From the Guidelines
For constipation in a 20-month-old child, I recommend starting with dietary changes and adequate hydration before considering medications, as this approach prioritizes the child's morbidity, mortality, and quality of life by minimizing potential side effects and promoting healthy bowel habits. To manage constipation in a 20-month-old child, the following steps can be taken:
- Increase fiber intake by offering more fruits (like pears, prunes, or apples), vegetables, and whole grains, as suggested by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1.
- Ensure the child drinks plenty of water throughout the day to help soften stool and make it easier to pass.
- If dietary changes don't help within a few days, a small amount of prune or pear juice (2-4 ounces daily) can be tried, as these juices contain sorbitol and other carbohydrates that can help increase the frequency and water content of stools 1.
- For medication, pediatric osmotic laxatives like Miralax (polyethylene glycol 3350) can be used at a dose of 1/2 to 1 teaspoon mixed in 2-4 ounces of liquid once daily, as recommended by the American Gastroenterological Association and the American College of Gastroenterology 1.
- Always consult the child's pediatrician before starting any medication, and avoid stimulant laxatives unless specifically recommended by a doctor.
- Regular physical activity also helps stimulate bowel movements, which is important for maintaining healthy bowel habits and preventing constipation. These approaches prioritize the child's morbidity, mortality, and quality of life by promoting healthy bowel habits, minimizing potential side effects, and avoiding unnecessary medication.
From the FDA Drug Label
children 16 years of age or under: ask a doctor The FDA drug label does not answer the question.
From the Research
Treatment Options for Constipation in Children
The recommended treatment for constipation in a 20-month-old child includes:
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, as the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 2, 3, 4
- Stimulant laxatives, like Senna and Bisacodyl, as adjunct therapies in specific clinical scenarios 2
- Increasing dietary fiber and fluid intake is not recommended as it provides no additional benefits for treating constipation 3
- Behavioral modification and bowel retraining to establish regular daily bowel movement 5, 6
Diagnosis and Referral
Diagnosis of functional constipation can be made in the absence of "red flag" symptoms and a normal physical assessment 3, 6 Referral to a pediatric gastroenterologist is recommended when there is a concern for organic causes or constipation persists despite adequate therapy 3, 4
Management and Follow-up
The goal of treatment is to produce soft, painless stools and to prevent reaccumulation of feces 4 Regular follow-up visits are important to monitor the child's condition and adjust treatment as needed 3, 4, 6 Education and reassurance for caregivers are crucial in managing constipation in children 3, 5