Treatment of Functional Constipation in a 3-Year-Old Child

Adding polyethylene glycol (MiraLAX) is the most effective next step in correcting functional constipation in this 3-year-old child. 1, 2

Clinical Assessment

The child presents with classic symptoms of functional constipation: crying before bowel movements, resistance to toilet training, and infrequent large stools (every 3 days) 2
The condition began approximately one year ago, indicating a chronic pattern that requires effective intervention 2
Physical examination shows a healthy child with normal abdominal and rectal findings, supporting a functional rather than organic cause 3

Polyethylene glycol is the first-line pharmacological treatment for pediatric functional constipation 2, 4
PEG works as an osmotic laxative that draws water into the intestinal lumen, softening stool and making bowel movements less painful 3
PEG has demonstrated superior efficacy compared to other interventions for childhood constipation 2, 3
The typical dosage is approximately 0.6-0.7 g/kg daily, which can be adjusted based on clinical response 3
PEG is tasteless and can be mixed with any beverage, improving compliance in young children 3

While increased fluid intake is recommended as part of comprehensive management, it alone is insufficient to treat established functional constipation 1
Fluid intake should be considered an adjunctive measure alongside PEG rather than primary therapy 1

Exercise is appropriate as a supportive measure but has limited evidence as a primary intervention for established constipation 1
Physical activity alone would not address the child's fear of painful defecation 2

Stool softeners like docusate have been shown to be less effective than osmotic laxatives like PEG 1
Studies have demonstrated that adding docusate to stimulant laxatives provides no additional benefit over stimulant laxatives alone 1

While probiotics (Bifidobacterium or Lactobacillus) may have some benefit, current evidence does not support them as first-line therapy for functional constipation 2
Probiotics may be considered as adjunctive therapy after initiating PEG 2

Disimpaction may be necessary if there is significant fecal loading, though this doesn't appear to be the case with this patient 5
Education for parents about normal bowel function and the pathophysiology of constipation 1
Behavioral modification to establish regular toileting habits and overcome toilet resistance 5
Regular follow-up to monitor response to treatment and adjust therapy as needed 5

PEG typically produces a bowel movement within 1-3 days of starting treatment 6
Studies show significant improvement in voiding symptoms, with increased voided volumes and decreased post-void residuals 3
Resolution of constipation correlates with improved toilet training success 3

PEG should be fully dissolved in 4-8 ounces of liquid before administration 6
Treatment may need to be continued for several months to establish regular bowel habits and overcome the child's fear of defecation 5
If constipation persists despite adequate PEG dosing, reassessment for other causes or referral to a pediatric gastroenterologist may be warranted 5