Cochrane for Clinicians

Putting Evidence into Practice

Laxatives for the Management of Childhood Constipation

 

Am Fam Physician. 2017 Oct 1;96(7):433-434.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are laxatives an effective and safe treatment for functional childhood constipation?

Evidence-Based Answer

Polyethylene glycol (PEG) is superior to placebo (mean difference [MD] = 2.61 more stools per week; 95% confidence interval [CI], 1.15 to 4.08), lactulose (MD = 0.70; 95% CI, 0.10 to 1.31), and milk of magnesia (MD = 0.69; 95% CI, 0.48 to 0.89) at increasing the number of bowel movements per week at two to 12 weeks. High-dose PEG (0.7 g per kg) is superior to low-dose PEG (0.3 g per kg) at increasing the number of stools per week (MD = 1.30; 95% CI, 0.76 to 1.84). PEG is not superior to enemas, flixweed, or liquid paraffin. There are no serious adverse effects associated with regular use of PEG. Common adverse effects with use of any of the tested laxatives include flatulence, abdominal pain, nausea, diarrhea, and headache.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Childhood constipation is a common disorder affecting up to 30% of children worldwide.2 It not only stresses the patient and family, but it is also a strain on the health care system. Children diagnosed with constipation visit the emergency department far more often than those without constipation3 and account for 3% of all general pediatric visits and 30% of all pediatric gastroenterology visits.1 Constipation in children costs the health care system $3.9 billion per year.2 Despite the widespread use of laxative medications in children, there is a relative lack of data on their effectiveness and safety.

This review included 25 randomized controlled trials with 2,310 participants who had functional constipation. Of all the treatments, PEG was studied the most extensively. After two weeks of treatment, patients treated with PEG (dosed based on age and clinical response, in one study 0.2 to 0.8 g per kg per day) had an increased number of bowel movements per week vs. patients who received placebo (two studies, 101 patients;

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Gordon M, MacDonald JK, Parker CE, Akobeng AK, Thomas AG. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev. 2016;(8):CD009118....

2. Liem O, Harman J, Benninga M, Kelleher K, Mousa H, Di Lorenzo C. Health utilization and cost impact of childhood constipation in the United States. J Pediatr. 2009;154(2):258–262.

3. Choung RS, Shah ND, Chitkara D, et al. Direct medical costs of constipation from childhood to early adulthood: a population-based birth cohort study. J Pediatr Gastroenterol Nutr. 2011;52(1):47–54.

4. Tabbers MM, DiLorenzo C, Berger MY, et al.; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition; North American Society for Pediatric Gastroenterology. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58(2):258–274.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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