From the Guidelines
For a 1-year-old with 4 days of constipation presenting to the ER, initial workup and treatment should prioritize disimpaction and maintenance therapy to prevent future episodes, with a focus on oral polyethylene glycol (PEG 3350, Miralax) at 0.5-1 g/kg/day mixed in clear liquids for disimpaction, followed by maintenance dosing of 0.2-0.8 g/kg/day, as recommended by recent guidelines 1.
Initial Workup
Initial workup should include:
- A thorough history focusing on diet, stool patterns, and any concerning symptoms like vomiting or abdominal distension
- Physical examination to assess for abdominal tenderness, masses, and anal fissures
- Abdominal X-ray may be warranted to evaluate stool burden and rule out obstruction
Treatment
Treatment should involve:
- First-line treatment with oral polyethylene glycol (PEG 3350, Miralax) at 0.5-1 g/kg/day mixed in clear liquids for disimpaction, followed by maintenance dosing of 0.2-0.8 g/kg/day
- Alternatively, lactulose (1-3 mL/kg/day divided twice daily) or milk of magnesia (1-3 mL/kg/day) can be used
- Rectal therapies like glycerin suppositories may provide more immediate relief
- Dietary modifications should include increased fluid intake, particularly water, and added fiber through fruits, vegetables, and whole grains
- Parents should be educated about normal stool patterns and the importance of responding promptly to the urge to defecate
Follow-up
Most pediatric constipation is functional, but persistent cases warrant follow-up to rule out underlying conditions like Hirschsprung's disease, hypothyroidism, or spinal cord abnormalities, as noted in studies 1.
Key Considerations
- The goal is to have a soft movement passed without discomfort every day, preferably after breakfast, as recommended by guidelines 1
- Treatment of constipation is crucial, and the need to choose foods that soften the stool should be discussed with parents
- A stool softener such as polyethylene glycol helps children optimally empty the bowel, with grade Ia evidence supporting its use 1
From the FDA Drug Label
children 16 years of age or under: ask a doctor The FDA drug label does not answer the question.
From the Research
Workup for Constipation in a 1-year-old
- The workup for constipation in a 1-year-old presenting to the ER involves a thorough medical history and physical examination to rule out any underlying medical conditions that may be causing the constipation 2.
- The evaluation should include a review of the child's bowel movements, diet, and fluid intake, as well as any previous treatments or medications that may be contributing to the constipation.
Treatment Options for Constipation
- Polyethylene glycol (PEG) with or without electrolytes is a commonly used treatment for constipation in children, and has been shown to be effective and safe in several studies 3, 4, 5, 6.
- The dosage and duration of treatment with PEG will depend on the individual child's needs and response to treatment, but typical dosages range from 0.6-1.5 g/kg daily 5.
- PEG without electrolytes may be preferred in some cases, as it has been shown to have a similar efficacy to PEG with electrolytes, but with fewer electrolyte disturbances 3.
Treatment of Fecal Impaction
- For children with fecal impaction, a more aggressive treatment approach may be necessary, including the use of enemas or other medications to help soften and remove the impacted stool 4, 6.
- PEG with electrolytes has been shown to be effective in treating fecal impaction, and may be used in conjunction with other treatments such as enemas or manual removal of the impacted stool 4.
Safety and Efficacy of PEG
- PEG has been shown to be safe and effective in the treatment of constipation and fecal impaction in children, with few side effects and no significant risk of electrolyte disturbances when used without electrolytes 3, 5, 6.
- The use of PEG with electrolytes may be associated with a higher risk of electrolyte disturbances, but these are typically mild and asymptomatic 3.