Table 1 ROMA IV criteria for functional constipation

Must include for 1 month at least two of the following in infants up to 4 years of age:

 - Two or fewer defecations per week;

 - History of excessive stool retention; BLUE

 - History of painful or hard bowel movements;

 - History of large diameter stools; BLUE

 - Presence of a large fecal mass in the rectum.

In toilet-trained children, the following additional criteria may be used:

 - At least one episode/week of fecal incontinence after the acquisition of toileting skills;

 - History of large-diameter stools that may obstruct the toilet.BLUE

Must include 2 or more of the following occurring at least once per week for a minimum of 1 month with insufficient criteria for a diagnosis of irritable bowel syndrome in children older than 4 years:

 - 2 or fewer defecations in the toilet per week in a child of a developmental age of at least 4 years BLUE

 - At least 1 episode of fecal incontinence per week

 - History of retentive posturing or excessive volitional stool retention BLUE

 - History of painful or hard bowel movements

 - Presence of a large fecal mass in the rectum BLUE

 - History of large diameter stools that can obstruct the toilet.