Medications for Use in Treatment of Constipation in Children

Lactulose (70% solution)1–3 mL/kg per d in divided dosesWell tolerated
Sorbitol (70% solution)1–3 mL/kg per d in divided dosesSimilar to lactulose but less expensive
Magnesium hydroxide (400 mg/5 mL, 800 mg/5 mL, or tablets)3 mL/kg per dMonitor for Mg toxicity, hypophosphatemia, hypocalcemia
Magnesium citrate (liquid, 16.17% Mg)<6 y of age: 1–3 mL/kg per d; 6–12 y of age: 100–150 mL/d in single or divided doses; <12 y of age: 150–300 mL/d in single or divided dosesMonitor for Mg toxicity, hypophosphatemia, hypocalcemia
PEG 33501–1.5 g/kg per d for 3 d; maintenance: 1 g/kg per d (usual dose 17 g/d)Palatable (can be dissolved in most fluids); not approved for use in infants
Phosphate enemas<2 y of age: to be avoided; ≥2 y of age: 6 mL/kg up to 135 mLMay be psychologically traumatic; may damage rectal wall; may cause abdominal distention or vomiting; tetany with hyperphosphatemia/hypocalcemia; avoid if renal disease is present
PEG electrolyte solutionFor disimpaction: 25 mL/kg per h (maximum: 1000 mL/h) via nasogastric tube until clear; maintenance: 10 mL/kg per dTaste is an issue; may cause nausea, bloating, cramps, vomiting
Mineral oil<1 y of age: not recommended; >1 y of age: maintenance 1–3 mL/kg per dSafe alternatives are available; should be used only if other agents fail; lipoid pneumonia if aspirated; leakage of stool; concern about impairing absorption of fat-soluble vitamins has not been substantiated clinically
Senna (syrup, 8.8 mg sennosides per 5 mL)2–6 y of age: 2.5 mL/d; >12 y of age: 5–15 mL/dMay cause permanent nerve or muscle damage, hepatitis, melanosis coli
Bisacodyl suppository (10 mg)May irritate rectal mucosa
Bisacodyl tablets (5 mg)Abdominal pain, diarrhea, hypokalemia
Glycerin suppositoriesMinimal adverse effects except for stress caused from insertion
  • Mg indicates magnesium.

  • Adapted with permission from Constipation Guidelines Committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2006;43(3):e1– e13.