SOAP Note: Treatment Plan for 10-month-old with Constipation Using Restorolax (Polyethylene Glycol)
Subjective
- 10-month-old child with constipation
- Requires treatment with Restorolax (polyethylene glycol)
Objective
- Age: 10 months
- Presenting with constipation
- No other medical conditions noted
Assessment
- Functional constipation in a 10-month-old child
Plan
Polyethylene glycol (Restorolax) at a starting dose of 0.7-0.8 g/kg/day is safe and effective for treating constipation in this 10-month-old child. 1
Medication
- Initial dose: 0.7-0.8 g/kg/day of polyethylene glycol (calculate exact dose based on child's weight)
- Administration: Mix powder in 4-8 ounces of liquid (water, juice, or milk)
- Timing: Administer once daily
- Duration: Expect results within 1-3 days 2
- Treatment course: Initial 4-week trial with reassessment
Monitoring
- Monitor bowel movement frequency and consistency
- Target: One non-forced bowel movement every 1-2 days 3
- Assess for adverse effects: abdominal pain, bloating, diarrhea
- Follow-up in 2 weeks to assess response
Dose Adjustment
- If inadequate response after 3-4 days: Increase dose by 25%
- If diarrhea occurs: Decrease dose by 25%
- Maximum effective dose typically around 1.2 g/kg/day 1
Supportive Measures
- Ensure adequate fluid intake throughout the day
- Encourage age-appropriate dietary fiber intake
- Maintain regular feeding schedule
- Consider adding probiotic foods appropriate for infant's age
Parent Education
- Explain that polyethylene glycol works by drawing water into the intestines to soften stool
- Emphasize importance of consistent administration
- Reassure that PEG has been shown to be safe in infants under 18 months 1
- Advise that treatment may need to continue for several months to establish regular bowel habits
Follow-up Plan
- Phone check-in after 1 week
- Office visit in 2 weeks to assess response
- Consider longer-term maintenance therapy if initial response is good but symptoms recur when medication is stopped
Cautions
- While PEG is generally well-tolerated in infants, monitor for transient diarrhea which may require dose adjustment 1
- If no improvement after dose optimization or worsening of symptoms, reassess for other causes of constipation
Research shows that polyethylene glycol at a maintenance dose of 0.78 g/kg/day is safe and effective for patients younger than 18 months, with similar dose and safety profiles to those reported in older children 1. The efficacy rate for PEG in treating pediatric constipation is very high (97.6%) 1, making it an excellent first-line choice for this 10-month-old patient.