Emotional and behavioral problems in children and adolescents: The role of constipation

Ivana R Dos Santos ¹, Glícia E de Abreu ¹, Eneida R Dourado ¹, Ana A N Martinelli Braga ¹, Victoria A Lobo ¹, Isabella W B de Carvalho ², José M Bastos Netto ², Ubirajara Barroso Jr ^{1 3}

• PMID: 33565678
• DOI: 10.1111/jpc.15368

Abstract

Aim: The functional constipation (FC) is a source of an expressive suffering in children, negatively affecting their emotional, social, and physical well-being. The objective of this study is to describe the clinical and behavioral characteristics of children/adolescents with CF.

Methods: A cross-sectional, observational, analytical study was conducted in public places by interviewing parents of children/adolescents about their child's bowel habits and psychological profile. Bowel symptoms were investigated using the Rome IV criteria. The Strengths and Difficulties Questionnaire (SDQ) was used to evaluate the emotional and behavioral problems.

Results: Of 799 children/adolescents included, 424 (53.1%) were female. Mean age was 9.1 ± 2.7 years. FC prevalence was 20.4%. The most common symptoms in Rome IV criteria were ‘painful or hard bowel movements’ (n = 110; 67.5%; 95% confidence interval: 60.0-74.3) and ‘retentive posturing or excessive volitional stool retention’ (n = 89; 54.6%; 95% confidence interval: 46.9-62.1). Median scores for internalising symptoms (7; interquartile range (IQR): 4-9 vs. 5; IQR: 2-7; P < 0.001) and externalising symptoms (7; IQR 4-11 vs. 6; IQR 3-9; P < 0.001) were higher in constipated children compared to non-constipated participants, respectively. The SDQ domains that were associated with FC were emotional symptoms (median 4, P < 0.001) and conduct problems (median 3, P < 0.001). No association was found between faecal incontinence and median scores for the internalising/externalising symptoms. All Rome IV criteria were associated with abnormal overall SDQ scores.

Conclusion: Children and adolescents with CF had more emotional and behavioral problems irrespective of whether faecal incontinence was present or not, with higher scores for internalizing and externalizing symptoms compared to non-constipated children.

Keywords: adolescent; bowel symptoms; child; constipation; emotional and behavioral problem.

© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).