Treatment of Constipation and Encopresis in Children
Type of Therapy | Agent | Dose | Selected Adverse Effects |
|---|---|---|---|
Disimpaction | |||
Oral | 15–20 mL/year of age (maximum 240 mL/day) for 3 days or until stool appears | Fecal incontinence, malabsorption of fat-soluble vitamins (if treatments are repeated) | |
25 mL/kg/hour (maximum 1000 mL/hour) by nasogastric tube until stool appears or 20 mL/kg/hour for 4 hours a day | Nausea, vomiting, cramping, bloating, diarrhea, fecal incontinence | ||
1–1.5 g/kg dissolved in 10 mL/kg water once a day for 3 days | Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating | ||
Rectal | Infants and children < 6 years: 1/2–1 pediatric suppository once a day for 3 days or until stool appears Children ≥ 6 years: 1 adult suppository once a day | None | |
2–11 years: 66 mL (1 prepackaged pediatric enema) once a day for 3 days or until stool appears ≥ 12 years: 133 mL (1 prepackaged adult enema) once a day for 3 days or until stool appears | Fecal incontinence, mechanical trauma | ||
Rectal sodium phosphate enema | 2–4 years: 33 mL (one half prepackaged pediatric enema) once a day for 3 days or until stool appears 5–11 years: 66 mL (1 prepackaged pediatric enema) once a day for 3 days or until stool appears ≥ 12 years: 133 mL (1 prepackaged adult enema) once a day for 3 days or until stool appears | Mechanical trauma, hyperphosphatemia | |
Maintenance agents | |||
Oral osmotic and lubricant laxatives | 1 mL/kg once a day or 2 times a day (maximum 60 mL/day) | Abdominal cramping, flatus, diarrhea | |
1–2 mL/kg once a day | If overdose, risk of hypermagnesemia, hypophosphatemia, or secondary hypocalcemia | ||
1–3 mL/kg once a day (maximum 45 mL/day [90 mL if inadequate response]) | Fecal incontinence | ||
1–18 months: 1/4 packet powder (4.25 g) in 60 mL (2 oz) water once a day > 18 months–3 years: 1/2 packet powder (8.5 g) in 120 mL (4 oz) water once a day ≥ 3 years: 1 packet (17 g) in 240 mL (8 oz) water once a day | Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating | ||
Oral stimulant laxatives (to be used for a limited period of time) | 2–11 years: 1 tablet once a day ≥ 12 years: 1–3 tablets once a day | Fecal incontinence, hypokalemia, abdominal cramps | |
> 1 year: 1.25 mL once a day up to 2.25 mL 2 times a day 2–5 years: 2.5 mL once a day up to 3.75 mL 2 times a day 6–11 years: 5 mL once a day up to 7.5 mL 2 times a day ≥ 12 years: 1 tablet once a day up to 2 tablets 2 times a day | Abdominal cramping, melanosis coli | ||
Maintenance dietary supplements | |||
Dietary fiber supplements | < 6 years: 0.5–1 g once a day 6–11 years: 1 g 1–3 times a day ≥ 12 years: 2 g 1–3 times a day | Bloating (but less than other fiber supplements), cramping, flatus | |
6–11 years: 1.25–15 g 1–3 times a day ≥ 12 years: 2.5–30 g 1–3 times a day | Bloating, cramping, flatus | ||
Infants and older children: 30 to 120 mL (1–4 oz) a day | Flatus, cramping, bloating | ||
2–20 years: 5 g plus 1 g for each year of age once a day | Bloating, cramping, flatus | ||
* Numerous commercial products and preparations are available in differing concentrations, so doses are given in terms of grams of fiber. | |||