Discharge Instructions for Pediatric Constipation
Medication Management
Start polyethylene glycol (PEG/MiraLAX) as the first-line treatment, as it is the most effective medication for functional constipation in children. 1, 2
- Dosing for PEG: Mix 17 grams (one capful or packet) in 4-8 ounces of any beverage (cold, hot, or room temperature) once daily 3
- Ensure the powder is fully dissolved before drinking—do not drink if clumps remain 3
- For children under 17 years, consult your pediatrician for specific dosing adjustments 3
- Continue treatment as directed by your doctor; improvement may take several days 2
Avoid stool softeners like docusate, as they are less effective than PEG and provide no additional benefit. 1, 2
Dietary Modifications
Increase dietary fiber gradually to age + 5 grams per day (for example, a 5-year-old needs 10 grams daily). 2, 4
- Focus on fruits, vegetables, and whole grains 2
- Critical: Only increase fiber if your child is drinking adequate fluids—fiber without fluids can worsen constipation 2
Ensure fluid intake of at least 1.5 liters per day (adjusted for your child's size). 2
- Vary beverage temperatures and flavors to encourage drinking 2
- Adequate hydration is essential but insufficient alone to treat established constipation 1
Avoid foods high in simple sugars and fats, as these can worsen constipation. 5
Behavioral and Lifestyle Measures
Encourage regular physical activity as a supportive measure, though exercise alone will not resolve constipation. 1
Establish a regular toileting routine:
- Have your child sit on the toilet for 5-10 minutes after meals, when the gastrocolic reflex is strongest 6
- Never force or punish your child for toileting difficulties 6
Treatment Goals and Monitoring
The goal is one non-forced bowel movement every 1-2 days with soft, comfortable stools. 2
Monitor for signs of fecal impaction:
- Large, hard stools that are difficult to pass 2
- Stool leakage or soiling (overflow incontinence) 6
- Severe abdominal pain or distension 6
When to Call Your Doctor
Contact your pediatrician immediately if your child develops:
- Persistent vomiting 5
- Severe abdominal pain 6
- Blood in the stool 6
- Fever 6
- Decreased urine output or signs of dehydration 5
- No improvement after 1-2 weeks of treatment 2
Important Education Points
Understand that constipation is a medical condition, not a behavioral problem:
- Hard stools cause pain, leading to stool withholding, which creates a cycle of worsening constipation 1
- Treatment often requires months of medication, not just days or weeks 6
- 40-50% of children experience at least one relapse within 5 years, so ongoing monitoring is essential 6
Do not stop medications abruptly once stools normalize:
- Maintenance therapy prevents recurrence 6
- Your doctor will guide you on when and how to gradually reduce medications 2
Follow-Up Care
Schedule a follow-up appointment in 2-4 weeks to reassess treatment effectiveness. 2