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Characteristics of Intestinal Habits in Children Younger Than 4 Years: Detecting Constipation

Mota, Denise M.*; Barros, Aluisio J.D.; Santos, Iná; Matijasevich, Alícia

Journal of Pediatric Gastroenterology & Nutrition: October 2012 - Volume 55 - Issue 4 - p 451–456
doi: 10.1097/MPG.0b013e318251482b

Objectives: The aim of the present study was to describe the prevalence of childhood constipation, stool characteristics, and their relationship with toilet training and age of introduction of cow's milk.

Methods: A total of 4231 children born in 2004, from a birth cohort study, were assessed at 12, 24, and 48 months of age, when their mothers provided information on sociodemographic characteristics, bowel habits, toilet training, and age of introduction of cow's milk and other foods.

Results: The prevalence of constipation was 27.3% and 31.0% at 24 and 48 months of age, respectively. Among girls, at 48 months of age, it was 34.4% versus 27.4% in boys (P < 0.001). The most common features of constipation were scybalous stools (47.7% and 41.0% at 24 and 48 months, respectively), evacuation difficulty (24.3% and 23.1%), and hard stools (17.8% and 34.1%). Toilet training starting before 24 months was associated with constipation at 24 months and its persistence up to 48 months. Among children who did not receive cow's milk in their first year of life, 22% had constipation at 24 months, 22.6% at 48 months, and 8.3% at 24 and 48 months. Among children who started cow's milk before 30 days of life, the respective proportions of children with constipation was 28.2%, 33%, and 12.4%.

Conclusions: The prevalence of constipation increases with age and cannot be detected using only information on evacuation interval. Toilet training before 24 months and introduction of cow's milk before 1 year of age is positively associated with constipation at 24 months and its persistence up to 48 months.

*Department of Mother and Child Health

Graduate Program in Epidemiology

Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

Address correspondence and reprint requests to Denise M. Mota, General Osório, 956, CEP: 96020-000 Pelotas, Rio Grande do Sul, Brazil (e-mail:

Received 25 August, 2011

Accepted 21 February, 2012

The study was supported by the Wellcome Trust Initiative, entitled Major Awards for Latin America on Health Consequences of Population Change. Previous phases of the study were supported by the World Health Organization, National Support Program for Centers of Excellence (PRONEX), the Brazilian National Research Council (CNPq), the Brazilian Ministry of Health, and the Children's Mission.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN