From the Guidelines
Treatment for stool retention in toddlers should start with polyethylene glycol (Miralax) at a dose of 0.5-1.5 g/kg/day mixed in 4-8 ounces of liquid, given once daily for several months until regular bowel habits are established, as recommended by the most recent and highest quality study 1. This approach is based on the principle of drawing water into the intestines to soften stool and make it easier to pass. In cases of severe impaction, a higher initial dose may be needed for 2-3 days, followed by maintenance dosing.
Key Considerations
- Dietary modifications are essential and should include increased fiber intake through fruits, vegetables, and whole grains, along with adequate fluid consumption (about 1-2 quarts daily) 1.
- Limiting constipating foods like dairy products, bananas, and processed foods can also help.
- Establishing a regular toileting routine is crucial - having the child sit on the toilet for 5-10 minutes after meals takes advantage of the gastrocolic reflex.
- Positive reinforcement through praise or small rewards for successful bowel movements can encourage cooperation.
Additional Measures
- If these measures don't work within a few weeks, or if there's severe pain, bleeding, or other concerning symptoms, medical evaluation is necessary to rule out underlying conditions like Hirschsprung's disease or anatomical abnormalities.
- In some cases, suppositories or enemas may be considered, but their use should be guided by a healthcare professional, taking into account the child's specific needs and potential risks, as outlined in the study 1.
Prioritizing Outcomes
The primary goal of treatment is to improve the child's quality of life by relieving symptoms of stool retention, while minimizing the risk of adverse events and promoting long-term bowel health. By following a stepped approach, starting with polyethylene glycol and adjusting as needed, healthcare providers can help toddlers with stool retention achieve regular bowel habits and reduce the risk of complications.
From the FDA Drug Label
children 16 years of age or under: ask a doctor children 16 years of age or under: ask a doctor The FDA drug label does not answer the question.
From the Research
Treatment Options for Stool Retention in Toddlers
- Polyethylene glycol (PEG) is the laxative of first choice in the treatment of functional constipation in children, both for disimpaction and for maintenance treatment, as it acts as an osmotic laxative and its efficacy is dose dependent 2.
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 3.
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories make excellent choices for adjunct therapies in specific clinical scenarios 3.
Management of Chronic Constipation
- Infants and toddlers with constipation usually have a history of infrequent, hard and painful bowel movements, often accompanied by screaming and stool-holding maneuvers, and treatment consists of fecal disimpaction, laxatives to prevent future impaction, promotion of regular bowel habits and, finally, toilet training 4.
- Consensus guidelines recommend either osmotic laxatives, mineral oil, or their combination for maintenance treatment in concert with patient and parental education and behavioral training 5.
Safety and Efficacy of Treatment Options
- PEG has a good safety profile, and is well tolerated by children, with only minor adverse events reported 2.
- PEG 3350 solution has been shown in recent clinical studies to be an effective maintenance treatment for pediatric constipation, and is an option for children with constipation who have failed or are intolerant of other pharmacotherapies 5.
- Novel therapies with a high safety profile have been developed, such as probiotics, synbiotics, serotonin 5-hydroxytryptamine 4 receptor agonists, chloride channel activators, and herbal and transitional medicines, but well-designed research to support the use of these therapies is needed 6.