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Guideline review
Idiopathic constipation in children clinical practice guidelines
  1. Siba Prosad Paul,
  2. Samuel Robin Broad,
  3. Christine Spray
  1. Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Dr Siba Prosad Paul, Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK; siba.paul{at}nhs.net

https://doi.org/10.1136/archdischild-2014-307956

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    Information about current guidelines

    Constipation in children is a common reason for consulting medical professionals. It has a reported prevalence of 5%–30% in children depending on the criteria used.1 ,2

    In 2010, the National Institute for Health and Care Excellence (NICE) published clinical practice guidelines on the diagnosis and management of constipation in children.1 The aim of this guideline was to offer ‘best practice advice on the care of children and young people with idiopathic constipation’.1 The subsequent NICE quality standard (2014) consisted of a concise set of prioritised statements to achieve quality improvements in managing children with constipation.2 Also in 2014, the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) jointly published a clinical guideline on the diagnostic evaluation and treatment of functional constipation for children.3 This review encompasses recommendations from both the NICE guidelines and the joint ESPGHAN/NASPGHAN guidelines, with guidance specifically from ESPGHAN/NASPGHAN shown in italics in the text below. Table 1 highlights the main differences between the NICE and joint ESPGHAN/NASPGHAN guidelines.

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    Table 1

    Comparison of the guidelines

    Previous guideline

    In 1999, the NASPGHAN published a medical position paper providing recommendations on paediatric constipation.4 This document served as the basic structure for the recently published joint ESPGHAN/NASPGHAN guidelines3 (box 1).

    Box 1

    Resources

    • NICE (National Institute for Health and Care Excellence) (2010) clinical guidelines 99: https://www.nice.org.uk/guidance/cg99/resources/guidance-constipation-in-children-and-young-people-pdf

    • ESPGHAN/NASPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition/North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition) (2014) guidelines: http://www.naspghan.org/files/documents/pdfs/cme/jpgn/Evaluation_and_Treatment_of_Functional.24.pdf

    • NICE (2014) quality standard 62: https://www.nice.org.uk/guidance/qs62

    • ERIC (Education and Resources for Improving Childhood Continence): http://www.eric.org.uk/

    Key issues that the guidelines address

    Definition of constipation

    NICE guidelines have defined constipation as ‘idiopathic’ if it cannot be explained by any anatomical, physiological, radiological or histological abnormalities. The ESPGHAN/NASPGHAN guidelines recommended that the Rome III criteria for the …

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