***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Constipation and encopresis are common problems in children . Still today , the role of fiber in the treatment of chronic constipation in childhood is controversial . The aim of our study was to evaluate whether fiber supplementation is beneficial in the treatment of children with functional constipation with or without encopresis . We used glucomannan as the fiber supplement . METHODS We evaluated the effect of fiber ( glucomannan , a fiber gel polysaccharide from the tubers of the Japanese Konjac plant ) and placebo in children with chronic functional constipation with and without encopresis in a double-blind , r and omized , crossover study . After the initial evaluation , the patients were disimpacted with 1 or 2 phosphate enemas if a rectal impaction was felt during rectal examination . Patients continued with their preevaluation laxative . No enemas were given during each treatment period . Fiber and placebo were given as 100 mg/kg body weight daily ( maximal 5 g/day ) with 50 mL fluid/500 mg for 4 weeks each . Parents were asked to have children sit on the toilet 4 times daily after meals and to keep a stool diary . Age , frequency of bowel movements into the toilet and into the undergarment , presence of abdominal pain , dietary fiber intake , medications , and the presence of an abdominal and /or a rectal fecal mass were recorded on a structured form at the time of recruitment and 4 weeks and 8 weeks later . Children were rated by the physician as successfully treated when they had > or =3 bowel movements/wk and < or = 1 soiling/3 weeks with no abdominal pain in the last 3 weeks of each 4-week treatment period . Parents made a global assessment s to whether they believed that the child was better during the first or second treatment period . RESULTS Forty-six chronically constipated children were recruited into the study , but only 31 children completed the study . These 31 children ( 16 boys and 15 girls ) were 4.5 to 11.7 years of age ( mean : 7 + /- 2 years ) . All children had functional constipation ; in addition , 18 had encopresis when recruited for the study . No significant side effects were reported during each 4-week treatment period . Significantly fewer children complained of abdominal pain and more children were successfully treated while on fiber ( 45 % ) as compared with placebo treatment ( 13 % ) . Parents rated significantly more children ( 68 % ) as being better on  fiber versus 13 % as being better on placebo . The initial fiber intake was low in 22 ( 71 % ) children . There was no difference in the percentage of children with low fiber intake living in the United States ( 70 % ) and Italy ( 71 % ) . Successful treatment ( physician rating ) and improvement ( parent rating ) were independent of low or acceptable initial fiber intake . The duration of chronic constipation ranged from 0.6 to 10 years ( mean : 4.0 + /- 2.5 years ) . Duration of constipation did not predict response to fiber treatment . Children with constipation only were significantly more likely to be treated successfully with fiber ( 69 % ) than those with constipation and encopresis ( 28 % ) . CONCLUSION We found glucomannan to be beneficial in the treatment of constipation with and without encopresis in children . Symptomatic children who were already on laxatives still benefited from the addition of fiber . Therefore , we suggest that we continue with the recommendation to increase the fiber in the diet of constipated children with and without encopresis OBJECTIVE To determine if Lactobacillus GG ( LGG ) is an effective adjunct to lactulose for treating constipation in children . STUDY DESIGN Eighty-four children ( 2 - 16 years of age ) with constipation ( <3 spontaneous bowel movements [ BMs ] per week for at least 12 weeks ) were enrolled in a double-blind , r and omized placebo-controlled trial in which they received 1 mL/kg/day of 70 % lactulose plus 10 9 colony-forming units ( CFU ) of LGG ( experimental group , n = 43 ) or a placebo ( control group , n = 41 ) orally twice daily for 12 weeks . The primary outcome measure was treatment success , and analyses were performed on an intention-to-treat basis . RESULTS Treatment success , defined as > or=3 spontaneous BMs per week with no fecal soiling , was similar in the control and experimental groups at 12 weeks ( 28/41 [ 68 % ] vs 31/43 [ 72 % ] , respectively ; P = .7 ) and at 24 weeks ( 27/41 [ 65 % ] vs 27/42 [ 64 % ] , respectively ; P = 1.0 ] . Groups