title: Nonpharmacologic treatments for childhood constipation: systematic review.
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.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, H7-250, PO Box 22700, 1100 DD Amsterdam, Netherlands. m.m.tabbers@amc.nl
authors.forename: Merit M
authors.initials: MM
authors.lastname: Tabbers
authors.forename: Nicole
authors.initials: N
authors.lastname: Boluyt
authors.forename: Marjolein Y
authors.initials: MY
authors.lastname: Berger
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D001521:Behavior Therapy; D002648:Child; D000529:Complementary Therapies; D003248:Constipation / Q000628:therapy*; D004043:Dietary Fiber / Q000627:therapeutic use*; D019587:Dietary Supplements; D005440:Fluid Therapy; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D009043:Motor Activity; D056692:Prebiotics; D019936:Probiotics / Q000627:therapeutic use
chemical_list: D004043:Dietary Fiber; D054368:Laxatives; D056692:Prebiotics