I received a question from one of our twitter followers about her daughter who was recently found to be constipated. She wanted some information on treating constipation.
Do you know how common constipation is in pediatrics? I must discuss this at least once a day, and I have dealt with “poop issues” in my own home while raising my boys. As a mother, I was really amazed at how much discomfort and disruption of a child’s life simple constipation can cause. Constipation is defined as reduced frequency of or painful stooling in a child for two or more weeks.
The majority of pediatric patients have functional constipation, and rarely have issues secondary to anatomic, physiologic or metabolic problems. It is not uncommon to see children have a change in their stools as they become toddlers with varying eating habits, during elementary school years when children don’t want to use the bathroom at school and even later in life.
Once your child has been potty trained, it is often difficult to get a good history of their “poop” habits, and many children and even teens will report that they have “normal” stools and then on abdominal exam or x-ray are found to have “tons of poop”. There are several ways to treat constipation, and there are several different products that may be used without problems.
For daily management of constipation I recommend using either milk of magnesia (MOM) or Miralax (polyethylene glycol) which may be used safely for long periods of time. MOM is easy to use in an infant and can be started in 1/4 to 1/2 teaspoon daily and may be increased as necessary in order to produce a soft stool at least every 24 to 48 hours.
As children get older they may not be as willing to take MOM in larger doses and Miralax has truly been a “miracle” in that it is tasteless and odorless and may be mixed with juice for easy acceptance. The starting dose for Miralax is 1/2 to 1 capful (17 grams) per day in a child over the age of one to two years. I tell the parents again to titrate the dose either up or down, to produce a soft stool every day or every other day.
I also advocate using bite sized prunes, prune juice-apple juice “cocktails”, and Metamucil cookies to help maintain normal “mushy” stools. For children who have problems with constipation or resistance in stooling, it is important that they have a dedicated time each day to use the bathroom. Good poop habits often take practice before becoming routine. Treating for many months may not be uncommon, especially in children who have ongoing constipation issues.
That’s your daily dose, we’ll chat again tomorrow.