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Omotola M, Ozturk C. Drug Treatment Versus Behavioral Therapies for Functional Constipation in Children Aged 0-5 Years: A Systematic Review. Iran J Health Sci 2025; 13 (3) :167-182
URL: http://jhs.mazums.ac.ir/article-1-1016-fa.html

Background and Purpose: Functional constipation (FC) is a gastrointestinal disorder that mainly affects the quality of life (QOL) of children under five years of age. This systematic review aims to compare the effectiveness of drug and behavioral therapies, their treatment outcomes, and preventive strategies for FC in children aged 0-5 years.
Materials and Methods: This is a systematic review study based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed, Web of Science, CINAHL, EBSCO, and Cochrane CENTRAL for English-language studies published from 2014 to June 2025. Thirty one studies met the inclusion criteria. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane risk-of-bias tool. 
Results: Polyethylene glycol (PEG) showed rapid symptom relief in most studies. In one study, the PEG group achieved 7.9 defecations per week versus 5.7 in the lactulose group (P=0.008). Adverse events were also fewer in the PEG group (15 vs 23, P=0.02). In another study, PEG 3350+electrolytes showed higher treatment efficiency (79.5%) compared to rectal enemas (58.3%) in children under two years of age. PEG at doses of 0.45–1.1 g/kg/day was safe and effective in children under 24 months of age, with lower side effects. Behavioral interventions, including toilet training and dietary changes, were effective in reducing recurrence and improving long-term bowel regularity. Their efficacy and impact on QOL can vary based on age, severity of constipation, and duration of treatment. 
Conclusion: The combined use of drug and behavioral therapies for FC in children aged 0-5 years is more effective and provides sustainable outcomes. This holistic treatment approach should consider age, constipation severity, and individual needs. To improve the efficacy of combined therapies, further high-quality RCTs are required to determine the most effective age-specific behavioral strategies and the best timing for their implementation.