The following is an informative leaflet from our hospital (Greenville Health System)
Guidelines for Treatment of Pediatric Constipation
Pediatric constipation is very common. Most children have functional constipation and do not have any organic pathology or require any type of evaluation other than a careful history and physical examination.
Typical signs and symptoms of functional constipation:
- 2 or less stools per week
- Rectal fecal impaction
- Stool withholding/ posturing (often perceived by parents as straining)
- History of hard or excessively large BMs
- At least one episode on incontinence per week in child who was previously toilet trained.
Warning signs of organic pathology:
- Failure to pass meconium in first 48 hours of life
- Blood in absence of anal fissures
- Abnormal position of the anus
- Decreased lower extremity strength/tone/reflexes
Treatment of functional constipation:
- Clean out
*If there is significant impaction, it can be helpful to give an enema or two prior to oral cleanout.
- Phosphate: 5 ml/kg up to 133 ml
- Mineral oil: 2-11 years 30-60 ml
>11 years 60-150 ml once per day
- Miralax in Gatorade over 4-6 hours: (can give bisacodyl or senna 1-2 hours before oral cleanout)
8-10 kg: 2 capfuls /12 ounces 11-13 kg: 3 capfuls/16 ounces
35-39 kg: 9 capfuls/40 ounces 40-43 kg: 10 capfuls/48 ounces
14-18 kg: 4 capfuls/20 ounces 44-47 kg: 11 capfuls/52 ounces
19-22 kg: 5 capfuls/24 ounces 48-51 kg: 12 capfuls/56 ounces
23-26 kg: 6 capfuls/28 ounces 52-56 kg: 13 capfuls/60 ounces
27-30 kg: 7 capfuls/32 ounces 57-60 kg: 14 capfuls/64 ounces
31-34 kg: 8 capfuls/36 ounces 61 + kg: 15 capfuls/64 ounces
- Magnesium Citrate 1 ounce per year of age up to 10 ounces 2-3 days in a row
- Polyethylene glycol: 2-0.8 g/kg/day
- Lactulose: 1-2 g/kg once or twice a day
- Mineral oil: 1-3 ml/ kg/ day once or divided , max 90 ml/ day
- Milk of Magnesia: 2-5 years: 2-5 ml once daily or divided/ 6-11 years: 5 ml-15 ml once or divided/ 12-18 years: 10 ml- 30 ml once or divided
Stimulant laxatives: (if needed to meet goal of producing soft good size BM most days with minimal soiling)
- Bisacodyl 3-10 years: 5 mg once a day; >10 years: 5-10 mg once a day
- Senna 2-6 years : 2.5-5 mg once or twice a day; 6-12 years: 7.5-10 mg once / day; >12 years: 15-20 mg once / day
3) Structured toilet sitting for children who have previously been toilet trained or do not having toilet refusal. Sit for 1 minute per year age twice a day after meals. Use a stool if feet don’t reach the floor or consider a Squatty Potty.
4) normalize fluid and fiber intake. Use a fiber goal of age in years + 5 grams of fiber per day
5) In resistant cases, consider trial of milk free diet.
Indications for pediatric GI referral: Warning signs of organic pathology or failure of multiple maintenance medication regimens.