What is the best treatment for toddler constipation?

From the Guidelines

The best treatment for toddler constipation typically involves dietary changes, increased fluid intake, and sometimes gentle medication, with a focus on establishing regular bowel habits and softening stool to make it easier to pass. To start, increase your child's fiber intake through fruits (like pears, prunes, and apples), vegetables, and whole grains, while ensuring they drink plenty of water throughout the day 1. Regular physical activity can also help stimulate bowel movements. For immediate relief, over-the-counter options like Miralax (polyethylene glycol 3350) can be effective and safe for children, as supported by grade Ia evidence 1, typically 1/2 to 1 capful daily mixed in 4-8 ounces of liquid, but consult your pediatrician for proper dosing based on your child's age and weight.

Some key points to consider:

• Increase fiber intake through fruits, vegetables, and whole grains
• Ensure adequate fluid intake throughout the day
• Regular physical activity can help stimulate bowel movements
• Consider over-the-counter options like Miralax for immediate relief
• Avoid excessive consumption of constipating foods like bananas, rice, applesauce, and dairy products

It's also important to note that some fruits, such as prunes, pear, and apple juices, contain sorbitol and other carbohydrates that can help increase the frequency and water content of stools for infants with constipation, as suggested by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1. However, it's crucial to consume these in appropriate amounts to avoid exacerbating the condition. If constipation persists despite these measures, or if your child experiences severe pain, blood in stool, or vomiting, consult a healthcare provider promptly as these may indicate a more serious condition requiring medical attention.

From the FDA Drug Label

Pediatric: Very little information on the use of lactulose in young children and adolescents has been recorded. As with adults, the subjective goal in proper treatment is to produce 2 or 3 soft stools daily. On the basis of information available, the recommended initial daily oral dose in infants is 2. 5 mL to 10 mL in divided doses. For older children and adolescents the total daily dose is 40 mL to 90 mL. USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days

The best treatment for toddler constipation is to produce 2 or 3 soft stools daily.

• For infants, the recommended initial daily oral dose of lactulose is 2.5 mL to 10 mL in divided doses 2.
• For older children and adolescents, the total daily dose of lactulose is 40 mL to 90 mL 2.
• Polyethylene glycol can relieve occasional constipation and generally produces a bowel movement in 1 to 3 days 3. Key points to consider when treating toddler constipation:
• The goal is to produce 2 or 3 soft stools daily
• Lactulose and polyethylene glycol are options for treatment
• Dosage and administration should be based on the child's age and weight, and should be adjusted as needed to achieve the desired effect.

From the Research

Treatment Options for Toddler Constipation

• 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 4.
• Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories can be used as adjunct therapies in specific clinical scenarios 4.
• Polyethylene glycol 3350 without electrolytes is a safe and effective long-term treatment option for childhood constipation, although there are limited studies for its use in children younger than 2 years of age 5.

Comparison of Laxative Therapies

• A study comparing Senna and polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation found that Senna was more effective in achieving daily bowel movement, reducing fecal soiling, and resulting in a "clean" abdominal x-ray 6.
• The study suggested that therapy with Senna should be the laxative treatment of choice as part of a bowel management program in children with repaired anorectal malformations and constipation 6.

Role of Fiber in Treatment

• Fiber supplementation, such as glucomannan, has been shown to be beneficial in the treatment of childhood constipation, with significant improvements in bowel movement frequency and reduction in abdominal pain 7.
• A review of the literature on dietary treatments for childhood constipation found that increasing the intake of dietary fiber and/or whole grain has the potential to relieve childhood constipation, although more randomized controlled trials are necessary to make a formal recommendation 8.