Treating constipation in children

Before prescribing medications, encourage parents to try giving the child extra fluids, increase fiber, etc.....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

As a pharmacist, parents often ask you about treating constipation in children. Constipation is common in young children. It's a great source of worry for parents, but it's rarely serious. It's usually due to fear of a painful bowel movement, not enough exercise and inadequate hydration, etc.

     Before prescribing medications, encourage parents to try giving the child extra fluids, increase fiber, etc. For infants, suggest corn syrup or juices with sorbitol such as prune, pear, or apple juice to help decrease constipation. If nondrug therapy fails, a laxative can be tried. Glycerin enemas or suppositories work the fastest (about 15-60 min) with minimal side effects. Avoid using enemas in infants. Sodium phosphate enemas (Enemax) can be used in kids 2 years old and up, the oral product (Fleet Phospho-soda, NOT available in Egypt) in kids 5 years or older. Tell parents that the enemas work within minutes and the oral prep within a few hours. 

Magnesium hydroxide (milk of mag) and magnesium citrate work within 4-8 hrs. They taste bitter, so suggest mixing with a beverage. Do NOT give sodium phosphate or magnesium products to children with kidney problems. Mineral oil works in 6-8 hrs. Suggest chilling the oral form to increase palatability. Do NOT give orally to infants or kids who are resistant to taking it, they might aspirate the oil. Lactulose (Duphalac) and sorbitol are often used for daily management of constipation. But kids will often complain about the taste. Miralax (polyethylene glycol) is gaining popularity for both short and long-term treatment of constipation. It works as well as other treatments, and is better tolerated. Tell parents Miralax can take 2-3 days to start working. Docusate can help kids pass hard, dry stools, if they can handle the bitter taste. Explain that it takes 1-3 days to kick in. Stimulants (senna, bisacodyl) can cause abdominal pain and cramping. 

Reserve for "rescue therapy" when other treatments fail. Tell parents to contact you if constipation is recurring, or accompanied by fever, abdominal pain, nausea, vomiting, anorexia, weight changes, or history of bloody diarrhea.

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