Can laxatives, such as polyethylene glycol (PEG), be used to treat constipation in a 5-year-old child?

Polyethylene Glycol (PEG) for Constipation in 5-Year-Old Children

Yes, polyethylene glycol (PEG) can be safely and effectively used to treat constipation in a 5-year-old child. 1

Safety and Efficacy of PEG in Children

• PEG is a recommended treatment option for constipation in children, including those who are 5 years old 1
• The Israeli Society of Pediatric Gastroenterology and Nutrition supports the use of PEG in children over 12 months of age, making it appropriate for a 5-year-old 1
• PEG has been shown to be better tolerated with similar or superior cleansing effectiveness compared to other laxatives in pediatric populations 1
• Compared to other laxatives, PEG achieves more treatment success in children with constipation (pooled relative risk: 1.47; 95% CI 1.23 to 1.76) 2

Dosing Recommendations

• For children with constipation, PEG-3350 can be administered at a dose of 1.5 g/kg/day 1
• Both 4-day regimens and 1-day preparations of PEG have been shown to be effective in children, though controlled trials specifically for the 1-day regimen are limited 1
• The mean effective maintenance dose in studies of young children was approximately 0.78 g/kg/day 3
• PEG can be given with 8 oz of water twice daily for maintenance therapy of constipation 1

Advantages of PEG for Pediatric Use

• PEG has no taste, making it more acceptable to children who may refuse other medications 4
• PEG does not show loss of efficacy over time, making it suitable for long-term management 4
• PEG is associated with fewer clinically significant side effects compared to other laxatives 4
• Unlike sodium phosphate preparations, which should be avoided in children under 12 years, PEG has a better safety profile for young children 1

Important Considerations When Using PEG

• Ensure adequate fluid intake when administering PEG to children 1
• For optimal results, PEG should be used as part of a comprehensive approach that includes:
  • Regular toileting habits 1
  • Proper toilet posture with buttock support, foot support, and comfortable hip abduction 1
  • Management of any underlying factors contributing to constipation 1
• PEG may cause transient diarrhea in some children, which typically resolves with dose adjustment 3

When to Consider Alternative Treatments

• If constipation persists despite PEG therapy, consider:
  • Evaluating for impaction or obstruction 1
  • Adding stimulant laxatives such as bisacodyl or senna 1
  • Assessing for other causes of constipation such as hypothyroidism or hypercalcemia 1
• For severe cases not responding to oral therapy, enemas may be considered, though these should be used sparingly in children 1

PEG represents a first-line pharmacological option for treating constipation in a 5-year-old child due to its proven efficacy, safety profile, and palatability compared to other available laxatives 1, 2.