Treatment of childhood constipation in general practice.

1. Age 4-17 years;

2. Functional constipation defined by the NHG Standaard Obstipatie as having at least two of the following symptoms:

A. Defecation ≤ 2 per week;

B. Cessation of defecation;

C. Painful, lumpy or hard defecation;

D. Large diameter stools that may obstruct the toilet;

E. Presence of a large faecal mass in the rectum or abdomen;

F. ≥ 1 episode of faecal incontinence per week.

1. Terminal illness;

2. Mental retardation;

3. Metabolic disease (e.g. hypothyreoidi);

4. Hirchsprung disease/ spine anomalies/ anorectal pathology (e.g. hemorrhoids, anal fissure, perirectal abscess, pruritis ani, fecal incontinence);

5. Gastrointestinal surgery in medical history;

6. Presence of an indication for referral to secondary care: suspicion for ileus, Hirchsprung disease, anatomic malformation or pelvic floor pathology, severe behavioural problems, developmental problems or a disturbed parent-child relationship concerning defecation;

7. Contraindication for PEG3350 electrolytes (e.g.Toxic megacolon, Inflammatory bowel disease, acute abdominal pain, allergies for one of the substances);

8. Children who already receive laxative treatment prescribed by the GP or children for who it's less than 3 months ago that they stopped taking laxatives.