Treatment for 5-Year-Old with Constipation
Polyethylene glycol (PEG) is the recommended first-line treatment for a 5-year-old child with constipation, administered at 17 grams dissolved in 4-8 ounces of beverage once daily. 1, 2
Initial Assessment
Before initiating treatment, evaluate for warning signs suggesting organic causes:
- Delayed passage of meconium (>48 hours after birth)
- Failure to thrive
- Abdominal distension
- Abnormal anal position
- Absence of anal or cremasteric reflex 1
In the absence of these red flags and with a normal physical examination, functional constipation can be diagnosed and treatment initiated immediately. 3
Treatment Algorithm
First-Line Pharmacologic Therapy
PEG should be started as the primary medication because it is safe, effective, and well-tolerated for long-term use in children. 1, 4, 5
- Dosing for children 17 years and under: Requires physician guidance, but typical dosing is 17 grams once daily dissolved in any beverage 2
- Ensure powder is fully dissolved before drinking 2
- Can be used for up to 7 days without physician consultation in older children, but longer-term use is often necessary and appropriate under medical supervision 2
Alternative Osmotic Laxatives
If PEG is unavailable or not tolerated, other osmotic agents can be used:
- Lactulose: 40-90 mL total daily dose for older children and adolescents, divided into multiple doses 6
- Magnesium hydroxide 5
Important caveat: Lactulose may cause hyponatremia and dehydration in young children, requiring close monitoring. 6
Adjunctive Dietary and Behavioral Measures
While medications are the cornerstone of treatment, these supportive measures should be implemented concurrently:
- Increase fluid intake 7
- Increase dietary fiber only if the child has adequate fluid intake and physical activity 7
- Encourage regular toileting habits with behavioral modification 4, 5
- Continue age-appropriate diet without unnecessary restrictions 4
When to Add Stimulant Laxatives
If osmotic laxatives alone are insufficient after adequate trial, add bisacodyl 10-15 mg daily with a goal of one non-forced bowel movement every 1-2 days. 7, 3
Disimpaction if Needed
If fecal impaction is present (check for overflow diarrhea suggesting impaction):
- Glycerin suppository can be used 7
- Mineral oil retention enema may be necessary 7
- Manual disimpaction with pre-medication (analgesic ± anxiolytic) for severe cases 7
Duration and Follow-Up
- Treatment typically requires months to years, not days or weeks 3, 5
- 40-50% of children experience at least one relapse within 5 years, so long-term maintenance is often necessary 3
- Regular reassessment of bowel habits is essential to monitor treatment effectiveness 1
- The goal is to produce soft, painless stools and prevent reaccumulation of feces 4
When to Refer
Refer to pediatric gastroenterology if:
- Symptoms are refractory to conventional treatment 4, 5
- Suspicion of organic pathology based on red flag symptoms 4
- Constipation becomes intractable despite appropriate medical management 5
Critical pitfall to avoid: Do not delay treatment waiting for spontaneous resolution. Functional constipation creates a vicious cycle of painful defecation leading to stool withholding, which worsens the problem. 8 Early, aggressive treatment prevents this escalation and improves long-term outcomes.