Initial laxative therapy for children 1 year or older

Tabbers, 2014 National Institute for Health and Care Excellence (NICE), 2010 Hyams, 2016

If nondrug measures for constipation are ineffective, consider starting an osmotic or stool-softening laxative. Use:

1macrogol 33501; for example: macrogol 3350 macrogol 3350 macrogol 3350

Movicol Junior (6.563 g per sachet, with electrolytes)

child 1 to 5 years: 1 sachet in 60 mL of water orally, daily

child 6 years or older: 2 sachets in 120 mL of water orally, daily (increase if needed up to 4 sachets daily, in divided doses)2

OR

OsmoLax (8.5 g per measuring scoop, without electrolytes)

child 2 to 5 years: 1 level scoop mixed with 120 mL of water orally, daily

child 6 to 12 years: 2 level scoops mixed with 240 mL of water orally, daily

OR

2lactulose lactulose lactulose lactulose

child 1 to 4 years: 2.5 to 10 mL orally, twice daily

child 5 years or older: 5 to 20 mL orally, twice daily. If needed, mix with other drinks to improve taste

OR

2paraffin 50% emulsion3 paraffin paraffin lactulose

child 1 to 5 years: 10 to 15 mL orally, daily

child 6 to 12 years: 15 to 20 mL orally, daily

child older than 12 years: 40 mL orally, daily

OR

3docusate docusate docusate docusate

child 3 to 5 years: 50 mg orally, daily

child 6 to 11 years: 50 to 150 mg orally, daily

child 12 years or older: 50 to 150 mg orally, once or twice daily

OR

3poloxamer 10% liquid poloxamer

child 12 to 17 months: 0.5 mL orally, three times daily

child 18 months to 3 years: 0.8 mL orally, three times daily.

Laxative dosage should be titrated until the stool has the consistency of wet cement or porridge. Daily dosing is preferable to intermittent or less frequent dosing.

If treatment does not induce regular defecation after 2 to 3 months, review adherence and consider trialling a different osmotic or stool-softening laxative. There is no evidence that long-term osmotic or stool-softening laxative use is harmful, addictive or damaging to enteric nerves.

If the above therapy is ineffective, referral to a specialist is recommended; see Therapy for refractory constipation in children 1 year or older. Referral is also indicated in children who have responded to the above therapy, but require long-term (ie more than 6 months) use of regular laxatives, or if a trial of stopping laxative therapy is unsuccessful.

1 Various preparations of macrogol 3350 (with or without electrolytes) are available; dose according to product information.Return
2 For children using 2 or more Movicol Junior sachets daily, consider switching to Movicol, which has 13.12 g of macrogol 3350 per sachet (equivalent to 2 Movicol Junior sachets). Mix each Movicol sachet in 125 mL of water.Return
3 Do not use paraffin emulsion in children younger than 1 year or children at risk of aspiration (eg due to swallowing difficulties, vomiting or reflux). The child must remain upright for 2 hours after the dose.Return