Treatment of Constipation in an 18-Month-Old Child
For an 18-month-old child with constipation, the first-line treatment should include increasing fluid intake, dietary modifications, and if needed, polyethylene glycol (PEG) as a safe and effective laxative option.
Initial Assessment and Non-Pharmacological Approaches
• Constipation in children is usually functional (caused by stool retention) rather than organic, but be alert for red flags that might indicate serious underlying conditions 1
• Increase fluid intake as a first step in managing constipation in young children 2
• Increase dietary fiber if the child has adequate fluid intake, as fiber can help improve stool consistency and frequency 2, 3
• Consider fruit juices that contain sorbitol, such as prune, pear, and apple juices, which can help increase stool frequency and water content in infants with constipation 2
• Rule out impaction, which may present with overflow diarrhea around the impacted stool 2
Pharmacological Management
• For infants over 6 months of age (including 18-month-olds), polyethylene glycol (PEG) is authorized, effective, and well-tolerated 4, 5
• PEG works by drawing water into the intestinal lumen, softening stool and increasing bowel movement frequency 1
• For children under 16 years, consult a doctor for proper PEG dosing as indicated on the FDA label 5
• If disimpaction is needed first (in case of severe constipation with hard stool):
- Use a higher initial dose of PEG for the first few days 4, 6
- After disimpaction, continue with maintenance therapy 1
• Alternative options if PEG is unavailable or not tolerated:
- Lactulose can be used in children under 6 months and older 4
- Mineral oil is another option but less commonly prescribed now 4
- Glycerin suppositories may be considered for immediate relief 2
Duration of Treatment and Follow-up
• Treatment should be continued for a sufficient duration, often months, as relapse of functional constipation is common 1, 7
• The goal of treatment is one non-forced bowel movement every 1-2 days 2
• Maintenance medications should be gradually reduced rather than abruptly discontinued once regular bowel habits are established 6
Important Considerations and Cautions
• Avoid antimotility drugs like loperamide in children under 18 years of age with acute diarrhea 2
• If constipation persists despite appropriate treatment, consider referral for further evaluation to rule out organic causes 6
• For children with chronic constipation, education of the family and child about proper toileting habits is instrumental in improving outcomes 1, 7
• Despite appropriate treatment, only 50-70% of children with functional constipation demonstrate long-term improvement, highlighting the importance of consistent management 1