American Gastroenterological Association-North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pediatric Functional Constipation Clinical Care Pathway.

BACKGROUND & AIMS: Functional constipation (FC) is a prevalent condition in pediatrics that significantly impacts quality of life and health care utilization. The American Gastroenterological Association (AGA) and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) collaborated to develop a clinical care pathway for pediatric primary care providers and pediatric gastroenterologists, based on consensus among content experts, for the diagnosis and management of FC in children. This pathway aims to provide a structured, practical approach to streamline clinical decision-making and improve patient outcomes.

METHODS

A multi-disciplinary panel of experts selected based on their clinical experience and leadership and/or scientific contribution to the field conducted a roundtable discussion of the state of the art, identifying key diagnostic and management principles. A consensus-driven approach with agreement between panel members was used to establish standardized recommendations for diagnosis, treatment, and transition to adult care.

RESULTS

The pathway integrates Rome IV pediatric FC criteria with a symptom-based approach to enhance clinical utility. Diagnostic recommendations prioritize history and physical examination, with limited use of diagnostic studies. Treatment strategies include dietary modifications, behavioral interventions, pharmacologic therapies, and escalation to subspecialty referrals, and advanced interventions when necessary. The pathway also provides guidance for special populations, including neurodivergent children, and outlines a structured transition process to adult care.

CONCLUSIONS

The AGA-NASPGHAN Pediatric Functional Constipation Clinical Care Pathway standardizes evaluation and management, ensuring a practical approach for clinicians. Future research should focus on optimizing real-world implementation and evaluating long-term patient outcomes.