What medication is recommended for treating constipation in an 11-year-old child?

From the Guidelines

For an 11-year-old with constipation, the most effective treatment approach is to start with lifestyle modifications, including increasing water and fiber in the diet, followed by the addition of an osmotic laxative treatment if necessary, as this method has been shown to be effective in managing chronic constipation 1. When considering medication, it's essential to prioritize treatments that are safe and effective for children.

• Increasing water intake helps prevent dehydration and makes stool softer.
• A high-fiber diet that includes fruits, vegetables, and whole grains can help add bulk to stool and make it easier to pass.
• If lifestyle changes are not enough, an osmotic laxative can be considered to help draw water into the intestines and soften stool. Some key points to consider when treating constipation in children include:
• The potential complications of untreated constipation, such as rectal prolapse, hemorrhoids, and intestinal perforation, as highlighted in a study on healthcare supervision for children with Williams syndrome 1.
• The importance of monitoring for abdominal pain, which can be a symptom of various conditions, including constipation, gastroesophageal reflux, and diverticular disease 1.
• Ensuring the child gets regular physical activity, as this can help stimulate bowel movements and improve overall digestive health. It's crucial to consult a healthcare provider if constipation persists, is severe, or is accompanied by other concerning symptoms, as they can provide personalized guidance and ensure the best possible outcome for the child.

From the FDA Drug Label

PURPOSE Osmotic Laxative Purpose Laxative The FDA drug label does not answer the question.

From the Research

Medication Options for Constipation in Children

• Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are considered the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 2.
• Stimulant laxatives, like Senna and Bisacodyl, can be used as adjunct therapies in specific clinical scenarios 2.
• Probiotics, fiber preparations, enemas, and suppositories are also available as adjunct therapies for pediatric constipation 2.
• Senna has been shown to be an effective laxative therapy in children with anorectal malformation and constipation, with a clear benefit compared to polyethylene glycol 3.

Considerations for Treatment

• Children's adherence to medication and parental concern regarding long-term laxative use are the main contributors to treatment failure 4.
• Novel therapies with a high safety profile, such as probiotics, synbiotics, and serotonin 5-hydroxytryptamine 4 receptor agonists, have been developed, but well-designed research is needed to support their use 4.
• Non-pharmacological management, including adequate fiber and fluid intake, physiotherapy, or neuromodulators, can also be effective in treating constipation in children 4.

Treatment Approach

• A comprehensive and person-centred assessment is fundamental to identifying constipation and developing an effective treatment plan 5.
• Nurses can employ pharmacological and non-pharmacological interventions in the management of constipation, including providing advice on lifestyle changes and the use of laxatives 5.
• Treatment should be tailored to the underlying mechanism(s) and needs of each patient, taking into account factors such as age, medical history, and lifestyle 6.