CONSTIPATION

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 (in children over 1 year of age)

If your child is under 1 year of age, then please read the other constipation information page first.

Cause: Digested food enters the large intestine (last part of the bowels) as a liquid and the large intestine absorbs this water to make the stool solid. Therefore, having less water in the digested food causes constipation. When the stool spends more time in the bowel, then it can absorb more water and the stool gets harder.

  Usual course: Most people have a few days of constipation now and then that resolves on its own. Some have moderate to severe constipation lasting for months and then it stops. Some have episodes of constipation lasting months and reappearing every year or so.

  Behavioral treatment: If you have more frequent bowel movements, then the stool will not have a chance to harden. There is a normal reflex that helps the bowels move about 10 minutes after a meal is eaten, therefore encourage having a bowel movement several times a day after meals. Ensure the are no negative feelings regarding having a bowel movement since  negative feelings about bowel movements only causes someone to hold the bowels longer. Once we get the stools softened, the negative feelings about having a bowel movement should resolve on their own. A warm bath may relax the rectal muscles and make the hard stool pass easier. Regular exercise will also help you child have regular bowel movements. For those children unable to walk, holding your child upright while walking with them helps their bowels move easier.

  Diet treatment: First, increase water intake. Complex sugars (that are difficult to absorb) and fiber cause water to stay in the stool longer, and therefore softens the stool. Therefore, eat more fruits and fruit juices (such as apricots, peaches, plums, pears and prunes) and eat more fiber found in grains, fruits and vegetables (especially beans, peas and spinach). Consistently eating the above will help greatly, while inconsistency can actually make matters worse. There is some evidence that certain foods make constipation worse, such as; milk, ice cream, cheese, white rice, squash, carrots, apples and bananas, therefore, you may want to limit the amount of these in the diet.

  Which treatment to use: Always try the diet treatment mentioned above first, and if that is not enough, then we try medicines. Stool softeners are the first choice since they only soften the stool. Laxatives are next, since they make you have a bowel movement. Enemas are a last resort for obvious reasons, and they essentially flush out the stool. You cannot become physically addicted to any of these treatments. Typically, what we do is take a stool softener every day during this “episode”. If your child goes 1 to 2 days without a bowel movement, then give a laxative. If your child goes several days without a bowel movement, or is uncomfortable, then give an enema. If you give an enema, then follow that by several days of a laxative, since the enema only removes the last part of the bowel movement.

  Suppositories: Glycerin suppositories simply lubricate the rectal canal to make it easier for the stool to come out. Be careful to lubricate the suppository with Vaseline before inserting. Be careful when inserting the suppository so you don’t injure the rectum. They can be used as often as you wish.

  Stool softeners:

Colace  (docusate sodium) will soften the stool when taken regularly. It may take 5-10 days to see a change in the bowel movement consistency. Start off taking a dose with each meal (3-4 doses per day). Every few weeks, drop one dose a day until you are off of the medicine. If the stool hardens again, then add another dose back. If you have to take it more than 3 months in a row, then notify the doctor. The doses given are for each meal or up to 4 doses per day. 1 tsp = 5 ml = 5 cc
Miralax (PEG) Miralax is called the miracle laxative. It is a sugar that your body can't absorb, but it draws water into the gut to loosen / soften the stool. In small doses, it tends to soften the stool, while in larger doses is acts as a laxative. Therefore if you try this medication at one dose level and find that the stools are loose, then simply cut back the dose a little. Its a poser that you mix with any liquid. The powder does not have any taste or texture and therefore its perfect for kids as they don't even know they are taking it. Miralax is available over the counter. The recommended adult dose is 17 gm (there is a mark / line on the cap) mixed in 8 ounces of any liquid given once a day. For the kid dose, we simply give proportionately less. For example, an 60 lb child might take 8 gm, and a 30 lbs child might take 4 gm. But we essentially give what works. It takes several days to see the full effect, therefore we change doses slowly over days.

 

Senakot

Syrup 218mg/5ml

20 lbs

2-4 ml

30 lbs

3-6 ml

40 lbs

4-8 ml

50 lbs

5-10 ml

60 lbs

6-12 ml

 

 

 

Laxatives: Senekot for children is a gentle overnight type of laxative. Laxatives make your bowels move rather than just soften the stool. Use a laxative when your child has gone longer than usual without having a bowel movement (this is typically 1 to 2 days, but we will give you a specific number of days for your child). Take the medicine daily until the bowels are of normal consistency and amount (usually 1 to 7 days). Notify the doctor if you must take this more than 7 days in a row. The doses given are for one dose at bedtime. 1 tsp = 5 ml = 5 cc

Colace

<3yrs old

3-6 yrs old

6-12 yrs old

>12 yrs old

Syrup 20mg/5ml

¼ to ½ tsp

½ to 1 tsp

1 to 2 tsp

2 to 5 tsp

Solution 10mg/1ml

½ to 1 ml

1 to 2 ml

2 to 4 ml

4 to 10 ml

Solution 50mg/1ml

too strong

too strong

1ml

1 to 2 ml

 

 

 

 

Enemas: Pediatric Fleets Enema is a common brand. Use when you haven’t had a bowel movement for a significant time (usually 5 to 7 days, but we will give you a specific number of days for your case). If there is no stool after 8 to 12 hours, then repeat the enema. Never give more than 2 enemas in a row without talking with the doctor. After you give an enema, give a laxative for 5 to 7 days after to completely remove the excessive stool from the bowel.

 YOUR TREATMENT PLAN: The blanks are left for you and your doctor to fill based on your individual child. The idea is that you give your child a consistent amount of that item. If that amount does not work, then we usually increase the amount or go to the next step as outlined above.

  1. Follow the diet plan above and use glycerin suppositories as you see fit.

  2. Give your child _______ ounces of water per day.

  3. Give your child _______ ounces of fruit juice every day (apple, prune, white grape, apple-prune)

  4. Give Colace _______ times per day and then remove one dose a day every _______ days. If the stools harden after a change, then add a dose back. If you are still giving Colace after ____ months, please notify the doctor.

  5. Give a dose of Senekot at bed time if your child has not had a bowel movement in ______ days.

  6. Give a Pediatric Fleets Enema in your child has not had a bowel movement in _____ days or if he / she is uncomfortable. Follow this by ______ days of Senekot each night to clean out the rest of the bowel.

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