What is the recommended treatment for child constipation?

Treatment for Child Constipation

The recommended first-line treatment for childhood constipation is polyethylene glycol (PEG), which should be used along with increased fluid intake, dietary fiber, and behavioral interventions including establishing a regular toileting routine. 1

Initial Assessment

Before initiating treatment, consider these key factors:

• Frequency and consistency of bowel movements
• Presence of pain during defecation
• History of withholding behavior
• Presence of fecal impaction
• Potential red flags suggesting organic causes (which account for <5% of cases) 2

Treatment Algorithm

Step 1: Education and Behavioral Interventions

• Explain to parents the chronic nature of functional constipation
• Establish regular toileting routine with proper posture (buttocks and feet supported)
• Implement reward systems for successful bowel movements
• Increase water intake
• Add fiber-rich foods (fruits, vegetables, whole grains) 1

Step 2: Disimpaction (if fecal impaction present)

• Oral disimpaction with PEG is preferred over enemas 1
• For severe impaction, consider:
  • Glycerine suppository with or without mineral oil retention enema
  • Manual disimpaction (only if necessary, with appropriate pain management) 3

Step 3: Maintenance Therapy

• First-line medication:

  • For children <1 year: Lactulose 2
  • For children >1 year: PEG with or without electrolytes 1, 2
  • Dosage should be adjusted to achieve 2-3 soft stools daily 1

• Alternative medications:

  • Lactulose
  • Milk of magnesia
  • Mineral oil 1

Step 4: Follow-up and Long-term Management

• Continue maintenance therapy for months to years
• Gradually taper medication once regular bowel habits are established
• Monitor for relapse and adjust treatment accordingly 1

Medication Specifics

Polyethylene Glycol (PEG):

• Dosing: One 17g packet dissolved in 4-8 ounces of beverage once daily
• Ensure powder is fully dissolved before drinking
• Generally produces bowel movement within 1-3 days 4
• Do not use for more than 7 days without medical supervision 4

Important Considerations

• Premature discontinuation of treatment is a common pitfall; maintenance therapy is often required for extended periods 1
• Constipation can contribute to urinary symptoms, including UTIs, daytime wetting, and enuresis 1
• Treatment may need to be maintained for many months before the child regains normal bowel motility and rectal perception 1
• Parental education about the chronic nature of functional constipation is essential 1

When to Refer to a Specialist

• Presence of red flags suggesting organic disease
• Treatment failure despite adherence to recommended regimen
• Persistent symptoms beyond 6 months of appropriate treatment 5
• Consider radionuclide intestinal transit study (scintigraphy) for evaluation of treatment-resistant cases 5

Remember that childhood functional constipation accounts for 90-95% of all cases 5, and with appropriate treatment following this evidence-based approach, most children will achieve significant improvement in their symptoms and quality of life.