Constipation In Children
Constipation develops over time and if not managed may lead to leakage. Leakage is when the child withholds the harder stool, but is unable to hold the softer stool and and it leaks around or if their colon is so full that the second the sphincter relaxes stool is let out. A child can be constipated even if they stool everyday. Untreated constipation can lead to:
- abdominal pain
- urinary accidents (day & nighttime)
- anxiety
- activity & school avoidance
CLEAN OUT
- Allow 2-3 days at home for clean out
- Start with bowel stimulant (Constipation slows down transit through the intestine, a stimulant gets the bowel moving again)
- Milk of magnesia ages 2-5 years old= 7.5ml up to twice daily for 2 days, ages 6-11 years old= 15ml up to twice daily for 2 days, >12 years old= 15-30ml up to twice a day
OR
- Ex Lax squares ages 2-6 years old= 1/2 square twice daily, 6-12 years old= 1 square twice a day, >12 years old= 1-2 squares twice a day.
AND
1 capful of Miralax in 8 ounces of fluid (Miralax is a stool softener that makes the stool soft so stools are not painful to pass)
The goal with clean out is to achieve brown watery/ liquid stool the consistency of butterscotch.
Once cleaned out, MUST start maintenance.
MAINTENANCE
Goal is 1-2 soft stools daily.
-Miralax 1tsp mixed in liquid every morning
-May increase or decrease as needed to achieve 1-2 soft stools per day
-May use fiber supplement instead, like fiber gummies (in our experience children are more likely to remember to take fiber gummies because they taste good and not many children will remind their parents to give them miralax)
-Child should pick a time 15 minutes after a meal to sit for at least 15 minutes on the toilet even if they do not go still sit for the full 15 minutes.
-Breakfast is the best meal to do this with because they will not have to stool at school, which most children do not like to do.
-If no stool for 2-3 days may give dose of milk magnesia or ex lax to stimulate the process again. Expect to continue maintenance for 12 months. Parent please keep track and be consistent with the above. Given autonomy the child will likely regress again.