title: The care of constipated children in primary care in different countries.
abstract: OBJECTIVE
  To investigate and compare the approach to childhood constipation by primary care physicians (PCP) in three Western countries to give insight into adherence to current guidelines and in actual care.
  
  
  METHODS
  Prospective study utilizing a two-page survey regarding the approach to children suspected to have functional constipation (FC). A total of 413 of 1016 (41%) distributed surveys were returned out of which 383 were suitable for analysis. Surveys were answered anonymously. Survey responses were analysed and are reported in a descriptive way.
  
  
  RESULTS
  In Italy, the Netherlands, and the USA, respectively, 75, 187 and 121 surveys were returned by PCP. The majority of PCP (62%) considered stool withholding as a result of painful defecation to be the most common cause of childhood constipation. Rectal examination was used as a standard diagnostic tool for the evaluation of FC by only 31% of PCP with significant differences among the countries (p < 0.05) and a minimum in the Netherlands (11%). Abdominal X-ray is used by 49% to diagnose FC. 63% of PCP were convinced that hard stool can be softened by drinking more water. Polyethylene glycol was the most common prescribed drug (85%). Significant differences were found among countries in the use of senna and bisacodyl suppositories (p < 0.05).
  
  
  CONCLUSIONS
  Significant differences in practice exist among PCP from different countries regarding the performance of a digital rectal examination, need for additional diagnostic tests and use of laxatives in childhood constipation.
authors.affiliation: Emma Children's Hospital, Amsterdam Medical Center, Netherlands. r.e.burgers@amc.nl
authors.forename: Rosa
authors.initials: R
authors.lastname: Burgers
authors.forename: Elvira
authors.initials: E
authors.lastname: Bonanno
authors.forename: Elisa
authors.initials: E
authors.lastname: Madarena
authors.forename: Francesca
authors.initials: F
authors.lastname: Graziano
authors.forename: Licia
authors.initials: L
authors.lastname: Pensabene
authors.forename: William
authors.initials: W
authors.lastname: Gardner
authors.forename: Hayat
authors.initials: H
authors.lastname: Mousa
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
mesh_terms: D002648:Child; D003248:Constipation / Q000175:diagnosis* / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011446:Prospective Studies; D014481:United States