Development and validation of a risk prediction model for functional constipation in school-aged children.

objectiveTo identify independent risk factors for functional constipation (FC) in school-aged children, and to develop and internally validate a nomogram-based risk prediction model for early screening of high-risk populations.

methodsIn this single-center, retrospective, cross-sectional case-control study, we enrolled 467 school-aged children who presented to the Constipation Clinic or Department of Child Health Care at Wuhan Children's Hospital between January 2024 and May 2025. Participants were randomly allocated into a derivation cohort (n = 326) and an internal validation cohort (n = 141) in a 7:3 ratio. Children in the derivation cohort were classified as FC or healthy controls based on Rome IV criteria. Independent risk factors were identified through multivariable logistic regression. A nomogram prediction model was then developed using the R software based on the results of the multivariable analysis. Model discrimination was evaluated by the area under the receiver operating characteristic curve (AUC-ROC), and calibration was assessed with the Hosmer-Lemeshow test. For internal validation, the predictive performance of the established nomogram was assessed on an independent validation cohort, which comprised 141 school-aged children (68 with FC and 73 healthy controls). This assessment was based on a receiver operating characteristic curve (ROC) analysis, with performance quantified by the area under the curve (AUC).

resultsMultivariable analysis identified the following independent risk factors for FC in school-aged children: shorter duration of exclusive breastfeeding, absence of any toilet training, child's concern over lack of privacy during defecation, complete unwillingness to defecate at school, frequent complaints of school-related stress, and suboptimal daily parent-child interaction time (all P < 0.05). The nomogram demonstrated excellent discrimination in the derivation cohort (AUC 0.88, 95% CI 0.85-0.92; sensitivity 74%, specificity 86%) with good calibration. Performance remained robust in the validation cohort (AUC 0.84, 95% CI 0.78-0.90; sensitivity 70%, specificity 82%).

conclusionsIncorporating key modifiable factors from type of infant feeding, toilet training, school environment, psychological adaptation, and parent-child interaction, the developed nomogram provides a simple, intuitive, and feasible clinical tool. It demonstrates good discriminative ability and predictive accuracy, offering a practical and actionable guide for the early identification of school-aged children at high risk of FC and for informing targeted preventive interventions.