In today's Examiner, the concluding part of Eamonn's piece on Constipation in children and infants
Posted by Eamonn Brady on
ASK YOUR PHARMACIST
Treatment of chronic constipation in children
Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacies, Pearse St and Clonmore, Mullingar. If you have any health questions e-mail them to info@whelehans.ie
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 (i.e. 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 (i.e. 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
For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).