Volume 183 - Issue 7
Constipation and toileting issues in children
Author: Anthony G Catto-Smith
Med J Aust 2005; 183 (7): 391-392. || doi: 10.5694/j.1326-5377.2005.tb07096.x
Published online: 3 October 2005
Published online: 3 October 2005
Anthony G Catto-Smith
Director, Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052. tony.cattosmithATrch.org.au
In reply: Hocking emphasises secondary behavioural and emotional effects that occur in some children with longstanding faecal soiling. Fortunately, there is good evidence that these tend to resolve with effective multimodal treatment of the constipation.1 The relatively high long-term relapse rate of soiling among children who have been treated in tertiary centres has only recently been recognised,2 but the psychological features of this relapsing group are not well defined. My review was directed toward general practitioners and was as much as possible evidence-based.
I am unaware of any good quality evidence to support Hocking’s assertion of the benefits of automatic referral to a child psychiatrist of all children over the age of 5 years with ongoing faecal soiling. Given the beliefs of both myself and Hocking, that constipation and soiling are likely to have multiple determinants and varying psychological effects, it would seem to be appropriate to triage “problem” patients through a general paediatrician, with referral for psychological assistance if deemed appropriate. This is best summed up in my article in the section that Hocking mentions, “When to refer”.3
References
- Nolan T, Debelle G, Oberklaid F, Coffey C. Randomised trial of laxatives in treatment of childhood encopresis. Lancet 1991; 338: 523-527.<eMJA full text>
- van Ginkel R, Reitsma J, Buller H. Childhood constipation: longitudinal follow-up beyond puberty. Gastroenterology 2003; 125: 357-363. 0_i1091533
- Catto-Smith AG. Constipation and toileting issues in children. Med J Aust 2005; 182: 242-246. 0_i1091535