Yvonne McCague
Contributions: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing
Suja Somanadhan
Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing
Eileen Furlong
Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing
This publication is part of the Maternal and Child Health collection.
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Childhood constipation is a prevalent issue that has various impacts on children and their families, including psychological, emotional, social, and health-related quality-of-life consequences. Primary or functional constipation (FC) does not have a known underlying cause but is linked to lifestyle, psychological, and behavioral factors. Misdiagnosis and inadequate management can lead to chronicity well into adulthood, diminishing the quality of life for both the child and their family. This scoping review seeks to address the question, “What do we know about the psychosocial effects of childhood constipation on children and their families?”
Approach
This scoping review will utilize the six stages of Arksey and O’Malley’s Framework, as well as the updated version by Peters et al. (2022). The PRISMA-ScR guidelines will be followed for the process and reporting. The Population, Concept, and Context (PCC) framework will shape the inclusion criteria and search strategy. Systematic searches will be conducted on PUBMED, CINAHL, ASSIA, PsycInfo, and the Cochrane Library from inception to present. Selected articles will undergo critical appraisal for trustworthiness and methodological rigor. Plans for consultation and dissemination of findings will also be outlined.
Conclusion
This scoping review aims to offer a comprehensive overview of the existing literature to enhance understanding and pinpoint gaps in knowledge concerning the psychosocial implications of childhood constipation on children and their families. Through this review, we hope to contribute to improving the overall management and support for children and families affected by childhood constipation.
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Children, constipation, psychosocial impact, families, scoping review
Funding: YM received a full PhD scholarship (2022) from SNMHS, University College Dublin to support this study.
Funders played no role in study design, data collection or analysis, decision to publish, or manuscript preparation.
How to reference: McCague Y, Somanadhan S, Stokes D and Furlong E. The psychosocial implications of childhood constipation on children and their families: A scoping review protocol. [version 2; peer review: 3 approved]. HRB Open Res 2024, 6:48 (https://doi.org/10.12688/hrbopenres.13713.2) First published: 13 Sep 2023, 6:48 (https://doi.org/10.12688/hrbopenres.13713.1) Latest published: 18 Jun 2024, 6:48 (https://doi.org/10.12688/hrbopenres.13713.2)
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1. The abstract now states “is associated with” instead of “can be caused by”.
2. Paragraph 3 was moved to position 2 to highlight prevalence.
3. Joinson et al’s (2019) epidemiological research on early childhood psychosocial risk factors was added.
4. Appak et al (2017) on the impact of constipation on psychological, social well-being, and overall HRQOL in children and adolescents was referenced in paragraph 5.
5. The World Health Organization’s definition of quality of life (QOL) was included for context in the introduction.
6. Additional studies on the long-term effects of childhood constipation were cited in the discussion section.
7. A table summarizing the main findings of the research was added to the results section for clarity.
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Childhood constipation is a defecation disorder that has become a significant and widespread chronic health challenge in children (Walter et al., 2019). Despite its prevalence, constipation is often underdiagnosed and poorly managed. (continues discussion on diagnosis and management of constipation)
Global epidemiological data on childhood constipation is limited. The prevalence varies globally, ranging from 0.7% to 32%. The overall pooled prevalence is 9.5%, with a higher prevalence of 17.5% in children under four years old. In pediatric gastroenterology clinics, the reported prevalence ranges from 25% to 45%.
The disparity in prevalence could be attributed to differences in definitions, symptom duration, study methodology, age distribution, and epidemiological data availability. Age distribution data is scarce, with mixed results on the relationship between constipation prevalence and age.
Multiple factors contribute to childhood constipation, including environmental and early childhood developmental aspects. Environmental factors such as a sedentary lifestyle, poor diet, low socioeconomic status, and limited parental involvement can heighten the risk of constipation. Early childhood factors like painful defecation, authoritarian parenting, and stressful events can also play a role.
Childhood constipation can negatively impact children’s growth and health. Studies have linked chronic constipation to decreased weight and height, as well as higher rates of overweight and obesity. Additionally, constipated children may exhibit more somatic complaints and bladder issues such as urinary tract infections and incontinence.
Constipation can affect children’s psychological and social well-being, leading to decreased quality of life. Research indicates that constipated children often have lower quality of life scores, elevated anxiety levels, disrupted sleep, and social difficulties. Psychological problems like anxiety, depression, aggression, and internalizing issues are more prevalent among children with constipation.
Childhood constipation has implications for children and adolescents in educational settings. Studies show that constipation and fecal incontinence can impact school performance, potentially resulting in social anxiety and academic underperformance. There is also evidence of a link between abuse, bullying, and childhood constipation. The psychological effects of constipation are significant, influencing interaction and quality of life.
Constipation coupled with fecal incontinence exacerbates quality of life challenges for children and their families. Adolescents dealing with constipation and fecal incontinence tend to have lower quality of life scores. Financially, constipation leads to increased healthcare expenses and time spent on laundry. Research demonstrates higher medical costs for children with constipation, with anxiety potentially escalating inpatient costs.
