What is the treatment for fecal retention in toddlers?

From the Guidelines

Treatment for colon retention in toddlers should start with dietary changes, increased fluid intake, and establishing regular toilet routines, with polyethylene glycol (Miralax) at a dose of 0.5-1.5 g/kg/day being a commonly recommended over-the-counter medication 1.

Key Considerations

• Increase fiber by offering fruits, vegetables, and whole grains while ensuring the child drinks plenty of water throughout the day.
• Regular toileting habits should be encouraged by having the child sit on the toilet for 5-10 minutes after meals when the gastrocolic reflex is strongest.
• Consistency is key, and treatment often needs to continue for several months to retrain the bowel.
• If symptoms persist despite these interventions, or if there is blood in the stool, severe abdominal pain, vomiting, or failure to thrive, consult a pediatrician promptly.

Medication Options

• Polyethylene glycol (Miralax) at a dose of 0.5-1.5 g/kg/day mixed in 4-8 ounces of liquid is commonly recommended for children 1.
• Mineral oil (1-3 ml/kg/day) or lactulose (1-3 ml/kg/day) are alternative options.
• For immediate relief of impaction, glycerin suppositories or a small Fleet enema may be used occasionally.

Important Notes

• Constipation occurs when stool moves too slowly through the colon, allowing excess water absorption which makes stool hard and difficult to pass.
• This can create a cycle where painful bowel movements lead to withholding behavior, making the problem worse.
• The most recent and highest quality study 1 supports the use of polyethylene glycol (Miralax) as a first-line treatment for constipation in toddlers.

From the FDA Drug Label

Warnings Do not use laxative products for longer than one week unless directed by a doctor. Ask a doctor before use if you have stomach pain, nausea or vomiting notice a change in bowel habits that last over two weeks are pregnant or breast feeding Stop use and ask a doctor if you have rectal bleeding or failure to have a bowel movement after use. Keep out of reach of children. In case of accidental overdose, get medical help or contact a Poison Control Center immediately. Uses for prevention of dry, hard stools for relief of occasional constipation This product generally produces a bowel movement within 12 to 72 hours.

The treatment for colon retention in toddlers is not directly addressed in the provided drug labels.

• Senna (PO) and docusate sodium (PO) have specific warnings and uses, but they do not provide guidance on treating colon retention in toddlers.
• The labels advise to keep out of reach of children and to ask a doctor before use in certain situations, indicating that these products may not be suitable for toddlers without medical supervision.
• Given the lack of direct information, it is essential to consult a doctor for proper evaluation and treatment of colon retention in toddlers 2 3.

From the Research

Treatment Options for Colon Retention in Toddlers

• The treatment of functional constipation in toddlers involves disimpaction using oral or rectal medication, with polyethylene glycol being effective and well tolerated 4.
• Maintenance medications such as mineral oil, lactulose, milk of magnesia, polyethylene glycol powder, and sorbitol may be required for months to years to prevent relapse 4.
• Education of the family and the child is crucial in improving functional constipation, with behavioral education improving response to treatment 4.
• In some cases, withholding cow's milk or adding fiber to the diet may help improve constipation 4.

Surgical Interventions

• For intractable constipation, surgical approaches such as antegrade colonic enemas and intestinal diversion have been shown to be highly effective 5.
• Antegrade continence enema (ACE) and enteral diversion have satisfactory outcomes in 63% and 95% of cases, respectively 5.
• Colon resection is not recommended as an initial therapy due to its high failure rate and the frequent need for additional surgery 5.

Diagnosis and Evaluation

• Constipation in children can be functional or organic, with functional constipation accounting for 90-95% of all cases 6.
• A thorough evaluation, including laboratory investigations and imaging studies, is necessary to rule out organic causes of constipation 6.
• Slow transit constipation is a type of constipation that can be diagnosed using colonic transit studies and may be associated with intestinal neuronal dysplasia (IND) 7.