Shared Decision-Making, Adherence, and Future Directions in Pediatric IBS-C and Functional Constipation

An expert outlines communication and shared decision-making strategies that support adherence and trust, and describes emerging patient-centered outcomes that are reshaping future care paradigms in pediatric functional constipation and IBS-C.

Long-term success in managing pediatric functional constipation and IBS-C depends heavily on the quality of clinician–family communication and the strength of the therapeutic relationship. Julie Khlevner, MD, identifies early, explicit validation of symptoms and family concerns as one of the most effective strategies for enhancing adherence and reducing frustration. She deliberately frames these disorders as chronic but manageable conditions of gut–brain interaction, shifting expectations away from a rapid cure and toward incremental symptom control, relapse prevention, and improved day-to-day functioning in school and social settings.

Shared decision-making is central to Khlevner’s practice. She engages families and adolescent patients in discussions that account for school schedules, extracurricular commitments, and personally meaningful treatment goals, while carefully explaining the role of each therapeutic component, including medications, toileting routines, dietary changes, and behavioral strategies. By preparing families for variable trajectories and the need for sustained routines, she seeks to reduce premature discontinuation of therapies and to maintain engagement even when progress is gradual rather than dramatic.

Looking ahead, Khlevner describes a field that is increasingly focused on phenotype-driven, individualized care and on broader, patient-centered outcome measures. She notes a shift away from narrow stool frequency metrics toward endpoints such as pain reduction, daily functioning, school participation, sleep quality, and overall health-related quality of life. As future clinical trials and routine practice adopt these outcomes, definitions of treatment success in pediatric functional constipation and IBS-C are likely to evolve, with implications for therapy selection, counseling, and multidisciplinary care models across the spectrum of pediatric disorders of gut–brain interaction.