Early childhood risk factors for constipation and soiling at school age: an observational cohort study

Objective. Constipation and soiling are common in childhood. This study examines the co-morbidity between childhood constipation and soiling and early childhood risk factors for these problems.

Design. The sample comprised 8,435 participants from the Avon Longitudinal Study of Parents and Children with maternally-reported measures of constipation (6 time-points between 4–10yrs) and soiling (5 time-points between 4–9yrs). We used latent class analysis to extract longitudinal patterns of constipation and soiling. We examined whether the latent classes are differentially associated with maternally reported risk factors in early childhood (stool consistency, breastfeeding, socioeconomic background, gestation, birthweight, developmental level and age at initiation of toilet training) using multinomial logistic regression models.

Results. We extracted 4 latent classes: ‘normative’ (74·5%: very low probability of constipation or soiling); ‘constipation alone’ (13·2%); ‘soiling alone’ (7·5%) and ‘constipation with soiling’ (4·8%). Hard stools at 2½ years were associated with increased odds of constipation alone. Developmental delay at 18 months was associated soiling alone and constipation with soiling, but not constipation alone. We found limited evidence of associations with socioeconomic background and no evidence of associations with age at initiation of toilet training, breastfeeding, gestational age or birthweight.

Conclusion. Constipation alone was the most prevalent pattern in this cohort. Treatment for hard stools in early childhood is needed to prevent chronic constipation at school age. Constipation with soiling was less common than soiling alone. Further research is needed into the causes of non-retentive soiling.