What medication can be given to a 1-year-old with constipation?

Medication for Constipation in a 1-Year-Old

Polyethylene glycol (PEG) 3350 is the first-line medication for constipation in a 1-year-old child, starting at approximately 0.8 g/kg/day and adjusting based on response. 1, 2

First-Line Treatment: Polyethylene Glycol 3350

PEG 3350 without electrolytes is safe, effective, and well-tolerated for infants and toddlers with functional constipation. 1, 2

Dosing Strategy

• Initial dose: Start at 0.8-1.0 g/kg/day (approximately 1 capful or 17g for a typical 1-year-old) 1, 2
• Effective maintenance dose: Average 0.78-0.8 g/kg/day (range 0.26-1.26 g/kg/day) 1, 2
• Dose adjustment: Titrate every 2-3 days to achieve 1-2 soft, painless stools per day 2, 3
• Administration: Mix powder with any liquid; tasteless and easy to administer 4

Evidence Supporting PEG in This Age Group

• Efficacy rate: 85-97.6% success in relieving constipation in children under 18 months 1, 2
• Safety profile: Minimal adverse effects; transient diarrhea in some patients that resolves with dose adjustment 1, 2
• Duration: Safe for long-term use (mean 6-11 months in studies) 1, 2

Alternative Approach: Juice with High Sorbitol Content

For mild constipation, prune, pear, or apple juice (2-4 oz daily) can be tried initially, leveraging the sorbitol and fructose content to increase stool water content. 5

• The American Academy of Pediatrics acknowledges that sorbitol-containing juices can help increase stool frequency and water content 5
• This approach is most appropriate for mild, recent-onset constipation rather than chronic cases 5
• Limitation: Excessive juice intake can cause toddler's diarrhea and should not exceed recommended amounts 5

What to Avoid

Do not use stimulant laxatives (bisacodyl, senna) as first-line therapy in infants; these are recommended only for short-term or rescue use with unknown long-term safety in this age group. 5

Avoid sodium phosphate preparations in young children due to risk of electrolyte abnormalities and mucosal injury. 5

Do not use magnesium-based laxatives without careful consideration, as they require caution in patients with any renal concerns. 5

Clinical Pearls

• Rule out red flags first: Ensure no signs of Hirschsprung disease (delayed meconium passage, failure to thrive), anatomic abnormalities, or metabolic disorders before starting treatment 2
• Ensure adequate hydration: Maintain fluid intake while using PEG to optimize effectiveness 5
• Expect rapid response: Most children show improvement within 2-4 weeks of starting PEG 2, 3
• Common pitfall: Starting dose too low—don't hesitate to use 1 g/kg/day initially and adjust upward if needed 1, 2
• Parental counseling: Explain that treatment may be needed for several months and that stopping too early often leads to recurrence 2