Laxatives in children

Management of constipation in children can be complex and often requires referral for specialist advice. See linked item constipation in children for more details concerning when referral is indicated,

Management includes:

• Treat constipation with laxatives and a combination of:
  • negotiated and non-punitive behavioural interventions suited to the child or young person's stage of development. These could include scheduled toileting and support to establish a regular bowel habit, maintenance and discussion of a bowel diary, information on constipation, and use of encouragement and rewards systems
  • dietary modifications to ensure a balanced diet and sufficient fluids are consumed
  • balanced diet should include:
    • adequate fluid intake
    • adequate fibre. Recommend including foods with a high fibre content (such as fruit, vegetables, high-fibre bread, baked beans and wholegrain breakfast cereals) (not applicable to exclusively breastfed infants). Do not recommend unprocessed bran, which can cause bloating and flatulence and reduce the absorption of micronutrients
    • use of laxatives
      
      
• offer the following oral medication regimen for disimpaction if indicated:
  • polyethylene glycol 3350 + electrolytes e.g. Movicol, using an escalating dose regimen, as the first-line treatment
  • polyethylene glycol 3350 + electrolytes may be mixed with a cold drink
  • add a stimulant laxative e.g. Senna, if polyethylene glycol 3350 + electrolytes does not lead to disimpaction after 2 weeks
  • substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if polyethylene glycol 3350 + electrolytes is not tolerated
  • inform families that disimpaction treatment can initially increase symptoms of soiling and abdominal pain.
• start maintenance therapy if the child or young person is not faecally impacted

Reference:

• 1) NICE (May 2010). Constipation in chidren