Managing Toddler Constipation with Polyethylene Glycol

Recommended Treatment Algorithm

• The American Academy of Pediatrics recommends starting with age-appropriate dosing of Polyethylene Glycol (PEG) and titrating to achieve 2-3 soft, non-forced bowel movements daily, with a goal of 1 non-forced bowel movement every 1-2 days 1
• Before starting maintenance therapy, it is essential to rule out fecal impaction through physical examination, especially if the child has paradoxical diarrhea (overflow around impaction), and perform disimpaction using high-dose PEG for the first few days or consider phosphate enemas with appropriate pre-medication 1

Critical Pitfalls to Avoid

• The National Comprehensive Cancer Network recommends never using stimulant laxatives (bisacodyl, senna) in toddlers, as these are only appropriate for older children and dying patients in palliative care, and avoiding magnesium-based laxatives in young children 1, 2