From the Guidelines
Treatment for pediatric constipation typically involves the use of osmotic laxatives, such as polyethylene glycol, as first-line therapy.
Treatment Options
- Osmotic laxatives, like polyethylene glycol, are often used as first-line treatment for constipation in children, as they are effective for constipation generally and are inexpensive, widely available, and well-tolerated 1.
- Stimulant laxatives, such as senna, can also be used to treat constipation in children, but evidence for their efficacy in pediatric constipation is limited 1.
- Dietary changes, including increasing intake of fluid and physical activity, should also be encouraged, when appropriate, to help manage constipation 1.
- Added dietary fiber may be considered for patients with adequate fluid intake, but its effectiveness in pediatric constipation is not well established 1.
Special Considerations
- If constipation persists, other laxatives, such as rectal bisacodyl or oral lactulose, may be considered 1.
- In cases of opioid-induced constipation, peripherally acting μ-opioid receptor antagonists, such as methylnaltrexone, may be effective in relieving constipation while maintaining pain management 1.
- Newer agents, such as lubiprostone and linaclotide, have shown promise in treating constipation, but their use in pediatric patients is not well established 1.
From the Research
Treatment Approaches
The treatment for pediatric constipation can be divided into several approaches, including:
- Non-pharmacological treatment, which involves education, demystification, lifestyle advice, and toilet training 2
- Pharmacological treatment, which consists of disimpaction, maintenance treatment, and eventually weaning if possible 2
- Non-pharmacologic approaches, such as dietary changes, supplements, and mind-body interventions 3
Pharmacological Treatment
Pharmacological treatment options for pediatric constipation include:
- Polyethylene glycol (PEG), which is considered the first choice of laxative for both disimpaction and maintenance treatment 4, 2
- Osmotic laxatives, which are used as first-line treatment 5
- Stimulant laxatives, which can be added if there is no improvement with osmotic laxatives 5
- Lubricants and enemas, which are available as alternative pharmacological treatment options 2
Non-Pharmacologic Approaches
Non-pharmacologic approaches for pediatric constipation include:
- Dietary changes, such as increasing fiber intake 4, 3
- Supplements, such as prebiotics, probiotics, and fiber 3
- Mind-body interventions, such as diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications 3
- Movement and manipulative interventions, such as abdominal massage, reflexology, acupuncture, and transcutaneous nerve stimulation 3
Management Stages
The management of pediatric constipation can be divided into three stages of therapy: