Constipation is a common pediatric problem that can often be managed at the primary care provider level. The goal is for the child to have a regular, soft stool daily. Medications should be given on a regular basis to ensure that this occurs, particularly children with encopresis and soiling where the goal is to stay “clean”. This process may take over a year for this problem to resolve, and some individuals with slow motility require stool softeners and laxatives throughout their lives.
Approach
A bowel cleanout is often necessary at the beginning of therapy and if the child gets backed up
Medications should be given in sufficient amounts to produce a daily, mushy bowel movement. Most children require this aggressive approach for 9-18 months to break the cycle of fear and pain with defecation from stool withholding. Stopping or decreasing the medications too soon is a common mistake.
PEG 3350/MiraLax is the mainstay of therapy. Stimulant therapy (Senna/bisacodyl) is often required for encopretics, neurologically impaired patients or patients with slow bowel motility.
Enemas and suppositories may be necessary in children with large amounts of stool in their rectum
Behavior
Sit on toilet 3-4 times a day with active pushing and no distractions (15-20 minutes after each meal and before bed) for 10 minutes.
To facilitate bowel movements: positioning (knees up/squat), 'squatty potty' sit on toilet backwards, blow into a straw w/balloon, abdominal pressure (pillow, stuffed animal, holding knees)
Diet
A modest increase in dietary fiber plays a minor role in the management of constipation. Your child should be taking 10-20 grams of fiber a day
Your child requires 24-32 oz. of water daily
Other items that may help include limiting animal based dairy (12-20 oz./day) and FODMAP's. In addition eliminating carbonated beverages, gum chewing and artificial sweeteners.
