How to manage constipation in a 7 kg girl?

Management of Constipation in a 7 kg Child

For a 7 kg child with constipation, first-line treatment should include polyethylene glycol (PEG) as the preferred osmotic laxative, with appropriate dosing for the child's weight. 1

Initial Assessment

• Determine if constipation is acute or chronic
• Look for red flags:
  • Blood in stool
  • Failure to thrive
  • Abdominal distension
  • Vomiting
  • Fever
• Perform digital rectal examination to check for impaction
• Consider potential causes:
  • Dietary factors (insufficient fluid/fiber)
  • Medication side effects
  • Metabolic disorders (hypothyroidism, hypercalcemia)
  • Anatomic abnormalities (in rare cases)

Treatment Algorithm

Step 1: If Fecal Impaction Present

• Digital disimpaction may be necessary if stool is palpable in the rectum 1
• Follow with glycerin suppository (pediatric size) to facilitate evacuation 2
  • Appropriate for children 2-6 years; for children under 2, consult physician
  • Insert one suppository well into the rectum

Step 2: Initial Pharmacological Management

• Polyethylene glycol (PEG) is the first-line osmotic laxative 1

  • Starting dose: 0.5-1 g/kg/day (3.5-7 g/day for a 7 kg child)
  • Adjust dose based on response
  • PEG has been shown to be effective and safe with durable response over 6 months 1

• Alternative if PEG is unavailable or not tolerated:

  • Lactulose: 1-2 g/kg/day (7-14 g/day for a 7 kg child) 3
  • May cause bloating and flatulence as side effects 1

Step 3: Maintenance Therapy

• Continue osmotic laxative until regular bowel pattern established
• Gradually increase dietary fiber as tolerated
  • Psyllium is the only fiber supplement with proven efficacy 1
  • Ensure adequate fluid intake with fiber

Step 4: For Persistent Constipation

• Add stimulant laxative as rescue therapy:
  • Bisacodyl (appropriate dose for weight) 1
  • Administer 30 minutes after a meal to enhance effect 1

Dietary and Behavioral Modifications

• Increase fluid intake appropriate for weight
• Encourage regular toilet time after meals (utilizing gastrocolic reflex)
• For older children, implement a reward system for successful bowel movements
• Consider the "BRAT" diet components (bananas, rice, applesauce, toast) as reasonable dietary recommendations 1
• Avoid:
  • Foods high in simple sugars (soft drinks, undiluted apple juice)
  • Foods high in fat that may delay gastric emptying

Important Considerations and Pitfalls

• Avoid bulk laxatives alone in opioid-induced constipation 1
• Do not use antimotility agents or nonspecific antidiarrheal medications as they can worsen constipation 1
• Monitor for side effects of osmotic laxatives:
  • Abdominal distension
  • Flatulence
  • Loose stool
• Avoid magnesium-containing laxatives in children with renal insufficiency 1
• Do not discontinue laxative therapy prematurely; constipation often recurs

Early intervention is critical to prevent complications such as fecal impaction, which can lead to overflow incontinence and psychological distress. Treatment may need to continue for several months to establish regular bowel habits and prevent recurrence.