From the Guidelines
For treating constipation in toddlers, the most effective approach is to start with dietary changes, including the use of certain fruit juices like prune, pear, and apple juices, as they contain sorbitol and other carbohydrates that can help increase the frequency and water content of stools, as suggested by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1.
Dietary Changes
Dietary modifications are crucial in managing constipation in toddlers. Increasing fiber intake through whole fruits (especially prunes, pears, and apples), vegetables, and whole grains, along with ensuring adequate fluid intake, can help soften stools and make them easier to pass. The rationale behind using fruit juices such as prune, pear, and apple is based on their sorbitol content, which can act as an osmotic laxative, drawing water into the bowel and softening the stool, as explained in the study published in Pediatrics 1.
Over-the-Counter Options
For toddlers who do not respond to dietary changes, over-the-counter options like polyethylene glycol (Miralax) can be considered. Typically, it is given as 1/2 to 1 teaspoon daily mixed in 4-8 ounces of liquid. Glycerin suppositories can also be used occasionally for more immediate relief.
Lifestyle Modifications
Encouraging regular physical activity and establishing a regular toileting routine can also promote bowel movements. Having the child sit on the toilet for 5-10 minutes after meals can help establish a bowel routine.
Immediate Relief
For immediate relief, a small amount of prune or apple juice can be given, as these juices contain sorbitol, which can help soften the stool and make it easier to pass, as noted in the study 1.
When to Consult a Pediatrician
It is essential to consult a pediatrician if symptoms persist beyond two weeks, if there's blood in the stool, if the child experiences severe abdominal pain, or if they're losing weight, as these may indicate a more serious condition requiring medical evaluation.
From the FDA Drug Label
children 16 years of age or under: ask a doctor children 16 years of age or under: ask a doctor
The treatment options for constipation in a toddler are not explicitly stated in the drug label. Consult a doctor for guidance on treating constipation in a toddler, as the label advises to ask a doctor for children 16 years of age or under 2.
From the Research
Treatment Options for Constipation in Toddlers
The treatment options for constipation in toddlers can be categorized into several approaches:
- Explanation and education of the child and parents about constipation and its management 3
- Disimpaction using oral laxatives such as polyethylene glycol 3350 (PEG) or phosphate enemas 3, 4
- Maintenance therapy consisting of dietary changes, behavioral modification, and the use of laxatives to achieve daily painless defecation 3, 5
- Use of osmotic laxatives such as PEG 3350 and lactulose, which are considered safe and effective for both short-term and long-term treatment of pediatric functional constipation 6
Medications and Interventions
Some of the medications and interventions used to treat constipation in toddlers include:
- Polyethylene glycol 3350 (PEG 3350) with electrolyte solutions, which is considered a first-line treatment for children of any age 3, 6
- Lactulose and lactitol-based medications, which are authorized and effective for infants under 6 months 4
- Mineral oil, which is less prescribed due to its potential risks 4
- Probiotics, which may increase stool frequency in children, but require further evidence from larger RCTs 7
- Fiber supplementation, which is recommended as part of a normal diet, but may not provide additional benefits for constipation 7
Additional Considerations
Additional considerations for treating constipation in toddlers include:
- Evaluating and addressing psychological concerns, which can contribute to constipation 4
- Educating parents and children about proper toilet habits and bowel movements to prevent relapses 3, 4
- Considering emerging treatments such as food intolerance, electrical stimulation, and fecal microbiota transplant, which require further research and evidence 7