From the Guidelines
For constipation in toddlers, the most effective treatment option is to start with dietary changes, including increasing fiber intake through fruits, vegetables, and whole grains, and ensuring adequate water consumption, as recommended by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1.
Treatment Options
The following treatment options can be considered:
- Increasing fiber intake through fruits, vegetables, and whole grains
- Ensuring adequate water consumption
- Using prune, pear, or apple juice to help increase the frequency and water content of stools, as the malabsorption of carbohydrate in these juices can help treat constipation 1
- Over-the-counter options, such as polyethylene glycol (Miralax) at a dose of 1-1.5 teaspoons daily mixed in 4-8 ounces of liquid, or occasional use of glycerin suppositories
- Establishing a regular toileting routine, having the child sit on the toilet for 5-10 minutes after meals when the gastrocolic reflex is strongest ### Important Considerations
- Constipation often occurs during toilet training or dietary transitions, as toddlers' developing digestive systems are sensitive to changes
- Seek medical attention if constipation persists beyond two weeks, is accompanied by fever, vomiting, blood in stool, or if the child shows signs of significant discomfort
- Consistency with treatment is key, as resolving constipation may take weeks to establish healthy bowel patterns ### Additional Recommendations
- Encourage regular physical activity to promote bowel movements
- Consider a one-time clean-out with higher doses of laxatives for severe cases, under the guidance of a pediatrician
- Educate parents on the importance of a balanced diet and healthy bowel habits to prevent constipation in the future 1
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. If the initial dose causes diarrhea, the dose should be reduced immediately. If diarrhea persists, lactulose should be discontinued children 16 years of age or under: ask a doctor The treatment options for constipation in a toddler are:
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 on constipation and its management 4, 5, 6
- Disimpaction using oral laxatives such as polyethylene glycol 3350 (PEG) or phosphate enemas 4, 5, 6
- Maintenance therapy consisting of: + Dietary changes to increase fiber intake 4, 5, 6, 7 + Behavioral modification to establish regular bowel habits 4, 5, 6 + Use of laxatives such as osmotic agents (e.g. PEG, lactulose) or stimulant laxatives (e.g. Senna, Bisacodyl) 4, 5, 6, 8
- Psychological concerns should be evaluated and treated 5
Medication Options
- Polyethylene glycol 3350 (PEG) is a commonly recommended oral laxative for toddlers with constipation 4, 5, 6, 8
- Lactulose is also an effective option, especially for infants under 6 months 5, 8
- Stimulant laxatives like Senna and Bisacodyl can be used as adjunct therapies in specific clinical scenarios 8
- Probiotics, fiber preparations, enemas, and suppositories can also be used as adjunct therapies 8