What is the best approach to treat constipation in a 13-year-old?

Treatment of Constipation in a 13-Year-Old

Polyethylene glycol (PEG) is the recommended first-line pharmacological treatment for constipation in a 13-year-old, with a dosage of 17g daily mixed in 4-8 ounces of liquid. 1, 2

Initial Management Approach

Lifestyle Modifications

• Increase fluid intake: Ensure at least 8 glasses of water daily, particularly important when using fiber supplements 1
• Dietary fiber: Gradually increase to 20-25g per day 1
• Regular toilet routine: Establish a regular schedule for defecation with adequate time and proper positioning (using a footstool to elevate knees above hips) 1

First-Line Medication

• Polyethylene glycol (PEG): 17g once daily dissolved in 4-8 ounces of liquid 1, 2
  • Ensure powder is fully dissolved before drinking
  • Can be used for up to 7 days initially; longer-term use should be discussed with physician
  • Side effects may include abdominal distension, loose stool, flatulence, and nausea 3

Second-Line Options

Fiber Supplementation

• Psyllium: For adolescents 12 years and older, 1 packet in 8 oz of liquid up to 3 times daily 4
  • Start with 1 dose per day and gradually increase as needed
  • Mix thoroughly with at least 8 ounces of water or other fluid
  • Most effective for mild constipation 3, 1
  • May cause initial bloating as body adjusts to increased fiber intake 4

Other Laxative Options

• Osmotic laxatives:
  • Lactulose: For adolescents, 40-90 mL total daily dose divided throughout the day 5
    • Reduce dose if diarrhea occurs
    • Discontinue if diarrhea persists

Monitoring and Follow-up

• Treatment goal: One non-forced bowel movement every 1-2 days 1
• Follow-up: Assess treatment efficacy within 2-4 weeks 1
• Monitor for:
  • Resolution of symptoms
  • Side effects such as bloating, flatulence, or diarrhea
  • Proper compliance with medication and lifestyle changes

Special Considerations

• Fruit juices: Certain juices (prune, pear, and apple) contain sorbitol and other carbohydrates that can help increase stool frequency and water content 3

  • However, juice should not replace whole fruits in the diet
  • Limit juice intake to avoid excess calorie consumption

• Potential pitfalls:

  • Inadequate fluid intake when using fiber supplements can worsen constipation 1
  • Insufficient dietary fiber is common in children with constipation 6
  • Without intensive dietary counseling, families often struggle to implement high-fiber diets 6

If symptoms persist despite appropriate treatment for 2-4 weeks, reevaluation is necessary to rule out underlying conditions that may require specialized testing or referral to a pediatric gastroenterologist.