Rome IV Diagnostic Criteria for Infant Functional Constipation
Official Rome IV criteria for the diagnosis of infant functional constipation.
Use in infants and toddlers (<4 years of age) with symptoms suggestive of constipation such as passing hard, painful stools and exhibiting 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:
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Constipation starting extremely early in life (<1 month).
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Passage of meconium >48.
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Family history of Hirschsprung disease.
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Ribbon stools.
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Blood in the stool in the absence of anal fissures.
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Failure to thrive or unintentional weight loss.
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Fever.
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Bilious vomiting.
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Severe abdominal distension.
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Abnormal physical exam findings including:
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Tuft of hair on spine or sacral dimple.
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Gluteal cleft deviation.
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Perianal fistula.
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Abnormal position of anus.
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Absent anal or cremasteric reflex.
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Anal scars.
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Decreased lower extremity strength/tone/reflex.
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 of functional constipation may include:
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Education.
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Regular toilet sitting with positive reinforcement
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Dietary fiber.
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Stool softeners (e.g. PEG-3350, lactulose, magnesium hydroxide).
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Stimulant laxatives (e.g. Senna).
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If fecal impaction is present, disimpaction is indicated, followed by a maintenance laxative regimen
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In infants: Trial of dairy elimination.
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Treatment is typically necessary for months to years.
The choice of therapy is outside the scope of this calculator and will depend on clinical context.
This calculator should only be used in children and adolescents who do not have signs or symptoms suggestive of anatomic, structural, metabolic or neuroenteric causes of their symptoms based on a detailed clinical history, physical exam and initial work-up.