ArticleArchives of disease in childhood2020
Challenging the view that lack of fibre causes childhood constipation.
Article in Archives of disease in childhood, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- ILSI Europe Systematic Review: The Impact of Digestible and Nondigestible Carbohydrate Consumption for Toddlers (1-4 Years) in Relation to Health Outcomes.Nutrition reviews · 2025Pooled it
- Examining causal pathways between family adversity and soiling: a prospective cohort study.BMJ paediatrics open · 2025Article
- The ten "hard" questions in pediatric functional constipation.Italian journal of pediatrics · 2024Review
- Frequency of Functional Constipation in Lebanese Children: A Cross-Sectional Study Based on Parental Reporting.International journal of pediatrics · 2024Article
- Oral exploration and food selectivity: A case-control study conducted in a multidisciplinary outpatient setting.Frontiers in pediatrics · 2023Article
- Constipation in Children and Adolescents.Deutsches Arzteblatt international · 2022Article
- Cows' Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review.Nutrients · 2022Review
- Prevention of pediatric functional constipation: a narrative review.Jornal de pediatriaReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
Abstract
objectivesTo assess evidence supporting the view that 'low fibre
designTriangulation integrated three approaches: a systematic review NICE guideline CG99 examining effectiveness of increasing fibre; a cohort study, Avon Longitudinal Study of Parents and Children (ALSPAC), to assess if constipation (or hard stools) can precede fibre intake at weaning; and a literature search for twin studies to calculate heredity.
settingCG99 examined the literature regarding the effectiveness of increasing fibre. ALSPAC asked parents about: hard stools at 4 weeks, 6 months and 2.5 years and constipation at age 4-10 years, as well as fibre intake at 2 years. Twin studies and data from ALSPAC were pooled to calculate concordance of constipation comparing monozygotic and dizygous twin pairs.
participantsCG99 reported six randomised controlled trials (RCTs). ALSPAC hard stool data from 6796 children at 4 weeks, 9828 at 6 months and 9452 at 2.5 years plus constipation data on 8401 at 4-10 years were compared with fibre intake at 2 years. Twin studies had 338 and 93 twin pairs and ALSPAC added a further 45.
resultsIncreasing fibre did not effectively treat constipation. Hard stools at 4 weeks predated fibre and at 6 months predicted lower fibre intake at 2 years (p=0.003). Heredity explained 59% of constipation.
conclusionsRCTs indicate that increasing fibre is not an effective treatment for constipation in children. Hard stools can precede and predict later fibre intake. Genetic inheritance explains most childhood constipation. Extended treatment with stool softeners may improve fibre intake and limit long-term damaging sequelae of constipation.
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Registered trials
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