Functional constipation in children: What physicians should know

Table 2 Rome IV criteria for pediatric functional constipation[6,7,9]

Child’s age	Diagnostic criteria
< 4 years old	Two or more criteria for at least 1 mo1: (1) Two or fewer defecations per week; (2) History of excessive stool retention; (3) History of painful or hard bowel movements; (4) History of large diameter stools; (5) Presence of a large fecal mass in the rectum; (6) At least one episode of fecal incontinence per week after the acquisition of toileting skills; and (7) History of large-diameter stools that may obstruct the toilet in toilet trained children
≥ 4 years old	Two or more symptoms for at least 1 mo in children at least 4 yr2: (1) Two or fewer defecations per week; (2) At least one episode of fecal incontinence per week; (3) History of retentive posturing or excessive stool retention; (4) History of painful or hard bowel movements; (5) Presence of a large fecal mass in the rectum; (6) History of large-diameter stool that may obstruct the toilet; and (7) Additional criteria: Without fulfilling irritable bowel syndrome criteria

¹After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.

²After appropriate evaluation, the symptoms cannot be fully explained by another medical condition.