Factors associated with treatment response to laxative therapy in pediatric functional constipation: A real-world retrospective study

Abstract: Background: Laxatives are the mainstay for pediatric functional constipation (FC), yet response factors need more real-world research. Objectives: This study investigated factors associated with laxative treatment response in children with functional constipation. Methods: Retrospective data were screened from 103 pediatric FC patients receiving polyethylene glycol treatment (The First Hospital of Qinhuangdao, Feb 2023–Nov 2025). After exclusion, 100 cases were included and divided into the responder group (n=68) and the non-responder group (n=32). The primary outcome measures included the Pediatric Constipation Score (PCS), the Bristol Fecal Morphology Scale (BSFS) and defecation frequency. Secondary endpoints included the incidence of abdominal pain, incidence of bloating, average daily dietary fiber intake, average daily water intake and average daily physical activity. A logistic regression analysis was conducted to identify independent risk factors associated with treatment response. Results: The baseline clinical characteristics of both groups were well-balanced (all P > 0.05). Post-treatment evaluation showed that the PCS score in the responder group decreased more significantly compared to the non-responder group (P<0.001). Meanwhile, increases in bowel movement frequency and BSFS scores were more pronounced in the responder cohort (all P<0.001). Compared to the non-responder group, the responder group also had lower incidences of abdominal pain and distension (all P<0.05). In terms of lifestyle-related indicators, the responder group had significantly higher daily average dietary fiber intake, average daily water intake and average daily physical activity levels (all P<0.001). Results from logistic regression analysis indicated that high baseline PCS scores, elevated incidence of abdominal pain, insufficient dietary fiber intake, low daily water intake and inadequate physical activity emerged as independent risk factors for poor laxative response in pediatric FC patients (all P<0.05). Conclusion: Laxative response in pediatric FC is affected by several factors, such as severe constipation, poor diet, low activity and abdominal pain.