Linaclotide, a guanylate cyclase C agonist approved for chronic idiopathic constipation and irritable bowel syndrome with constipation in adults, was evaluated for its efficacy and safety in children aged 6-17 with functional constipation. 
This phase 3, randomized, double-blind, placebo-controlled trial was conducted across 64 sites in seven countries. A total of 330 participants meeting modified Rome III criteria were randomly assigned to receive linaclotide 72 μg or placebo once daily for 12 weeks. The primary outcome was the change in spontaneous bowel movement (SBM) frequency, and the secondary outcome was stool consistency over the treatment period.
Out of 330 enrolled patients, 328 were analyzed (164 per group). Baseline SBM rates were 1.28 per week for placebo and 1.16 for linaclotide, increasing to 2.29 and 3.41 SBMs per week, respectively. Linaclotide significantly improved SBM frequency compared to placebo (LSM change: 2.22 vs. 1.05 SBMs per week; difference: 1.17; 95% CI: 0.65-1.69; p < 0.0001) and stool consistency (LSM change: 1.11 vs. 0.69; difference: 0.42; 95% CI: 0.21-0.64; p = 0.0001). 
The most common adverse event was diarrhea, reported in 4% of the linaclotide group compared to 2% of placebo. One case of severe diarrhea led to hospitalization but resolved without complications. No deaths occurred. 
Linaclotide demonstrated efficacy and tolerability in treating pediatric functional constipation and is now approved by the FDA for this indication.
 

A network meta-analysis found a combination of probiotics and laxative effective at treating pediatric functional constipation. 
Pediatric constipation affects 0.7% to 29.6% of children globally, with functional constipation accounting for 95% of cases. Despite its prevalence, pharmacological treatments have limited efficacy, with a 60% success rate. Probiotic supplements have shown potential benefits in randomized controlled trials (RCTs), though the probiotic strains used varied significantly across studies. 
This network meta-analysis (NMA) aimed to evaluate the efficacy and acceptability of various probiotic supplements in managing pediatric functional constipation. The analysis included nine RCTs with 710 participants (mean age: 5.5 years; 49.4% girls), assessing the impact of probiotics, alone or with laxatives, on bowel movement frequency and treatment acceptability.
Results demonstrated that most probiotics, whether used individually or with laxatives, significantly improved bowel movement and stool frequency compared to placebo/control. Protexin combined with laxatives showed the greatest improvement (SMD = 1.87, 95% CI: 0.85 to 2.90), outperforming all other products. Among single probiotic treatments, only Lactobacillus casei rhamnosus Lcr35 achieved significant efficacy compared to placebo/control (SMD = 1.37, 95% CI: 0.32 to 2.43). All probiotic products had similar rates of fecal incontinence and dropouts as the control groups. 
This NMA supports the use of combined probiotics and laxatives for pediatric functional constipation, provided no contraindications exist, and highlights the importance of specific probiotic strains in treatment efficacy.
 

According to a recent study, the administration of XLTG11 at a dosage of 1 × 1010 CFU per day to children resulted in an elevation in fecal frequency, brought about favorable alterations in gut microbiota, and effectively regulated short-chain fatty acid (SCF) genes and genes associated with methane metabolism. This study’s results were published in the Brazilian Journal of Microbiology. 
In this double-blinded, randomized trial, eligible children were divided into two groups: the intervention group (n = 65) received conventional treatment with probiotics, and the control group (n = 66) received conventional treatment without probiotics. The primary outcome measure focused on fecal frequency. To predict gene family abundances based on 16S information, fecal gut microbiota analysis and PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) were utilized.
During the treatment period, there was a significant increase in the weekly frequency of feces in each group (F = 41.97, p < 0.001). The frequency of feces (times/week (t/w)) in the intervention group was notably higher compared to the control group post-intervention (3.69 ± 2.62 t/w versus 3.18 ± 1.43 t/w for the first week, 4.03 ± 2.54 t/w versus 2.89 ± 1.39 t/w for the second week, 3.74 ± 2.36 t/w versus. 2.94 ± 1.18 t/w for the third week, and 3.45 ± 1.98 versus 3.17 ± 1.41 t/w for the fourth week) (F = 7.60, p = 0.0067). The dominant species shifted to Bifidobacterium breve, Bifidobacterium longum, and Escherichia coli in the group that received the intervention. The genes associated with short-chain fatty acid metabolism were upregulated, while methane metabolism was downregulated.
The above study demonstrated that giving children XLTG11 at a daily dose of 1 × 1010 CFU resulted in more frequent bowel movements, brought about positive changes in gut microbiota, and effectively controlled SCFs genes and genes associated with methane metabolism.
 

Recent research demonstrated that the CHIldren with acute COugh (CHICO) intervention is a valuable tool for clinicians to make decisions about antibiotic prescriptions and engage with caregivers about their worries and treatment options. Adjusting the intervention might be necessary to create a better fit with how clinicians manage their consultations, both in traditional settings and through remote means. The data from this study were presented in The British Journal of General Practice.
Interviews were conducted to assess the acceptability and utilization of the CHICO intervention. Various healthcare providers from clinics with different antibiotic dispensing patterns, including those with high and low rates, were recruited for the study. The data collection and thematic analysis were based on normalization process theory.
Clinicians generally found the intervention to be beneficial because it was straightforward and quick to implement, allowing them to address carer concerns while reassuring both themselves and the carers about the treatment decisions being made. However, it was mainly used as a supportive tool for treatment choices rather than a method for changing behavior. The advice leaflet that came with it was useful for explaining treatment decisions and encouraging self-care. There were instances where the intervention did not align with the clinicians' standard procedures, which could hinder its application. As familiarity with the algorithm grew, the reliance on interventions decreased, a trend that increased during the COVID-19 pandemic when practices changed and remote consultations became more common.
In summary, the CHICO intervention serves as a valuable resource for healthcare professionals. It helps clinicians make informed decisions about antibiotic prescriptions and encourages discussions with caregivers regarding their concerns and available treatment options.