Whelehans pharmacy treatment of chronic constipation in children
Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie
This is a continuation of last week’s article in the Westmeath Examiner. As I mentioned last week, stool softeners and laxatives are rarely needed for constipation in children; the likes of diet changes will ease the problem. However chronic constipation refers to constipation that lasts longer term (eg. weeks or months) and is a more serious problem. If constipation is long term, doctors may consider prescribing laxatives.
Age 1 to 6 months
If it is a problem from birth or meconium (sticky tar like faeces a baby passes for the first few days after birth) has not passed in first 24 hours then discuss with hospital staff as Hirschsprungs Disease or another complication is a possibility. Other things to look at are type of milk (If formula fed) and ensure adequate fluid intake (150mls/kg). A dietician can advise.
Maintenance regime
If it is an ongoing problem, laxatives may need to be prescribed. Options are A. Macrogol (Movicol): ½ to 1 sachet daily or B. Lactulose: 2.5mls twice daily (adjust depending response) or C. Lactulose and Senna*: 2.5mls once daily.
Dis-impaction regime: if faecal impaction (ie. Blockage) has occurred
Movicol ½ - 1 sachet daily is a treatment option; if this is not tolerated then Lactulose and Senna are alternative options
Age 6 months to one year
*Ensure adequate fluid intake *Ensure overfeeding is not a problem and there is not excess milk *May benefit from dietician assessment if diet is thought to be poor *Abdominal pain, stomach bloating or vomiting occurs are worrying signs *An anal fissure (tear in anal skin that is painful when passing stools) is a possibility; easily rectified by medical intervention if it occurs
Maintenance regime and dis-impaction regime
Please note, the regime for this age is the same as the regime described above for one to six months (see above)
Children over 1 year
*Ensure adequate fluid intake *Adequate exercise? An active lifestyle can help bowel movement *Ensure regular toileting *Behaviour modification (eg) toilet training/rewarding/toilet diaries etc
Maintenance regime
Movicol dosage options are: 1-6 years: 1 sachet daily (adjust to response to max of 4 sachets/day); 6-12 years: 2 sachets daily (to a max of 4 sachets/day); Over 12 years: same as adult regime
Lactulose dosage options are: 1-5 years: 2.5 to 10mls twice daily (adjust to response); over 5 years: 5 to 20mls twice daily (adjust to response)
Senna* dosage options are: 1-4 years: 2.5 to 10mls once daily; over 4 years: 2.5 to 20mls once daily. Note: Senna should only be used if lactulose or movicol do not work
Dis-impaction regime: if faecal impaction (ie. Blockage) has occurred
Movicol dosage options are: *1-5 years: 2 sachets on day 1, then 4 sachets for 2 days, then 6 sachets for 2 days and 8 sachets daily thereafter *5-12 years: 4 sachets on day 1, then increase by 2 sachets daily until max of 12 sachets daily *Over 12 years: same as adult regime. If dis-impaction not achieved by 2 weeks, add a stimulant laxative like Senna. Enemas can be considered if there is still no relief
Disclaimer: please ensure you consult with your healthcare professional before making any changes recommended