Pediatricians’ perceptions and practice of the management of constipation in Thailand

Abstract

Background Previous studies have shown that physicians’ perception and practice can differ from proposed guidelines with regards to constipation. Most studies were performed in westernized countries, but only few studies in developing nations. Therefore, we aimed to study the perception on management of constipation among Thai pediatricians. Methods We performed a national survey using an online 37‐item questionnaire that included demographics, perception and practice on constipation in children. We used a 5‐point scale to determine perception in each aspect (5 as strongly agreed and 1 as strongly disagreed). Results We received 275 responses (response rate of 11.0%), most were female (69.1%), subspecialists (55.6%) and worked in the government‐based setting (69.5%). We noted that only 51.8% considered disimpaction if physical examination is suggestive of fecal impaction. Most pediatricians used lactulose for both disimpaction and maintenance phases (83.4 and 91.9%, respectively); however, pediatricians perceived that the caregivers of constipated children were concerned about tolerance or dependence of most commonly used laxatives, ranged from 45.8 to 63.8%. We also found that recently graduated pediatricians were more likely to provide advice on fluid intake, toilet training, and laxative use, as well as consider polyethylene glycol for disimpaction than the older individuals (P = .003, .02, .004, and .02, respectively). Conclusions The proportion of pediatricians who consider disimpaction remained suboptimal. Providing appropriate knowledge on the pharmacologic management, especially disimpaction and issues on laxatives, may be helpful for pediatricians and caregivers. The education may also need to be tailored to various pediatricians’ experience and work settings.