CONSTIPATION IN INFANTS AND CHILDREN: EVALUATION AND TREATMENT A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition Running Title: Algorithm for Evaluation and Treatment of Constipation

Background Constipation, defined as a delay or difficulty in defecation, present for two or more weeks, is a common pediatric problem encountered by both primary and specialty medical providers. Methods The Constipation Subcommittee of the Clinical Guidelines Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulated clinical practice guidelines for the management of pediatric constipation. The Constipation Subcommittee, consisting of two primary care pediatricians, a clinical epidemiologist and pediatric gastroenterologists, based its recommendations on an integration of a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique, a structured quantitative method. Results The Subcommittee developed two algorithms to assist with medical management, one for older infants and children and the second for infants less than one year of age. The guidelines provide recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management and indications for consultation by a specialist. The Constipation Subcommittee also provided recommendations for management by the pediatric gastroenterologist. Conclusion This report, which has been endorsed by the Executive Council of the North American Society for Pediatric Gastroenterology and Nutrition, has been prepared as a general guideline to assist providers of medical care in the evaluation and treatment of constipation in children. It is not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.