Chronic Constipation : In Children

Liquid Paraffin Lubricant/stool softener
12 months-6 yrs: 10-15 mL daily 7-12 yrs: 20 mL daily adults: 40 mL daily ONSET: 1-3 days		·  Avoid in children < 6 months, and those with swallowing difficulty or significant gastroesophageal reflux ·  Traditionally there have been warnings to avoid paraffin-based mixtures for 2 hours before sleep; however aspiration in neurologically normal children (beyond infancy) with normal swallowing is extremely unlikely. ·  Malabsorption of fat-soluble vitamins is reported very rarely with chronic use		·  Liquid Paraffin is a non-absorbable oil which lubricates the stool.  It is a colourless, odourless, almost tasteless liquid which is easily camouflaged in many foods, especially ice cream. In liquids it will float and disperse into droplets without changing the taste of the liquid. ·  Parachoc™ contains 50% liquid paraffin, sweeteners and flavour.  Sometimes children find it too sweet. ·  The dose may be increased above the initial recommendations to get additional effect. Oil leakage from the anus should prompt a reduction in dose.
Lactulose Osmotic stool softener
10-20ml/day (starting dose) in 1-2 doses Max. 90ml/day ONSET: 1-3 days		·  Flatulence, abdominal discomfort common ·  Hyperglycaemia and electrolyte disturbance both very uncommon		·  Mixed with fruit juice, water or milk to improve taste. ·  Has been used in children from 1 month of age
Macrogol 3350  (Movicol -Half™ sachets) Osmotic stool softener
One sachet BD on day 1, two BD day 2&3, three BD day 4&5, four BD on day 6&7, titrate until desired result is achieved. For 6-11years olds: up to six sachets BD (refer to PI) ONSET: 1-4 days		·  Nausea and vomiting, diarrhoea, abdominal cramps and distension ·  Electrolyte disturbance very uncommon		·  Dissolve the contents of one sachet in 62.5 mL of water then drink. More palatable with cold water (or cordial) ·  May be taken with or without food ·  Movicol-Half™ has been used in children from 2 years of age
Sennosides (eg.Senokot™) Gut stimulant
½- 1 teaspoon of granules/day ONSET 6-12 hours	·  Abdominal cramps common		·         Can be a useful adjunct to softeners. Senna granules can be eaten or mixed with water, milk or food

*Intended to be used along with Chronic constipation Guideline

Reference:

http://www.rch.org.au/clinicalguide/guideline_index/Suggested_initial_medications_for_children_6_months_with_severe_chronic_constipation/