Clinical Efficacy of Infantile Massage in the Treatment of Infant Functional Constipation: A Meta-Analysis
Authors: Liu Zhi , Gang Li , Yunwei Ma , Lin Ling 
Published: June 2021

Background:Functional constipation in children is a common disease that causes a psychological burden on infants and young children across the world. It will greatly affect infant quality of life in early childhood and even affect their psychological and physical health. At present, infant functional constipation is treated with western drugs alone, but this can produce drug dependency. In recent years, Traditional Chinese Medicine (TCM) infant massage has been used as a complementary and alternative therapy, and its effectiveness and safety have been proven, attracting the attention of numerous researchers.

Objective:Our study aimed to compare the influence of infant massage intervention on defecation frequency and consistency, determine the effectiveness, and safety of infant massage in the treatment of infant functional constipation, and obtain high-quality clinical evidence.

Methods:Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement, inclusion, and exclusion criteria were formulated. Randomized controlled trials (RCTs) on TCM infant massage for the treatment of infant functional constipation were found following a search of four mainstream medical databases. RCTs found to meet the study's requirement were included; data information was then extracted, and the quality was assessed using the Cochrane bias risk assessment tool. Through RevMan software, a meta-analysis was carried out for overall effective rate, stool form, defecation frequency, defecation difficulty, and constipation symptom scoring index. The relative risk (RR) and 95% confidence interval (95% CI) were calculated, heterogeneity was tested and its source was found, and publication bias was assessed through the Egger's and Begg's tests and by means of funnel plots.

Results:A total of 23 RCTs and 2,005 patients were included. The results of the meta-analysis showed that compared to drug therapy alone, TCM infant massage had a superior effect on the treatment of infant functional constipation. This difference was statistically significant (p&lt; 0.05) and evaluated according to the overall effective rate (RR = 1.25; 95% CI = 1.17, 1.33), defecation frequency [mean difference (MD) = −0.72; 95% CI = −0.80, −0.65], and constipation symptom score (MD = −0.81; 95% CI = −1.20, −0.43), showing that TCM infant massage is indeed superior to drug therapy alone in the treatment of infant functional constipation. TCM infant massage was found to be equivalent to drug therapy alone in terms of the stool form score [−0.30 (−0.38, −0.22)] and the defecation difficulty score [−0.73 (−0.81, −0.65)], since the difference was not statistically significant (p&gt; 0.05). The source of heterogeneity might be related to the state of patient, manipulation of the massages, efficacy of drugs in the control group, and difference in judgment criteria for efficacy. The Egger's test and Begg's test showed that publication bias did not occur in our study.

Conclusion:TCM infant massage can increase defecation frequency and reduce the symptoms of constipation in children suffering from functional constipation; in addition, the clinical trial showed beneficial effects. Since some of the RCTs featured a very small sample size, the reliability and validity of our study's conclusion may have been affected as well; therefore, the explanation should be treated with some caution. In the future, a large number of higher-quality RCTs are still needed to confirm the results of our study.