also did not differ in their mean number of spontaneous BMs per week or episodes of fecal soiling per week at 4 , 8 , and 12 weeks . Adverse events and overall tolerance did not differ between groups . CONCLUSION LGG , as dosed in this study , was not an effective adjunct to lactulose in treating constipation in children OBJECTIVE To develop an evidence -based guideline for the primary pediatric care of children ( birth to 18 years old ) with idiopathic constipation and soiling . DATA SOURCES References were identified through a MEDLINE search from January 1975 through January 1998 to address 3 focus questions : ( 1 ) the best path to early , accurate diagnosis ; ( 2 ) best methods for adequate clean-out ; and ( 3 ) best approaches to promote patient and family compliance with management . DATA SELECTION Twenty-five references were identified . DATA EXTRACTION References were review ed by a multidisciplinary team and grade d according to the following criteria : r and omized controlled trial ; controlled trial , no r and omization ; observational study ; and expert opinion . Evidence tables were developed for each focus question . DATA SYNTHESIS An algorithm and clinical care guideline were developed by consultation and consensus among team members . Emphasis was placed on methods to promote early identification of pediatric idiopathic constipation and soiling , to recognize points of referral , and to increase patient and family compliance with treatment through use of education , developmentally based interventions , and variables for tracking success of management . CONCLUSION An algorithm and guideline for pediatric idiopathic constipation and soiling are presented for use by primary care physicians Simple , incentive based behaviour modification , with or without a modest programme of psychotherapy involving outpatient visits every four to six weeks , seems to be associated with a useful cure rate in children with lower bowel function disorders . Appreciable social disadvantage seems to be the most important factor mitigating against a successful outcome , associated with non-compliance with treatment . Failure to respond to treatment was associated with important psychological problems . These were more common in the socially disadvantaged groups . Children from satisfactory social background s who have lower bowl disturbances can be effectively treated by fairly simple programmes . More elaborate and expensive strategies should be reserved for those whose psychosocial circumstances make it possible to predict a less satisfactory outcome Background Nutrilon Omneo ( new formula ; NF ) contains high concentration of sn-2 palmitic acid , a mixture of prebiotic oligosaccharides and partially hydrolyzed whey protein . It is hypothesized that NF positively affects stool characteristics in constipated infants . Methods Thirty-eight constipated infants , aged 3–20 weeks , were included and r and omized to NF ( n = 20 ) or a st and ard formula ( SF ; n = 18 ) in period 1 and crossed-over after 3 weeks to treatment period 2 . Constipation was defined by at least one of the following symptoms : 1 ) defecation frequency < 3/week ; 2 ) painful defecation ; 3 ) abdominal or rectal palpable mass . Results Period 1 was completed by 35 infants . A significant increase in defecation frequency ( NF : 3.5 pre versus 5.6/week post treatment ; SF 3.6 pre versus 4.9/week post treatment ) was found in both groups , but was not significantly different between the two formulas ( p = 0.36 ) . Improvement of hard stool consistency to soft stool consistency was found more often with NF than SF , but did not reach statistical significance ( 90 % versus 50 % ; RR , 1.8 ; 95 % CI , 0.9–3.5 ; p = 0.14 ) . No difference was found in painful defecation or the presence of an abdominal or rectal mass between the two groups . Twenty-four infants completed period 2 . Only stool consistency was significantly different between the two formulas ( 17 % had soft stools on NF and hard stools on SF ; no infants had soft stools on SF and hard stools on NF , McNemar test p = 0.046 ) . Conclusion The addition of a high concentration sn-2 palmitic acid , prebiotic oligosaccharides and partially hydrolyzed whey protein result ed in a strong tendency of softer stools in constipated infants , but not in a difference in defecation frequency . Formula transition to NF may be considered as treatment in constipated infants with hard stools BACKGROUND The purpose of the present paper was to evaluate the efficacy of