This systematic review found that there is some evidence that fibre supplements are more effective than placebo in childhood constipation. However, no evidence for any effect was found for fluid supplements, prebiotics, probiotics, or behavioural intervention. Data included in the review consisted of included systematic reviews and randomised controlled trials (RCTs) that reported on non-pharmacologic treatments. No RCTs for physical movement, multidisciplinary treatment, or alternative medicine were found. Overall, the authors included 9 studies with 640 children and the results found:

• Some evidence shows that fibre may be more effective than placebo in improving both the frequency and consistency of stools and in reducing abdominal pain.

• Compared with normal fluid intake, no evidence was found to suggest that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools.

• No evidence was found to support the use of prebiotics or probiotics.

• Behavioural therapy with laxatives is not more effective than laxatives alone.

The authors conclude, “This study clearly shows that there is a lack of well-designed RCTs of high quality concerning non-pharmacologic treatments for children with functional constipation.” They recommend that further well designed studies are conducted.