What treatment can I give a 2-year-old with constipation?

Treatment for Constipation in a 2-Year-Old Child

Polyethylene glycol (PEG) is the first-line treatment for constipation in a 2-year-old, starting at a dose of approximately 0.8 g/kg/day. 1, 2

Initial Non-Pharmacological Approaches

• Increase dietary fiber through age-appropriate foods to help establish regular bowel movements 3
• Encourage adequate fluid intake throughout the day to soften stool and facilitate passage 4
• Promote physical activity appropriate for a 2-year-old to stimulate bowel motility 3
• Establish regular toileting routines, particularly after meals when the gastrocolic reflex is strongest 3

First-Line Pharmacological Treatment

• Polyethylene glycol (PEG) without electrolytes:
  • Start with approximately 0.8 g/kg/day (typically 1 capful mixed in 8 oz of water) 1, 2
  • Adjust dose to achieve 1-2 soft, painless stools per day 1
  • PEG has been shown to be effective in 97.6% of infants and toddlers with constipation 2
  • PEG has fewer side effects than other laxatives and is well-tolerated in children under 2 years 1, 2

Alternative Treatments

• Lactulose:
  • Can be used if PEG is unavailable or not tolerated 4, 5
  • However, PEG has demonstrated higher success rates (56%) compared to lactulose (29%) 5
  • Lactulose may cause more abdominal pain, straining, and pain during defecation than PEG 5
  • Pediatric dosing should be adjusted based on response 6

Monitoring and Follow-up

• Assess response to treatment by tracking:
  • Stool frequency (goal: at least 3 bowel movements per week) 3
  • Stool consistency (aim for soft, painless stools) 1
  • Presence of discomfort during defecation 5
• Rule out fecal impaction before starting treatment, especially if diarrhea accompanies constipation (which can indicate overflow around impaction) 4

Precautions and Side Effects

• With PEG, transient diarrhea may occur but typically resolves with dose adjustment 1, 2
• With lactulose, monitor for excessive gas, bloating, or abdominal discomfort 6
• For infants receiving lactulose, be aware of potential for hyponatremia and dehydration 6

When to Escalate Treatment

• If no improvement after 1-2 weeks of appropriate dosing of first-line therapy 4
• If signs of impaction develop or persist despite treatment 4
• If there are concerning features suggesting an underlying medical condition 4

PEG has consistently demonstrated superior efficacy and tolerability compared to other laxatives in young children, making it the optimal first choice for treating constipation in a 2-year-old 1, 2, 5.