Rome IV criteria for the diagnosis of functional constipation in children

Infants and toddlers up to 4 years old

At least 2 of the following present for at least 1 month:

2 or fewer defecations per week

History of excessive stool retention

History of painful or hard bowel movements

History of large-diameter stools

Presence of a large fecal mass in the rectum

In toilet-trained children, the following additional criteria may be used:

At least 1 episode/week of incontinence after the acquisition of toileting skills

History of large-diameter stools that may obstruct the toilet

Children and adolescents (developmental age ≥4 years)

At least 2 of the following present at least once per week for at least 1 month:*

2 or fewer defecations in the toilet per week

At least 1 episode of fecal incontinence per week

History of retentive posturing or excessive volitional stool retention

History of painful or hard bowel movements

Presence of a large fecal mass in the rectum

History of large-diameter stools that may obstruct the toilet

The symptoms cannot be fully explained by another medical condition

* In addition, the symptoms are insufficient to fulfill the diagnostic criteria of irritable bowel syndrome.

Data from:

Benninga MA, Faure C, Hyman PE, et al. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016.
Hyams JS, Di Lorenzo C, Saps M, et al. Functional Disorders: Children and Adolescents. Gastroenterology 2016.

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