What is the best medication for an 11-year-old with constipation?

Best Medication for Constipation in an 11-Year-Old Child

Polyethylene glycol (PEG) is the recommended first-line medication for treating constipation in an 11-year-old child due to its superior efficacy, safety profile, and strong evidence base. 1

First-Line Treatment Options

Polyethylene Glycol (PEG)

• PEG is strongly recommended as the first-line treatment for chronic idiopathic constipation with moderate certainty of evidence 1
• For children, PEG 3350 has been shown to be safe and effective at a maintenance dose of approximately 0.6-0.8 g/kg/day 2, 3
• PEG works by sequestering fluid in the bowel, creating an osmotic effect that softens stool and increases bowel movement frequency 1
• Side effects are generally mild and include abdominal distension, loose stool, flatulence, and nausea 1

Fiber Supplements

• Psyllium can be considered for mild constipation before PEG use or in combination with PEG 1
• For children 6-11 years old, the recommended dosage is 1/2 packet in 8 oz of liquid, up to 3 times daily 4
• New users should start with 1 dose per day and gradually increase to 3 doses per day as necessary 4
• Minor bloating may occur as the body adjusts to increased fiber intake 4

Treatment Algorithm

1. Initial Approach:

   • Start with PEG 3350 at 0.6-0.8 g/kg/day 2, 3
   • Ensure adequate fluid intake with medication (8-10 ounces of fluid with each dose) 1

2. If Inadequate Response:

   • Consider increasing PEG dose while monitoring for side effects 1
   • Add fiber supplement (psyllium) if not already included 1, 4

3. For Persistent Constipation:

   • Consider osmotic laxatives like lactulose as an alternative 5
   • For pediatric patients, the recommended initial daily oral dose varies by age, with older children and adolescents typically receiving 40-90 mL total daily dose 5

Comparative Efficacy

• Studies directly comparing PEG 3350 with lactulose found that PEG provided a significantly higher success rate (56% vs 29%) with fewer side effects 6
• PEG was associated with less abdominal pain, straining, and pain during defecation compared to lactulose, though taste was reported as less pleasant 6
• One study showed PEG 3350 had a higher treatment success rate (95.3%) compared to liquid paraffin (87.2%) with fewer adverse events 7

Important Considerations

• Ensure the child is adequately hydrated, as constipated patients in the lowest quartile of fluid intake are more likely to remain constipated 1
• PEG has demonstrated durability of response over 6 months 1
• A 1-day PEG 3350 bowel preparation regimen has been shown to be safe and effective in children (93% success rate), which may be useful for more severe cases requiring rapid intervention 8
• For children with functional constipation, treatment with PEG has been shown to improve not only bowel movements but also associated symptoms like encopresis 6

Pitfalls to Avoid

• Avoid stimulant laxatives as first-line therapy in children, as they can cause abdominal cramping and, with excessive use, may lead to electrolyte disturbances 1
• Do not use bulk-forming agents without adequate fluid intake, as this may worsen constipation 1
• Recognize that treatment may need to be continued for several months to establish regular bowel habits 1
• Avoid sudden discontinuation of medication once improvement occurs, as this often leads to relapse 1

By following this evidence-based approach, constipation in an 11-year-old can be effectively managed with PEG 3350 as the first-line treatment, with consideration of fiber supplements as adjunctive therapy when appropriate.