probiotics ( Lactobacillus casei rhamnosus , Lcr35 ) for treating children with chronic constipation and to compare its effect with magnesium oxide ( MgO ) and placebo . METHODS This double-blind placebo-controlled , r and omized study enrolled 45 children under 10 years old with chronic constipation . They were r and omly assigned to receive Lcr35 ( 8 x 10(8 ) c.f.u./day ; n = 18 ) , MgO ( 50 mg/kg/day ; n = 18 ) , or placebo ( n = 9 ) orally twice daily for 4 weeks . Lactulose use ( 1 mL/kg per day ) was allowed when no stool passage for 3 days was noted . Glycerin enema was used only when no defecation was noted for > 5 days or abdominal pain was suffered due to stool impaction . Bacterial cultures of stool were performed before and after treatment to evaluate the change of intestinal flora . Comparisons of the frequency of defecation , consistency of stool and the use of lactulose or enema during the period of treatment were made among the three groups . RESULTS The patients who received MgO or probiotics had a higher defecation frequency ( P = 0.03 ) , higher percentage of treatment success ( P = 0.01 ) , less use of glycerin enema ( P = 0.04 ) and less hard stool ( P = 0.01 ) than the placebo group . There was no significant difference between MgO and probiotic groups in the aforementioned comparisons . The first effect of MgO ( second week ) on constipation was slightly earlier than that of probiotic ( second to third week ) . Abdominal pain occurred less frequently in the probiotic group than in both the MgO and the placebo groups ( P = 0.03 ) . There was no statistically significant difference among the three groups in the use of lactulose , episodes of fecal soiling , and change of appetite . No adverse effect was noted in probiotic and placebo groups . Only one patient in the MgO group suffered from mild diarrhea . CONCLUSION Lcr35 was effective in treating children with chronic constipation . There is no statistically significant difference in efficacy between MgO and Lcr35 , but less abdominal pain occurred when using Lcr35 . Study with larger case number and longer follow up is needed in the future OBJECTIVES : This study examines long-term prognoses for children with constipation in adulthood and identifies prognostic factors associated with clinical outcomes . METHODS : In a Dutch tertiary hospital , children ( 5–18 years of age ) who were diagnosed as having functional constipation were eligible for inclusion . After a 6-week treatment protocol , prospect i ve follow-up evaluations were conducted at 6 and 12 months and annually thereafter . Good clinical outcomes were defined as ≥3 bowel movements per week for ≥4 weeks , with ≤2 fecal incontinence episodes per month , irrespective of laxative use . RESULTS : A total of 401 children ( 260 boys ; median age : 8 years [ interquartile range : 6–9 years ] ) were included , with a median follow-up period of 11 years ( interquartile range : 9–13 years ) . The dropout rate during follow-up was 15 % . Good clinical outcomes were achieved by 80 % of patients at 16 years of age . Thereafter , this proportion remained constant at 75 % . Poor clinical outcomes at adult age were associated with : older age at onset ( odds ratio [ OR ] : 1.15 [ 95 % confidence interval [ CI ] : 1.02–1.30 ] ; P = .04 ) , longer delay between onset and first visit to our outpatient clinic ( OR : 1.24 [ 95 % CI : 1.10–1.40 ] ; P = .001 ) , and lower defecation frequency at study entry ( OR : 0.92 [ 95 % CI : 0.84–1.00 ] ; P = .03 ) . CONCLUSIONS : One-fourth of children with functional constipation continued to experience symptoms at adult age . Certain risk factors for poor clinical outcomes in adulthood were identified . Referral to a specialized clinic should be considered at an early stage for children who are unresponsive to first-line treatment Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain cons 
    Output:
    
Some evidence shows that fiber 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 , we found no evidence that water intake increases or that hyperosmolar fluid treatment is more effective in increasing stool frequency or decreasing difficulty in passing stools .
We found no evidence to recommend the use of prebiotics or probiotics .
Behavioral therapy with laxatives is not more effective than laxatives alone .
: There is some evidence that fiber supplements are more effective than placebo .
No evidence for any effect was found for fluid supplements , prebiotics , probiotics , or behavioral intervention .