How to manage constipation in a child?

From the Guidelines

To manage constipation in a child, start by increasing dietary fiber through fruits, vegetables, and whole grains while ensuring adequate fluid intake (about 1-2 liters daily depending on age). This approach is supported by the most recent and highest quality study available, which emphasizes the importance of a balanced diet in maintaining healthy bowel habits 1.

Key Recommendations

• Encourage regular physical activity and establish a consistent bathroom routine, having the child sit on the toilet for 5-10 minutes after meals.
• For mild constipation, prune or pear juice can help (2-4 ounces for younger children), as suggested by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1.
• If dietary changes aren't effective, over-the-counter medications like polyethylene glycol 3350 (MiraLAX) can be used at a dose of 0.5-1.5 g/kg/day mixed in beverages.
• For impacted stool, a disimpaction regimen may be needed using higher doses of MiraLAX (1-1.5 g/kg/day) for 3-6 days or glycerin suppositories for younger children.
• Maintenance therapy should continue for at least 2-3 months after regular bowel movements are established, with gradual weaning.

Important Considerations

• Constipation occurs when stool moves too slowly through the colon, allowing excess water absorption and resulting in hard, difficult-to-pass stools.
• Seek medical attention if constipation is accompanied by fever, weight loss, blood in stool, or if it persists despite treatment. The study from Pediatrics 1 provides valuable insights into the management of constipation in children, highlighting the role of dietary fiber, fluid intake, and physical activity in preventing and treating constipation. While another study from The Journal of Urology 1 focuses on the evaluation and treatment of monosymptomatic enuresis, it also underscores the importance of addressing bowel habits in the context of urinary issues, further supporting the need for a comprehensive approach to managing constipation in children.

From the FDA Drug Label

children 16 years of age or under: ask a doctor Children under 6 years Ask a doctor Children 6 to under 12 years 1/2 suppository once daily

To manage constipation in a child, consult a doctor for guidance on the appropriate treatment, as the provided drug labels do not offer explicit instructions for managing constipation in children without consulting a doctor.

• For children under 6 years, ask a doctor before administering bisacodyl 2.
• For children 6 to under 12 years, bisacodyl can be administered at a dose of 1/2 suppository once daily 2.
• For children 16 years of age or under, ask a doctor before administering polyethylene glycol (PO) 3. Do not use senna or other laxative products for longer than one week unless directed by a doctor 4.

From the Research

Managing Constipation in Children

To manage constipation in children, several strategies can be employed, including:

• Dietary changes: Increasing the intake of dietary fiber and whole grains can help relieve constipation in children, as suggested by 5.
• Laxative therapy: Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are effective and safe for both long and short term treatment of pediatric functional constipation, according to 6.
• Stimulant laxatives: Senna is a stimulant laxative that can be used to treat constipation in children, particularly those with anorectal malformations, as shown in 7.
• Behavioral modifications: Educating families about the nature of functional constipation and encouraging behavioral changes, such as proper toilet training and bowel habits, can help manage constipation in children, as recommended by 8.
• Stool softeners: Using stool softeners can help make it easier for children to pass stools and relieve constipation.

Treatment Options

The choice of treatment for constipation in children depends on the underlying cause and severity of the condition. Some treatment options include:

• Polyethylene glycol 3350 (PEG 3350): An osmotic laxative that can be used to treat functional constipation in children, as suggested by 6.
• Senna: A stimulant laxative that can be used to treat constipation in children with anorectal malformations, as shown in 7.
• Lactulose: An osmotic laxative that can be used to treat functional constipation in children, as recommended by 6.
• Probiotics: May be used as an adjunct therapy to help manage constipation in children, as mentioned in 6.

Prevention

Preventing constipation in children can be achieved by:

• Encouraging a balanced diet that includes plenty of fiber and whole grains, as suggested by 5.
• Ensuring adequate fluid intake, as recommended by 8.
• Establishing good bowel habits, such as regular toilet training and bowel movements, as recommended by 8.
• Avoiding excessive dietary dairy or carbohydrates, as mentioned in 8.