Treatment failures and recurrent constipation can also impact the quality of life for parents. Parents of children with constipation often face conflicts, lower quality of life scores, and dissatisfaction with healthcare providers. The burden of childhood constipation extends to the family, affecting various aspects of physical, emotional, and social life.
Childhood constipation is a multifaceted health issue with behavioral implications, influencing children’s physical, emotional, social, and academic domains. Parents commonly express anxiety, frustration, and a lack of confidence in healthcare providers. Further research is essential to understand and address the psychosocial influences of childhood constipation on children and families.
The Sláintecare Reports emphasize the importance of addressing chronic conditions in children to enhance child health services. Studying the impact of childhood constipation aligns with efforts to improve child health services. Research priorities in the UK and Ireland underscore childhood constipation as a key focus for investigation.
Recent findings indicate a growing interest in childhood constipation, particularly in treatment options. Studies stress the need to evaluate the effects of constipation on children’s lives and family well-being. Recognizing these impacts is crucial for enhancing child health services.
This scoping review aims to identify and explore current literature on the psychosocial effects of childhood constipation on children and families. The inclusive methodology will map evidence, clarify essential concepts, and pinpoint literature gaps. Scoping reviews allow for systematic searches that include grey literature and resources like Google Scholar. The objectives are:
1. To delve into available literature on the psychosocial consequences of childhood constipation.
2. To describe current studies on childhood constipation, highlighting challenges, support received, and areas for improvement.
3. To develop insights into the psychosocial repercussions of childhood constipation.
4. To offer guidance for future research in this field.
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This review adheres to Arksey and O’Malley’s Framework and PRISMA-ScR guidelines. The review encompasses six stages:
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The initial stage involves formulating a research question aligned with the review’s aim. The PCC framework aids in crafting clear review questions and search criteria. The research question for this scoping review is:
“What is the psychosocial impact of childhood constipation on children and families?”
Eligibility Criteria. The PCC framework establishes inclusion and exclusion criteria, all detailed in Table 1.
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| Exploring the Consequences | How does childhood constipation affect the psychology and social interactions of both children and their families? |
| Criteria for Inclusion | Criteria for Exclusion |
Research Focus
The study focuses on children under 18 with constipation and their families, examining the psychosocial impacts of childhood constipation on individuals and families. The research is limited to children under 18 with primary constipation.
Geographical locations are not restricted, but studies are limited to those published in English. The research will include primary studies utilizing quantitative, qualitative, and mixed-methods approaches. Case studies, expert opinions, and literature reviews will not be included.
Search Strategy
Factors contributing to constipation, such as lifestyle, child development, and psychological disorders, will be explored. Multiple electronic databases and grey literature resources will be searched, guided by JBI’s three-step strategy.
Initial searches in PUBMED and CINAHL will be conducted to develop a comprehensive search strategy. Subsequent searches will utilize all identified keywords and index terms in selected databases. Hand searching through reference lists of articles and further refinement of search terms will be carried out as necessary.
Study Selection
Screening of search results will precede full-text screening to identify eligible studies based on title and abstract. Eligible studies meeting inclusion criteria will undergo detailed full-text screening. Any disagreements will be resolved by a third reviewer. The selection process will be detailed and transparent, following the PRISMA guidelines.
Data Extraction
Data charting will be conducted using the JBI Template Data Extraction Instrument to maintain transparency and reduce bias. Key information including author, publication year, study design, population, outcomes, and key findings will be collected. Data will be charted in Excel following JBI templates.
While critical appraisal is not mandatory in scoping reviews, studies will be systematically assessed for methodological rigor. Various appraisal tools will be employed based on the study type.
Data Synthesis
Results of the search and screening process will be presented using a PRISMA-ScR flowchart. Data will be synthesized quantitatively and qualitatively, with analysis conducted using SPSS Version 24. The findings will be disseminated through conferences and peer-reviewed publications.
Study Progress
At present, the study is in the preliminary search stage of databases. The research team is conducting an extensive review of relevant literature and compiling a list of key sources to analyze. They are also formulating research questions and hypotheses to guide their investigation. Once this stage is completed, the next steps will involve data collection, analysis, and interpretation to draw meaningful conclusions from the study.
Research Significance
Childhood constipation is increasingly recognized as a global health issue with significant implications for children and their families. This scoping review aims to address the psychosocial impact of childhood constipation in Ireland, directing future research in this area.
The protocol ensures a systematic and thorough review, allowing for deviations to enhance comprehensive analysis. No ethical approval is necessary as publicly available literature will be reviewed.
Data Availability
No Underlying Data
No data is associated with this article. The project follows the Open Science Framework, with extended data available under the CC0 1.0 Public domain dedication.
Study Context
This scoping review protocol is part of a larger PhD study conducted by the first author (YM).