Treatment of Constipation in Children

Initial Assessment and Non-Pharmacological Interventions

The American Gastroenterological Association recommends performing a careful digital rectal examination to assess for fecal impaction before initiating treatment, and evaluating pelvic floor motion during simulated evacuation to exclude defecatory disorders 2
A physical examination should be performed to rule out bowel obstruction through abdominal examination if symptoms are severe 3

The American College of Gastroenterology recommends establishing regular toilet sitting times, especially 15-30 minutes after meals, to take advantage of the gastrocolic reflex, and increasing dietary fiber intake gradually through fiber-rich foods 1
Adequate fluid intake is essential to support fiber effectiveness, as recommended by the Gastroenterology society 4
Promoting age-appropriate physical activity is also recommended 1

The Praxis Medical Insights society recommends polyethylene glycol (PEG) 17g daily as first-line pharmacological treatment, combined with increased dietary fiber intake and behavioral interventions including scheduled toilet sitting after meals 1
If fecal impaction is present, disimpaction with glycerin suppositories may be performed before starting maintenance therapy 5
For first-line maintenance treatment, PEG 17g mixed with 8 oz water once daily is the preferred agent, with a treatment goal of achieving at least 3 non-forced bowel movements per week without abdominal pain 1
If constipation persists, increasing PEG to twice daily dosing or adding a stimulant laxative such as bisacodyl 5-10mg daily may be considered 5, 6

The Journal of the National Comprehensive Cancer Network recommends avoiding the use of docusate (stool softener) alone or adding it to other laxatives, as studies show it provides no additional benefit and is less effective than stimulant laxatives alone 7
Psyllium or supplemental fiber should not be used in children with reduced motility or severe constipation, as it may worsen symptoms or cause obstruction 7
Fiber supplements should not be used without adequate hydration, as recommended by the Gastroenterology society 4