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The management of chronic constipation in childhood has a number of problems and challenges for the paediatrician. It is seldom clear from the first contact with the child and family whether physical or psychological factors are paramount. Experience of managing a large number of such children has shown that most childrens' defaecation problems persists as a result of an intricate weave of a number of primary, secondary, physical, and psychological factors. Embarking on a single minded approach by the doctor may lead to a tightening of this knotty problem and subsequent loss of confidence and compliance. One of the objectives of this paper is to share some of this experience and define some of the features in the histories and the clinical examination which indicate the need for a particular emphasis in management.
Graham Clayden (Sun,) studied this question.