey WD, et al. Functional Bowel Disorders. Gastroenterology. 2006;130:1480-1491. (Consensus definition)
  12. Clayden G, Wright A. Constipation and incontinence in childhood: two sides of the same coin? Arch Dis Child. 2007;92:472-474. (Review article)
  13. Culbert TP, Banez GA. Integrative approaches to childhood constipation and encopresis. Pediatr Clin N Am. 2007;54:927-947, xi. (Review article)
  14. Rockney RM, McQuade WH, Days AL. The plain abdominal roentgenogram in the management of encopresis. Arch Pediatr Adolesc Med. 1995;149:623-627. (Retrospective case study; 60 subjects)
  15. Loening-Baucke V. Prevalence rates for constipation and faecal urinary incontinence. Arch Dis Child. 2007;92:486-489. (Retrospective review; 482 subjects)
  16. Bardisa-Ezcurra L, Ullman R, Gordon J, et al. Diagnosis and management of idiopathic childhood constipation: summary of NICE guidance. BMJ. 2010;340:c2585. (Review article)
  17. Focht DR 3rd, Baker RC, Heubi JE, et al. Variability in the management of childhood constipation. Clin Pediatr. 2006;45:251-256. (Cross sectional survey)
  18. Loening-Baucke V, Swidsinski A. Constipation as a cause of acute abdominal pain in children. J Pediatr. 2007;151:666-669. (Chart review; 1002 children)
  19. * Biggs WS, Dery WH. Evaluation and treatment of constipation in infants and children. Am Fam Physician. 2006;73:469-477. (Review article)
  20. Rahman Z, Gerayli F, Carter NJ. What treatment works best for constipation in children? J Fam Pract. 2009:58:329-331. (Review article)
  21. * Bulloch B, Tenenbein M. Constipation: diagnosis and management in the pediatric emergency department. Pediatr Emerg Care. 2002;18:254-258. (Review article)
  22. Miller MK, Dowd MD, Franker M. Emergency department management and short-term outcome of children with constipation. Pediatr Emerg Care. 2009;58:329-331. (Chart review; 121 subjects)
  23. Bongers ME, van den Berg MM, Reitsma JB, et al. A randomized controlled trial of enemas in combination with oral laxative therapy for children with chronic constipation. Clin Gastroenterol Hepatol. 2009;7:1069-1074. (Randomized controlled trial; 102 subjects)
  24. Kokke F, Scholtens P, Alles MS, et al. A dietary fiber mixture versus lactulose in the treatment of childhood constipation: a double-blind randomized control trial. J Pediatr Gastroenterol Nutr. 2008:47:592-597. (Double-blind randomized controlled trial; 135 subjects)
  25. Candy D, Belsey J. Macrogol (polyethylene glycol) laxatives in children with functional constipation and fecal impaction: a systematic review. Arch Dis Child 2009;94:156-160. (Review article)
  26. Thomson MA, Jenkins HR, Bisset WM, et al. Polyethylene glycol 3350 plus electrolytes for chronic constipation in children: a double blind, placebo controlled, crossover study. Arch Dis Child. 2007;92:996-1000. (Double blind controlled crossover study; 51 subjects)
  27. Nurko S, Youssef N, Sabri N, et al. PEG3350 in the treatment of childhood constipation: a multicenter, double-blinded, placebo-controlled trial. J Pediatr. 2008;153:254-261. (Prospective randomized multicenter double-blind placebo controlled study; 103 subjects)
  28. * Pasbankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. 2001;139:428-432. (Prospective study; 20 subjects)
  29. Chung S, Cheng A, Goldman R. Polyethylene glycol 3350 without electrolytes for treatment of childhood constipation. Canad Fam Physician. 2009;55:481-482. (Review article)
  30. * Youssef NN, Peters JM, Henderson W, et al. Dose response of PEG 3350 for the treatment of childhood fecal impaction. J Pediatr. 2002;141:410-414. (Prospective double-blind parallel randomized study; 40 subjects)
  31. Harrington L, Schuh S. Complications of fleet enema administration and suggested guidelines for use in the pediatric emergency department. Pediatr Emerg Care. 1997;13:225-226. (Review article)
  32. * Candy DC, Edwards D, Geraint M. Treatment of faecal impaction with polyethylene glycol plus electrolytes (PGE+E) followed by a double-blind comparison of PEG+E versus lactulose as maintenance therapy. J Pediatr Gastroenterol Nutr. 2006;43:65-70.(Randomized double-blind comparison study; 65 subjects)
  33. 33. Corkins MR. Are diet and constipation related in children? Nutr Clin Prac. 2005;20:536-539. (Review article)
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Brandon C. Carr

Publication Date

February 1, 2012

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