In children with constipation almost 80 to 90% will be functional constipation. A child with functional constipation will usually have the following clinical features
Age of onset usually 1 to 2 year of age, mostly after introduction of semisolids.
Retentive posturing or withholding maneuver - Standing while straining to pass stools, against wall, cross legged, at times would hide behind doors or under a cot, with flushing of face - All these are attempts to retain stools but are perceived by parents the other way round
There can be retentive fecal incontinence- Means small amount of fecal matter staining undergarments in presence of impacted rectum. Incontinence is clinically significant if developmental age more than 4 years age and frequency is 2 or more per week.
Absence of red flags for any organic cause after detailed clinical evaluation