This article concludes my overview on constipation in children. To get a better perspective of the subject, I refer you to my two previous articles titled, ‘Constipation in newborn babies,’ and ‘Constipation in children: causes, symptoms, signs and other considerations.’
When a clinician comes across a child with constipation, they narrow their assessment down to whether to prescribe medications or to recommend a natural remedy. The age of the child, the period of onset and the severity of the constipation come into account in making decisions. Is there any underlying disease? If a clinician suspects an underlying illness, he or she is obligated to look into and address such causes.
Luckily, in the majority of children with constipation there is no major underlying illness, so a clinician proceeds with trying to make the child achieve regular bowel movement.
Some children may need longer treatment time, involving multiple medical specialties and even behavioral therapists, in order to solve their constipation problems. Seeking expert opinion from trusted clinicians is very important in persevering with prolonged management in certain children.
What is presented here is a simplification of what could be a very complex medical issue.
My favorite food list to combat constipation
For babies who are already six months old and on solid food, and for infants under the age of one year, I tend to suggest first that parents add fruit juice or prune juice to the diet. Use two to four ounces of 100 percent apple or pineapple juice divided into several small drinks a day. Stop the extra juice when the baby moves its bowels; over-treating the baby leads to diarrhea.
Beans, vegetables, plums and other whole fruits are my favorite foods to combat constipation in older children. My usual ‘limit, don’t eat’ list includes chips, processed food, pizza crust, cheese, French fries, fried plantain, and French toast sticks.
Medical ways to treat constipation
I reserve rectal stimulation and a limited trial of glycerin suppository for newborn babies and those who are below six months and not yet on solid foods.
Older children and teenagers often require medication in addition to dietary counseling to treat their constipation. And because constipation in older children may have been going on for weeks or even months, treatment may need to last a long time to achieve adequate daily bowel movements.
There are many medications available to treat constipation, some of which do not require a prescription from a licensed medical practitioner. When indicated, clinicians recommend treatment based on their experience and familiarity with a particular medication.
Medication choices and availability also differ, depending on where an individual lives and in what country their medical practitioner resides. Side effects, including allergies and life-threatening reactions, can arise from the use of any medicine, so be very watchful while your child is on medication. If unsure, stop the treatment and call for immediate expert help.
Below are a few of the popular medications available for treating constipation in children in the United State of America.
Six popular medications used by pediatricians to treat constipation in children
Miralax: Though this powdered medicine has not officially been approved by the FDA-Food and Drug Administration-USA for use in children, it continues to gain popularity among clinicians. Some clinicians say they have even used it in children as young as six months. I do use it in older children. Of note is that several parents have reported rage, hostility and mood changes in their children during the period they were on Miralax.
Lactulose: This medicine, which contains sugars, lactose and galactose, is a very reasonable choice if treating constipation in children, unless the child suffers from diabetes or a genetic disorder called galactosemia, in which the body does not have the capability to deal with galactose. Details on dosage and side effects can be found on the medication labels. I did not find Lactulose displayed on the shelf in the drugstores I visited. A clinician’s guidance is needed.
Senna: To my surprise, this is a very popular laxative, perhaps because it is an extract of the Senna plant. There are even chocolate formulation tablets in the drugstores. In a liquid formulation carried by a hospital-based pharmacy, one teaspoon contains 8.8 mg of Senna. At this concentration children who are aged two to six can take half a teaspoon at night. I intend to incorporate Senna liquid in my practice for treatment of constipation. However, a warning: don’t use Senna for more than one week. Like Lactulose, Senna liquids were not displayed on the shelves of drugstores.
Mineral oil: A couple of parents have had their children on mineral oil when they visited my practice. Like many pediatricians, I have not warmed to the use of mineral oil as a treatment of constipation in children due to the associated risks of aspiration pneumonia, as well as its propensity to interfere with absorption of vitamins A, D, E, and K. There is plenty of mineral oil displayed on the shelves of drugstores.
Milk of magnesium: This medication, which is both an antacid and a laxative, is another reasonable choice in treating children with constipation. It is available at drugstores without prescription. One to three teaspoons a day of the 400mg/tsp concentration is all a child needs between ages two to five years. Like mineral oil, milk of magnesium is plentiful on the shelves of drugstores. Its content of magnesium is a downside, especially in people with poorly-functioning kidneys.
Colace—Docusate Sodium: Colace comes in different formulations of capsules, tablets, syrup, liquid and rectal enema. Oral treatment may take a long time to work, say one to three days, so be patient with this laxative. One more thing about Colace: the liquid does not taste good, so you may need to mix it with juice or formula. I like to prescribe the 60mg/15ml syrup formulation, beginning with half a teaspoon and increasing up to one teaspoon daily, to treat short episodes of constipation in toddlers and children.
The above article is not intended to treat or to diagnose any medical condition. Take your child to a pediatrician if you are concerned that he or she is constipated.