TABLE 1.
Medications for the treatment of paediatric constipation
| Laxative | Dosage | Side effects |
|---|---|---|
| Lactulose | 1 mL/kg/day – 3 mL/kg/day in divided doses | Flatulence, abdominal cramps |
| Milk of magnesia (Magnesium hydroxide) | 1 mL/kg/day – 3 mL/kg/day of 400 mg/5 mL available as liquid | Magnesium poisoning (infants). In overdose, hypermagnesemia, hypophosphatemia and secondary hypocalcemia |
| Polyethylene glycol 3350 | Disimpaction: 1 g/kg/day – 1.5 g/kg/day for 3 days Maintenance: Starting dose at 0.4 g/kg/day – 1 g/kg/day |
Limited. Occasional abdominal pain, bloating, loose stools |
| Polyethylene glycol-electrolyte solution (lavage) | Disimpaction: 25 mL/kg/h (to 1000 mL/h) by nasogastric tube until clear effluent Maintenance: 5 mL/kg/day – 10 mL/kg/day (older children) |
Nausea, bloating, abdominal cramps, vomiting and anal irritation |
| Mineral oil | Disimpaction: 15 mL/year – 30 mL/year of age (up to 240 mL daily) Maintenance: 1 mL/kg/day – 3 mL/kg/day <1 year of age: Not recommended |
Lipid pneumonia if aspirated. Theoretical interference with absorption of fat-soluble substances, but no evidence |
| Senna | 2–6 years: 2.5 mL/day – 7.5 mL/day 6–12 years: 5 mL/day – 15 mL/day |
Idiosyncratic hepatitis, melanosis coli, hypertrophic osteoarthropathy, analgesic nephropathy |
| Bisacodyl | Oral: 3–12 years: 5 mg – 20 mg Rectal: <2 years: 5 mg/day 2–11 years: 5 mg/day – 10 mg/day |
Abdominal cramping, nausea, diarrhea, proctitis (rare) |
| Docusate sodium | 5 mg/kg/day divided three times a day or as a single dose | Abdominal pain, cramping, diarrhea |
| Glycerin suppositories | – | None |
| Phosphate enemas | <2 years old: Not recommended >2 years: 6 mL/kg (up to 135 mL) |
Risk of mechanical trauma to rectal wall Abdominal distention or vomiting Hyperphosphatemia, hypocalcemia |