From the Guidelines
For constipated children, start Polyethylene Glycol (PEG) at a dose of 1-1.5 g/kg/day (maximum 17g daily) for 3-7 days, followed by a maintenance dose of 0.4-0.8 g/kg/day for at least 2 months, and then taper the dose by 25% every 2-4 weeks while monitoring for recurrence of constipation. This approach is based on the most recent and highest quality study available, which demonstrated the efficacy of PEG in increasing complete spontaneous bowel movements (CSBMs) and spontaneous bowel movements (SBMs) in individuals with chronic idiopathic constipation 1. The study also showed that PEG is well-tolerated with minimal side effects, making it suitable for longer-term use in children.
Key Considerations
- The initial higher dose of 1-1.5 g/kg/day helps clear impacted stool, while the maintenance dose of 0.4-0.8 g/kg/day establishes regular bowel habits.
- Gradual tapering of the dose by 25% every 2-4 weeks is recommended to prevent recurrence of constipation.
- Throughout treatment, it is essential to encourage increased fluid intake, dietary fiber, regular toileting habits, and physical activity to support healthy bowel habits.
- PEG works by drawing water into the intestines, softening stool and making it easier to pass, with minimal side effects such as bloating, flatulence, and diarrhea 1.
Monitoring and Adjustments
- Regular monitoring of bowel movements and stool consistency is crucial to adjust the dose and prevent recurrence of constipation.
- If constipation returns during the weaning process, it is recommended to return to the previous effective dose and try weaning more slowly later.
- The use of PEG is supported by the American Gastroenterological Association and the American College of Gastroenterology, which recommends its use in the management of chronic idiopathic constipation 1.
From the Research
Proper Dosing of Polyethylene Glycol (PEG) for Constipated Children
- The recommended initial dose of PEG for constipated children is 0.4 g/kg per day 2 or 1 g/kg body weight/d, which can be adjusted to yield 1 to 2 soft painless stools/d 3.
- The mean effective dose of PEG has been reported to be 0.84 g/kg/d (range, 0.27-1.42 g/kg/d) 4, 0.8 g/kg body weight/d 3, and 0.7 g/kg/day 5.
- PEG can be administered daily, with adjustments made every 3 days as required to achieve 2 soft stools per day 4.
Tapering of Polyethylene Glycol (PEG)
- There is no specific information available on tapering PEG in constipated children.
- However, studies have shown that long-term PEG therapy is effective for the treatment of chronic constipation with and without encopresis in children, with an average effective long-term dose of 0.7 g/kg/day 5.
- It is recommended to monitor serum electrolytes in patients predisposed to water and electrolyte imbalances during PEG therapy 6.