How is functional constipation defined in children (Rome IV criteria)?

Functional constipation requires at least two of: defecation fewer than twice per week, faecal incontinence at least once per week, retentive posturing/stool withholding, painful or hard stools, a large faecal mass in the rectum, and large-diameter stools - present at least weekly for one month, with no organic disease.

Clinical relevance. The Rome IV criteria allow a positive clinical diagnosis of functional constipation without routine investigation.

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Defining childhood constipation (Rome IV)

Constipation in children is a clinical diagnosis defined by symptom criteria rather than stool frequency alone.

Rome IV criteria - at least two of:

• Defecation fewer than 2 times per week.
• Faecal incontinence at least once per week.
• Retentive posturing or excessive volitional stool retention.
• Painful or hard bowel motions.
• A large faecal mass in the rectum.
• Large-diameter stools that may block the toilet.

Timing and exclusion

• Criteria fulfilled at least once per week for one month.
• No organic disease to explain the symptoms.

Normal range

• Normal stool frequency ranges from 3 per day to 3 per week, a pattern typically attained by age 4 (does not apply to exclusively breastfed infants over 6 weeks).