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Barbara Felt, MD; Christopher G. Wise, MS, PhD; Alan Olson, MD; Paramjeet Kochhar, MD; Sheila Marcus, MD; Arnold Coran, MD

Arch Pediatr Adolesc Med. 1999;153:380-385.

Objective  To develop an evidence-based guideline for the primary pediatric care of children (birth to 18 years old) with idiopathic constipation and soiling.

Data Sources  References were identified through a MEDLINE search from January 1975 through January 1998 to address 3 focus questions: (1) the best path to early, accurate diagnosis; (2) best methods for adequate clean-out; and (3) best approaches to promote patient and family compliance with management.

Data Selection  Twenty-five references were identified.

Data Extraction  References were reviewed by a multidisciplinary team and graded according to the following criteria: randomized controlled trial; controlled trial, no randomization; observational study; and expert opinion. Evidence tables were developed for each focus question.

Data Synthesis  An algorithm and clinical care guideline were developed by consultation and consensus among team members. Emphasis was placed on methods to promote early identification of pediatric idiopathic constipation and soiling, to recognize points of referral, and to increase patient and family compliance with treatment through use of education, developmentally based interventions, and variables for tracking success of management.

Conclusion  An algorithm and guideline for pediatric idiopathic constipation and soiling are presented for use by primary care physicians.

From the Divisions of General Academic Pediatrics (Drs Felt and Kochhar) and Gastroenterology (Dr Olson), Department of Pediatrics and Communicable Diseases (Dr Wise), Medical School Administration (Dr Wise), Child and Adolescent Psychiatry (Dr Marcus), and Pediatric Surgery (Dr Coran), University of Michigan School of Medicine, Ann Arbor.

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