Treatment of Constipation in Children

Fecal disimpaction

Oral

Oral or via nasogastric tube polyethylene glycol–electrolyte solutionOral or via nasogastric tube polyethylene glycol–electrolyte solution

Oral, children > 2 years and adolescents: 20 mL/kg/hour (maximum dose of 1 L/hour) for 4 hours/day for 2 days

Nasogastric tube, children and adolescents: 25–40 mL/kg/hour (maximum 2 L/hour) until stool is liquid

Nausea, vomiting, cramping, bloating, diarrhea, fecal incontinence

Oral polyethylene glycol without electrolytesOral polyethylene glycol without electrolytes

Children and adolescents: 1–1.5 g/kg/day dissolved in 10 mL/kg water for 3–6 days (maximum daily dose 100 g/day

Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating

Rectal

Glycerin suppositoriesGlycerin suppositories

Infants and children < 2 years: 1/2–1 pediatric suppository once/day for up to 3 days

2 to < 6 years: 1 pediatric suppository once daily

≥ 6 years: 1 adult suppository once/day

None

Rectal mineral oil enemaRectal mineral oil enema

2–11 years: 59 mL (½ bottle) as a single dose

≥ 12 years: 118 mL (full bottle) as a single dose

Fecal incontinence, mechanical trauma

Rectal sodium phosphate enema (do not use in children < 2 years old)

2–4 years: 33 mL (1/2 prepackaged pediatric enema) once/day for 2 days or until stool appears

5–11 years: 66 mL (1 prepackaged pediatric enema) once/day for 2 days or until stool appears

≥ 12 years: 133 mL (1 prepackaged adult enema) once/day for 2 days or until stool appears

Mechanical trauma, hyperphosphatemia

Maintenance agents for chronic constipation

Oral osmotic and lubricant laxatives

Lactulose (10 g/15 mL solution)Lactulose (10 g/15 mL solution)

1–3 mL/kg/day divided once or twice daily (maximum 90 mL/day)

Abdominal cramping, flatus, diarrhea

Magnesium hydroxide (400 mg/5 mL solution or 400-mg chewable tablet)Magnesium hydroxide (400 mg/5 mL solution or 400-mg chewable tablet)

Weight-based dosing: 80 to 240 mg/kg/day (1–3 mL/kg/day of 400 mg/5 mL product) divided once or twice daily (maximum 4800 mg/day or 60 mL/day of 400 mg/5 mL product)

Age-based dosing:

• 2–5 years: 5–15 mL/day (400–1200 mg/day) divided once or twice daily

• 6–11 years: 15–30 mL (1200–2400 mg/day) divided once or twice daily

• ≥ 12 years: 15–60 mL (1200–4800 mg/day) divided once or twice daily

If overdose, risk of hypermagnesemia, hypophosphatemia, or secondary hypocalcemia

Mineral oil, oral or rectal (oral mineral oil should not be used in infants Mineral oil, oral or rectal (oral mineral oil should not be used in infants< 1 year or in neurologically impaired children to avoid aspiration)

Children and adolescents, oral: 1–2 mL/kg/day divided once or twice daily (usual maximum daily dose is 45 mL/day)

Rectal:

• 2–11 years: 30–60 mL once daily.

• ≥ 12 years: 60–150 mL once daily

Fecal incontinence

Polyethylene glycol powder dissolved in waterPolyethylene glycol powder dissolved in water

Weight-based dosing: 0.4 to 0.8 g/kg/day divided once or twice daily (usual maximum daily dose 17 g/day)

Age-based dosing:

• 1–18 months: 1/4 packet powder (4.25 g) in 60 mL (2 oz) water once/day

• > 18 months–3 years: 1/2 packet powder (8.5 g) in 120 mL (4 oz) water once/day

• ≥ 3 years: 1 packet (17 g) in 240 mL (8 oz) water once/day

Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating

Oral stimulant laxatives (to be used for a limited period of time)

Bisacodyl (5 mg oral tablets)Bisacodyl (5 mg oral tablets)

3–9 years: 1 tablet once/day

≥ 10–11 years: 1–2 tablets once/day

≥ 12 years: 1–3 tablets once/day

Fecal incontinence, hypokalemia, abdominal cramps

Senna syrup: 8.8 mg sennosides/5 mLSenna syrup: 8.8 mg sennosides/5 mL

< 2 years: 1.25–2.5 mL (2.2–4.4 mg sennosides) once/day (maximum 5 mL [8.8 mg sennosides] per day)

2–5 years: 2.5–3.75 mL (4.4–6.6 mg sennosides) once or twice daily (maximum 3.75 mL [6.6 mg sennosides] per day )

6–11 years: 5–7.5 mL (8.8–13.2 mg sennosides) once or twice daily (maximum 7.5 mL [13.2 mg sennosides] per day)

≥ 12 years: 10–15 mL (17.6–26.4 mg sennosides) once or twice daily (maximum 15 mL [26.4 mg sennosides] per day)

Abdominal cramping, melanosis coli

Maintenance diet supplements

Dietary fiber supplements

Methylcellulose*Methylcellulose*

6–11 years: 1 g 1–3 times/day

≥ 12 years: 2 g 1–3 times/day

Less bloating than other fiber supplements, cramping, flatus

Psyllium* Psyllium*

6–11 years: 1.25–15 g 1–3 times/day

≥ 12 years: 2.5–30 g 1–3 times/day

Bloating, cramping, flatus

Sorbitol-containing fruit juices (eg, prune, pear, apple)

Infants and older children: 30 to 120 mL (1–4 oz)/day

Flatus, cramping, bloating

Wheat dextrin* Wheat dextrin*

2–20 years: 5 g plus 1 g for each year of age once/day

Bloating, cramping, flatus