Fiber the best bet to help kids with constipation

The research, led by pediatric gastroenterologist Dr. Merit M. Tabbers, was limited by only nine studies of 640 children to review and do suggest that further, more comprehensive studies on children’s constipation need to be conducted to confirm their results.

However, limited, looking at the results of the studies they reviewed, they found that three studies showed that fiber supplements did provide some relief, but they also note that some 70% of the participants in the study were not receiving adequate fiber in their diet to begin with. One of the studies followed 31 children for four weeks and found that the use of dietary fiber supplements reduced stomach pain and increased the number of regular bowel movements.

Other dietary options the researchers evaluated were the use of increased water or fluid and the use of probiotics or prebiotics. Probiotics are live microorganisms such as bacteria that increase and encourage the growth of “good bacteria” essential for a healthy intestinal system. However, none of the studies the researchers reviewed showed any benefits from these methods in children with chronic constipation.

Behavioral therapies were also evaluated and again showed no evidence of effectiveness.

The researchers advise that these results be viewed cautiously and recommend the need for more well-designed clinical trials in this area. They recommend parents talk with their child’s pediatrician about the possible need for increased fiber in their diet and the possible use of laxatives and stool softeners.

More information: Nonpharmacologic Treatments for Childhood Constipation: Systematic Review, Pediatrics, Published online September 26, 2011. doi:10.1542/peds.2011-0179

ABSTRACT
Objective: To summarize the evidence and assess the reported quality of studies concerning nonpharmacologic treatments for childhood constipation, including fiber, fluid, physical movement, prebiotics, probiotics, behavioral therapy, multidisciplinary treatment, and forms of alternative medicine.
Methods: We systematically searched 3 major electronic databases and reference lists of existing reviews. We included systematic reviews and randomized controlled trials (RCTs) that reported on nonpharmacologic treatments. Two reviewers rated the methodologic quality independently.
Results: We included 9 studies with 640 children. Considerable heterogeneity across studies precluded meta-analysis. We found no RCTs for physical movement, multidisciplinary treatment, or alternative medicine. Some evidence shows that fiber may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain. Compared with normal fluid intake, we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools. We found no evidence to recommend the use of prebiotics or probiotics. Behavioral therapy with laxatives is not more effective than laxatives alone.
Conclusions: There is some evidence that fiber supplements are more effective than placebo. No evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioral intervention. There is a lack of well-designed RCTs of high quality concerning nonpharmacologic treatments for children with functional constipation.

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