Tuesday, December 20, 2016

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/

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