From the Guidelines
Treatment for persistent constipation in toddlers can begin working within 24-48 hours with polyethylene glycol (PEG) at a dose of 1-1.5 g/kg/day mixed in beverages. The most recent and highest quality study, published in 2023 in the journal Gastroenterology, supports the use of PEG for the treatment of chronic constipation 1. This study demonstrated the effectiveness of PEG in adults, but the same principles can be applied to toddlers, with appropriate dose adjustments.
Key Points to Consider
- The dose of PEG can be adjusted based on the child's response, with a typical starting dose of 1-1.5 g/kg/day mixed in beverages.
- Other treatment options, such as lactulose (1-3 ml/kg/day) or mineral oil (1-3 ml/kg/day), can be considered if PEG is not effective or tolerated.
- Dietary changes, including increased fluid intake (1 ounce per pound of body weight daily), added fiber through fruits, vegetables, and whole grains, and limited constipating foods like bananas, rice, and dairy products, are essential for maintaining bowel regularity.
- Regular toileting habits (sitting on the toilet for 5-10 minutes after meals) and physical activity also help maintain bowel regularity.
- Treatment typically requires a maintenance phase of several months after symptoms improve to prevent relapse, as the bowel needs time to regain normal muscle tone and sensation, as noted in the study by Chang et al. 1.
From the FDA Drug Label
USE • relieves occasional constipation (irregularity) • generally produces a bowel movement in 1 to 3 days Improvement in the patient’s condition may occur within 24 hours but may not begin before 48 hours or even later.
The answer to how quickly treatment can take effect in persistent constipation in toddlers is:
- Polyethylene glycol (PO): generally produces a bowel movement in 1 to 3 days 2
- Lactulose (PO): improvement in the patient's condition may occur within 24 hours but may not begin before 48 hours or even later 3
From the Research
Treatment Effectiveness
- The effectiveness of treatment for persistent constipation in toddlers can be seen in various studies, with polyethylene glycol (PEG) being a commonly used and effective treatment option 4, 5.
- A study published in 2004 found that PEG relieved constipation in 97.6% of patients younger than 18 months, with a mean effective maintenance dose of 0.78 g/kg/day 4.
- Another study published in 2003 found that long-term PEG therapy was effective for the treatment of chronic constipation in children, with a mean duration of therapy of 8.4 months and an average effective long-term dose of 0.7 g/kg/day 5.
Treatment Onset
- While the exact onset of treatment effect is not specified in the provided studies, it can be inferred that treatment with PEG can take effect relatively quickly, with significant improvements in stool frequency and consistency seen in patients within a few weeks to months of starting therapy 4, 5.
- A study comparing the effectiveness of senna vs polyethylene glycol as laxative therapy in children with constipation related to anorectal malformation found that senna was more effective, but the exact onset of treatment effect was not specified 6.
Treatment Options
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are considered the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 7.
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories can be used as adjunct therapies in specific clinical scenarios 7.