I seek comments from the authors on their recent article [1] related to constipation in children.

Recommendations of the North American Society for Pediatric Gastroenterology and Nutrition for constipation [2] were updated in 2006 [3]. These guidelines and others [4], recommend testing for hypothyroidism, hypercalcemia, celiac disease and chronic lead exposure in children with constipation who respond poorly to standard treatment. Authors have not reported any case of hypothyroidism in their series of children. Is there need for testing for hypothyroidism in children with constipation who respond poorly to standard treatment in Indian set-up?

1. Khanna V, Poddar U, Yachha SK. Etiology and clinical spectrum of constipation in Indian children. Indian Pediatr. 2010;47:1025-30.

2. Baker SS, Liptak GS, Colletti RB, Croffie JM, DiLorenzo C, Ector W, et al. Constipation in infants and children: evaluation and treatment. A medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1999;29:612-26.

3. Baker SS, Liptak GS, Colletti RB, Croffie JM, DiLorenzo C, Ector W, et al. Clinical Practice Guideline. Evaluation and Treatment of Constipation in Infants and Children: Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43:e1-e13.