Lactulose Dosing for a 12-Month-Old Child
For a 12-month-old child, the recommended dose of lactulose is 2.5-10 mL per day in divided doses, which corresponds to approximately 1.7-6.7 grams of lactulose daily.
Pediatric Dosing Guidelines
- The FDA-approved initial daily oral dose of lactulose for infants is 2.5 mL to 10 mL in divided doses 1
- For older children and adolescents, the total daily dose increases to 40-90 mL 1
- Dosing should be adjusted based on clinical response with the goal of achieving 2-3 soft bowel movements per day 2
- If the initial dose causes diarrhea, the dose should be reduced immediately 1
- If diarrhea persists despite dose reduction, lactulose should be discontinued 1
Calculation of Grams from Volume
- Standard lactulose solution contains approximately 667 mg of lactulose per mL 2
- Therefore, 2.5-10 mL corresponds to approximately 1.7-6.7 grams of lactulose
- This is significantly lower than adult dosing, which typically ranges from 20-30 grams (30-45 mL) per day 2, 3
Administration Considerations
- Lactulose can be administered with water, milk, fruit juice or other beverages to improve palatability 2
- Treatment should be continued for a sufficient duration to establish regular bowel patterns 4
- The dose should be titrated to produce 2-3 soft stools daily 1
Monitoring and Adjustments
- Monitor for excessive bowel movements which may indicate need for dose reduction 2
- Watch for signs of dehydration, which can occur with excessive lactulose use 5
- Bloating and flatulence are common dose-dependent side effects that may limit use 2
Alternative Options
- For infants over 6 months of age, polyethylene glycol (PEG) is an authorized and effective alternative 4
- Studies show PEG may decrease total colonic transit time more effectively than lactulose (47.6±2.7 vs 55.3±2.4 hours) 6
- Lactitol can be used as an alternative at a dose of 250-400 mg/kg/day, which is almost half the dose of lactulose (500-750 mg/kg/day) for pediatric patients 7
- Lactitol has shown fewer side effects such as abdominal pain and flatulence compared to lactulose in pediatric studies 7
Important Cautions
- Overuse of lactulose can lead to complications including dehydration, hypernatremia, and severe perianal skin irritation 5
- Low doses (below laxative threshold) may have prebiotic effects that can benefit gut health 8
- Always start with the lower end of the dosing range and titrate up as needed based on clinical response 1