Recalled and recorded bowel habits confirm early onset and high frequency of constipation in day-care nursery children

Abstract

-Context -Mothers recall early-onset constipation in children attending gastroenterology clinics. Objectives -To study the bowel habit of young children in the community to determine, first, whether early-onset constipation is confirmed in this setting and, second, the agreement between recalled and recorded bowel habit. Methods -Defecation data of 57 children aged 6.0-40.7 mo were obtained by maternal recall (questionnaire on predominant stool characteristics) and by record (1,934 defecations registered prospectively at home and in the nursery). The bowel habit was classified according to stool frequency and proportion of stool characteristics (soft, hard and/or runny). Two criteria were used to classify recorded data, since the cutoff point for hard stools to identify constipation is undefined in children: predominant criterion and adult criterion, respectively with >50% and ≥25% of stools with altered consistency. Bowel habit categories were: adequate, constipation, functional diarrhea and "other bowel habit". Nonparametric statistics, and the Kappa index for agreement between recalled and recorded bowel habit, were used. Results -Constipation occurred in 17.5%, 10.5%, 19.3% of the children by recall, the predominant and the adult criteria, respectively. Constipation was the main recalled alteration, vs 12.3% "other bowel habit". Only one child classified as having functional diarrhea (by the adult criterion). Agreement between recalled and recorded bowel habit was fair for constipation, by the predominant and the adult criteria (K = 0.28 and 0.24, respectively), but only slight (K ≤0.16) for other bowel habit categories. Individual data, however, pointed to a better relationship between recalled constipation and the adult rather than the predominant criterion. Conclusions -Frequent early-onset constipation was confirmed. Fair agreement between recalled and recorded constipation by the two used criteria indicates that recalled data are quite reliable to detect constipation.

The interpretation of Rome III criteria and method of assessment affect the irritable bowel syndrome classification of children

“…The relatively high convergence between the normative diary coding scheme and the parent‐report questionnaire also suggests that parents are assessing their child’s symptoms as compared with general norms for pain and stooling, rather than assessing symptoms within the child over time. This same higher convergence between parent recall and diary coding of normative definitions of constipation, but not by intra‐individual comparisons, was found in a recent study of infant stooling 21 . If assessing stooling changes within the child over time is important, parents will need that specific directive.…”

“…This same higher convergence between parent recall and diary coding of normative definitions of constipation, but not by intra-individual comparisons, was found in a recent study of infant stooling. 21 If assessing stooling changes within the child over time is important, parents will need that specific directive.…”

Proposals to Approximate the Pediatric Rome Constipation Criteria to Everyday Practice

“…In Brazilian community studies, 21% to 22% of infants already present constipation (17,26) . Also, 1/3 to 2/3 of mothers of children attended with constipation refer its onset in the first year of life (16,(27)(28)(29)(30) , and these data are trustable, since in a similar population it has been shown that recalled data were similar to recorded data (31) . Van Tilburg et al (10) also showed this similarity, but agreement between daily dairies and the Rome III questionnaire was poor.…”