SALT LAKE CITY — Pediatricians and family physicians choose different treatments for constipation in infants and children, a survey of 328 physicians found.
Of the 143 family physicians who responded to the mailed questionnaire, 53% treated constipation for longer than 3 months, compared with 84% of the 185 surveyed pediatricians, Dr. Douglas G. Field said. Only 1% of pediatricians treated for less than 1 month, compared with 13% of family physicians.
He presented the findings in a poster at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), which has published guidelines for managing pediatric constipation (J. Pediatr. Gastroenterol. Nutr. 1999;29:612–26).
Many children with constipation need long-term therapy to maintain a regular bowel pattern, studies have shown, so a child should be weaned from medication only after he or she has been having regular bowel movements without difficulty, said Dr. Field of Penn State Children's Hospital, Hershey, Pa., and his associates.
The difference between specialties in treatment length might explain the higher success rate reported by the pediatricians surveyed, he added. Only 4% of pediatricians referred more than 25% of their patients with constipation to pediatric gastroenterologists, compared with 31% of family physicians.
The main reason for referral by both primary care specialties was lack of response to therapy (in 65%–69% of referrals).
Most pediatricians and family physicians used suppositories and prune juice to disimpact infants with constipation, practices supported by the NASPGHAN guidelines.
For children, the most commonly used rectal treatments were enemas or suppositories, and the most common oral treatments were polyethylene glycol (by pediatricians) or mineral oil (by family physicians), again supported by the guidelines.
Family physicians veered from the guidelines, however, by using mineral oil in infants—for disimpaction in 7% of infants and for maintenance therapy in 9% of infants.
Pediatricians used mineral oil in 1% of infants for disimpaction and in 1% for maintenance therapy.
Many children with constipation need long-term therapy to maintain a regular bowel pattern. DR. FIELD