What laxative is recommended for a 1.5-year-old child with constipation?

Laxative for 1.5 Year Child

Direct Recommendation

For a 1.5-year-old child with constipation, polyethylene glycol (PEG/MiraLax) is the first-line laxative of choice, given at age-appropriate dosing of 2.5-10 mL daily in divided doses, adjusted to produce 2-3 soft stools daily. 1

Dosing Specifics for Toddlers

• The FDA-approved dosing for infants and young children is 2.5-10 mL daily in divided doses 1
• Start at the lower end (2.5 mL) and titrate upward based on response 1
• The goal is to produce 2-3 soft stools daily 1
• If diarrhea occurs, reduce the dose immediately and discontinue if diarrhea persists 1

Why PEG is Preferred in Pediatrics

• PEG (macrogol) is not metabolized, maintains normal pH and bowel flora, and hydrates hardened stools without causing significant side effects 2
• PEG increases stool volume, decreases colon transit time, and triggers the defecation reflex naturally 2
• Effectiveness does not decrease with prolonged use, making it suitable for chronic management 2
• PEG is generally well-tolerated even in young children when adequate fluid intake is maintained 2

Alternative Options if PEG Fails

• Lactulose can be used as a second-line agent at 2.5-10 mL daily in divided doses for infants 1
• However, lactulose commonly causes flatulence, bloating, and abdominal cramping, making it less desirable than PEG 2
• Lactulose produces clinically significant increases in stool frequency, weight, volume, and water content 3

Critical Considerations for This Age Group

• Ensure adequate fluid intake is maintained, as osmotic laxatives require sufficient hydration to work effectively 2
• Bulk-forming laxatives (like psyllium) are NOT recommended for young children who cannot take in the required fluid volume 2
• Stimulant laxatives (senna, bisacodyl) are generally reserved for older children and are not first-line in toddlers 4, 5

Important Pitfalls to Avoid

• Do not assume dietary fiber alone will resolve constipation in a toddler—many children with constipation worsen with increased fiber 6
• Do not withhold laxative therapy due to unfounded concerns about dependency—there is no evidence of addiction or "rebound constipation" with appropriate laxative use 6
• Do not use stimulant laxatives as first-line in this age group, as they are more appropriate for older children with refractory constipation 4

Duration and Follow-up

• Continue laxative therapy until the child maintains regular, soft bowel movements for at least 6 months 4
• Reassess every 2 weeks initially to ensure adequate response without diarrhea 1
• Long-term maintenance therapy may be necessary—children with functional constipation often require prolonged treatment (median 8 years in some studies) 4