Non-pharmacological Treatment for Children With Functional Constipation: A Systematic Review and Meta-analysis.

Objective To evaluate the effectiveness and safety of non-pharmacological interventions for the treatment of childhood functional constipation functional constipation. Study design Randomized controlled trials (RCTs) evaluating non-pharmacological treatments in children with functional constipation which reported at least one outcome of the core outcome set for children with functional constipation. Results 52 RCTs were included with 4668 children, aged between 2 weeks and 18 years, of whom 47% were females. Studied interventions comprised of gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n=3), Cassia Fistula emulsion (n=2), and a cow’s milk exclusion diet (n=2 in a subpopulation with constipation as a possible manifestation of cow’s milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao’er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture. Conclusions More well-designed high quality RCTs concerning non-pharmacological treatments for children with functional constipation are needed before changes in current guidelines are indicated.