{
  "abstract": "Functional constipation (FC) is a common condition in children that can significantly affect their quality of life and often requires long-term management. Given the multifactorial nature of FC, treatment should be personalised and include both non-pharmacological and pharmacological approaches. 1–3 This review analyses the efficacy and safety of non-pharmacological interventions in the management of childhood FC. Electronic searches were conducted in PubMed, MEDLINE, Embase, and PsycINFO up to March 2025 for randomised controlled trials (RCTs) including children aged 0-18 years with FC and treated with non-pharmacological interventions, compared to placebo, no treatment or any other intervention. Primary outcomes were treatment success, defecation frequency and withdrawals due to adverse events. The certainty of the evidence was assessed using the GRADE framework. We included a total of 93 RCTs, comprising 7,787 children (50.4% female). We investigated 47 interventions, including dietary, psycho-educational, physiotherapy, complementary and alternative medicine, and electrical stimulation. Abdominal transcutaneous electrical stimulation (ATES) combined with pelvic floor muscle exercises (PFME) probably improves treatment success and defecation frequency compared with PFME alone (RR 1.75, 95% CI 1.25 to 2.44; MD 1.85, 95% CI 1.28 to 2.43; moderate certainty). Percutaneous tibial nerve stimulation (PTNS) associated to PFME may improve treatment success (RR 1.73, 95% CI 1.08 to 2.77; low certainty) and probably increase defecation frequency (MD 1.82, 95% CI 0.82 to 2.82; moderate certainty). Behavioural therapy combined with PEG may not improve treatment success (RR 0.83, 95% CI 0.62 to 1.12; low certainty) and probably reduces defecation frequency (MD -1.80, 95% CI -2.88 to -0.72; moderate certainty). It is uncertain if there is any difference in defecation frequency when probiotics are added to laxatives compared to laxatives alone (MD: 0.12, 95% CI -0.09 to 0.34; low certainty). Cow’s milk free diet (CMFD) in addition to PEG may improve defecation frequency when compared to normal diet in addition to PEG (RR: 1.34, 95% CI 1.15 to 1.57; low certainty). Some non-pharmacological treatments for childhood FC demonstrate beneficial effects and may be considered as part of management. Future RCTs should focus on improving methodological rigor.References Pijpers MA, Bongers ME, Benninga MA, Berger MY. Functional constipation in children: a systematic review on prognosis and predictive factors. J Pediatr Gastroenterol Nutr. 2010;50(3):256–68.Vriesman MH, Rajindrajith S, Koppen IJN, van Etten-Jamaludin FS, van Dijk M, Devanarayana NM, et al. Quality of life in children with functional constipation: a systematic review and meta-analysis. J Pediatr. 2019;214:141–50.Koppen IJN, van Wassenaer EA, Barendsen RW, Brand PL, Benninga MA. Adherence to polyethylene glycol treatment in children with functional constipation is associated with parental illness perceptions, satisfaction with treatment, and perceived treatment convenience. J Pediatr. 2018;199:132–9.e1.",
  "authors": [
    {
      "affiliations": [
        "University of Lancashire, School of Medicine, Preston, UK"
      ],
      "name": "Daniel Arruda Navarro Albuquerque"
    },
    {
      "affiliations": [
        "Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Paediatric Gastroenterology, Amsterdam, The Netherlands"
      ],
      "name": "Anna de Geus"
    },
    {
      "affiliations": [
        "University of Lancashire, School of Medicine, Preston, UK"
      ],
      "name": "Morris Gordon"
    },
    {
      "affiliations": [
        "University of Lancashire, School of Medicine, Preston, UK"
      ],
      "name": "Vassiliki Sinopoulou"
    },
    {
      "affiliations": [
        "North Cumbria Integrated Care NHS Foundation Trust"
      ],
      "name": "Mohammad Sameerullah Khan"
    },
    {
      "affiliations": [
        "University of Lancashire, School of Medicine, Preston, UK"
      ],
      "name": "Aderonke Ajiboye"
    },
    {
      "affiliations": [
        "University of Lancashire, School of Medicine, Preston, UK"
      ],
      "name": "Shiyao Liu"
    },
    {
      "affiliations": [
        "Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Paediatric Gastroenterology, Amsterdam, The Netherlands"
      ],
      "name": "Marc Benninga"
    },
    {
      "affiliations": [
        "Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Paediatric Gastroenterology, Amsterdam, The Netherlands"
      ],
      "name": "Merit Tabbers"
    }
  ],
  "title": "OC91 Efficacy and safety of non-pharmacological treatments for paediatric functional constipation: a systematic review and meta-analysis",
  "uid": "a05b7a5a-5ef8-582c-b8fc-acab2cdf2a5a"
}