title: Parental child-rearing attitudes are associated with functional constipation in childhood.
abstract: OBJECTIVE
  Parenting factors are assumed to play a role in the development and maintenance of childhood constipation. However, knowledge about the association between parenting factors and childhood constipation is limited. This study investigates the association between parental child-rearing attitudes and prominent symptoms of functional constipation and assesses the strength of this association.
  
  
  METHODS
  Cross-sectional data of 133 constipated children and their parents were collected.
  
  
  METHODS
  The gastrointestinal outpatient clinic at the Emma Children's Hospital in the Netherlands.
  
  
  METHODS
  Children with functional constipation aged 4-18 years referred by general practitioners, school doctors and paediatricians.
  
  
  METHODS
  Parental child-rearing attitudes were assessed by the Amsterdam version of the Parental Attitude Research Instrument (A-PARI). Symptoms of constipation in the child were assessed by a standardised interview. Negative binomial and logistic regression models were used to test the association between child-rearing attitudes and constipation symptoms.
  
  
  RESULTS
  Parental child-rearing attitudes are associated with defecation and faecal incontinence frequency. Higher and lower scores on the autonomy attitude scale were associated with decreased defecation frequency and increased faecal incontinence. High scores on the overprotection and self-pity attitude scales were associated with increased faecal incontinence. More and stronger associations were found for children aged ≥6 years than for younger children.
  
  
  CONCLUSIONS
  Parental child-rearing attitudes are associated with functional constipation in children. Any parenting issues should be addressed during treatment of children with constipation. Referral to mental health services is needed when parenting difficulties hinder treatment or when the parent-child relationship is at risk.
  
  
  BACKGROUND
  ISRCTN2518556.
authors.affiliation: Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Giel-Jan
authors.initials: GJ
authors.lastname: de Vries
authors.affiliation: Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
authors.forename: Bob F
authors.initials: BF
authors.lastname: Last
authors.affiliation: Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Psychosocial Department, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Grootenhuis
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D002668:Child Rearing; D002675:Child, Preschool; D003248:Constipation / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003672:Defecation / Q000502:physiology; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*
keywords: Child Psychology; Gastroenterology