Abstract
BACKGROUND: Functional constipation (FC) is a global burden, and data on its prevalence based on Rome IV diagnostic criteria in young children, particularly after the coronavirus disease 2019 era, are limited. AIM: To determine the prevalence of FC in Thai infants and toddlers using the Rome IV criteria and identify associated factors. METHODS: The Thai version of the Rome IV Diagnostic Questionnaire for Pediatric Functional Gastrointestinal Disorder (R4PDQ-Toddler) was developed and then officially approved by the Rome Foundation. Guardians of children aged 6-48 months from six hospitals in five regions in Thailand were surveyed between August 2023 and September 2024. The questionnaire collected demographic data, the R4PDQ-Toddler gathered defecation data, and factors potentially associated with FC were recorded. RESULTS: A total of 1874 guardians participated, yielding a high response rate of 98.1%. The mean age of the children was 20.3 months ± 11.4 months, and 53.5% were male. The prevalence of FC was 16.1% [95% confidence interval (CI), 14.5%-17.8%]. Painful or hard bowel movements (81.5%), large-diameter stools (77.5%), and excessive stool retention (72.2%) were the most common symptoms. Factors independently associated with FC were age > 1 year [adjusted odds ratio (aOR), 3.36; 95%CI: 2.29-4.94], a first-degree relative with a history of constipation (aOR: 2.48; 95%CI: 1.85-3.35), fiber supplementation (aOR: 7.85; 95%CI: 3.56-17.30), and exposure to stressful family events (aOR: 1.41; 95%CI: 1.03-1.92). CONCLUSION: FC is prevalent in Thai infants and toddlers. Older age, family history, fiber supplementation, and stress are key factors, highlighting genetic, dietary, and gut-brain influences that need further investigations.