Understanding Safe Laxative Use For Young Children

Constipation is a common issue for children, and it can be worrying for parents. It's important to remember that occasional constipation is normal and not usually a cause for concern. However, if your child is experiencing regular discomfort, it's important to address the issue.

Before giving your child any over-the-counter (OTC) laxatives, it's recommended to try lifestyle changes first. This includes increasing their fluid intake and ensuring they get enough fibre in their diet. Simple dietary changes can often help relieve constipation.

If these changes don't help, you may need to consider laxatives. Laxatives are medications that can help treat and prevent constipation by softening stools or stimulating bowel movements. It's important to talk to your child's doctor before giving them any laxatives to ensure you're giving the correct type and dosage for their age.

Remember that the goal is to help your child develop regular bowel habits, and laxatives may be necessary until they can achieve this without help. It's also crucial to monitor the frequency of laxative dosages to prevent your child from becoming dependent on them.

Laxatives for children: when to use them

Constipation is common in children and can be worrying for parents. It is characterised by hard, painful stools, and can be caused by a lack of fibre, water, or both, in a child's diet. Processed food, dairy, white bread, and some meats can also contribute to constipation.

Before using laxatives, it is recommended to try addressing these dietary issues, as well as making other lifestyle changes such as increasing physical activity and optimising toilet posture and bathroom schedules. If these changes do not help, a healthcare professional may recommend the use of laxatives.

Laxatives are relatively safe for children and can be an effective way to relieve constipation. They work by either softening the stool or stimulating a bowel movement. There are several different types of laxatives, including:

• Osmotic laxatives: These draw water into the stool to help it move through the colon quicker. Polyethylene glycol (Miralax) is the most commonly used osmotic laxative and is considered a first-choice treatment for constipation in children. It is tasteless and generally well-tolerated. However, overuse may reduce the intestine's ability to contract, leading to worsened constipation or dependence on the medication.
• Stool softeners: These add moisture to the stool, making it easier to pass.
• Lubricant laxatives: These coat the stool, making it slippery and easier to pass. Mineral oil is the most commonly used lubricant and is typically used in children over 3 years old.
• Stimulant laxatives: These stimulate the rectal muscles to help push the stool out. Bisacodyl (Dulcolax) is an example of a stimulant laxative.

It is important to closely follow dosage instructions and not give more than one type of laxative at a time. Laxatives should only be used under the guidance of a healthcare professional, as they can have side effects and may not be suitable for children with certain medical conditions.

For children with very hard or impacted stools, a bowel washout may be necessary. Lactulose, sodium picosulphate, and macrogol are common medicines used for this purpose.

In summary, laxatives can be a safe and effective way to relieve constipation in children when lifestyle changes are not sufficient. However, it is important to work with a healthcare professional to determine the best treatment option and to monitor for any side effects.

Types of laxatives

There are four main types of laxatives for children: stool softeners, osmotic laxatives, lubricant laxatives, and stimulant laxatives. Each type works differently to produce a bowel movement.

Stool Softeners

Stool softeners add moisture to the stool, making it less hard and easier to pass. They are also known as emollient stool softeners. Docusate sodium (Colace, Docu-Soft, Diocto, DSS) is a common stool softener. Senna concentrate/docusate (Peri-Colace, Senokot, Dok Plus) is a combination of a stool softener and a stimulant.

Osmotic Laxatives

Osmotic laxatives increase the water content in the intestines, making it easier for hard stool to pass. They produce an osmotic effect in the colon that results in distention and promotes peristalsis. Polyethylene glycol (MiraLAX, Dulcolax Balance) is the most commonly used osmotic laxative and is considered a first-choice treatment for constipation in children. It is tasteless and generally well-tolerated by children. Lactulose (Constulose, Enulose, Generlac, Kristalose) is another type of osmotic laxative that is generally well tolerated and has a sweet taste. Bulking agents, such as psyllium (Metamucil) and calcium polycarbophil (Fibercon), are fiber supplements that work by increasing the amount of water absorbed in the stool.

Lubricant Laxatives

Lubricant laxatives coat the stool, making it slippery and easier to pass. They also soften the stool by decreasing water absorption from the gastrointestinal tract. Mineral oil (Kondremul) is a commonly used lubricant laxative.

Stimulant Laxatives

Stimulant laxatives stimulate the rectal muscles to push the stool out. They also increase peristaltic activity in the gastrointestinal tract and stimulate salt and water secretion in the colon. Senna (Ex-Lax, Senokot, Fletcher's, Little Tummys) and bisacodyl (Dulcolax), Bisco-Lax are examples of stimulant laxatives.

It is important to note that laxatives are generally safe for children but should only be used under the guidance of a healthcare professional. They can have side effects, and overuse may lead to dependence or intestinal issues.

Dietary changes to prevent constipation

Before making any dietary changes, it is important to consult a healthcare professional. They will be able to advise you on the best course of action for your child's specific needs.

Now, let's look at some dietary changes that may help prevent constipation in children:

Increase Fluid Intake

It is important for children to stay hydrated by drinking enough water and other fluids. This will help to soften stools and make them easier to pass. Offer water throughout the day and ensure it is easily accessible to your child. You can also offer natural fruit and vegetable juices, clear soups, and squash. However, it is best to avoid sugary drinks, concentrated fruit juices, and fizzy drinks as they contain few nutrients and can be bad for teeth.

High-Fiber Diet

A high-fiber diet is crucial in preventing constipation. Fiber helps to strengthen bowel function and keeps things moving smoothly through the digestive tract. Include a variety of fiber-rich foods in your child's diet, such as:

• Whole grains: Whole wheat bread and pasta, oatmeal, bran flake cereals, and higher fiber white breads.
• Legumes: Lentils, black beans, kidney beans, soybeans, and chickpeas.
• Fruits: Berries, apples with the skin on, oranges, pears, apricots, prunes, peaches, and plums.
• Vegetables: Carrots, broccoli, green peas, collard greens, and pulses.
• Nuts and seeds: Almonds, peanuts, pecans, and ground or puréed nuts/seeds for children under five.

The recommended daily fiber intake varies depending on age and sex. It is calculated as 14 grams for every 1,000 calories in your child's diet. For younger children, this translates to about 20 grams of fiber per day. For adolescent girls, it is recommended to have 29 grams per day, while adolescent boys should aim for 38 grams per day.

Gradual Changes

When making dietary changes to increase fiber and fluid intake, it is best to do so gradually. Introduce new foods and increase fiber content slowly over a period of a few days to give your child's body time to adjust.

Avoid Constipating Foods

Some foods can contribute to constipation due to their low fiber content. These include processed foods, such as hot dogs, frozen meals, and microwavable dinners, as well as dairy products and cow's milk. It is best to limit the consumption of these foods and prioritize high-fiber options instead.

Encourage Physical Activity

Regular physical activity helps to stimulate normal bowel function. Encourage your child to be active by incorporating fun activities like walking, running, skipping, dancing, or playing together.

Establish a Bathroom Routine

Create a bathroom routine by setting aside time after meals for your child to use the toilet. Encourage them to try and have a bowel movement after eating. You can also provide a footstool to ensure they are comfortable and have enough leverage when sitting on the toilet.

Educate Your Child

Talk to your child about constipation in simple terms they can understand. Explain what causes it, such as eating processed foods and not drinking enough water. Also, teach them about the benefits of drinking more water and eating healthier foods. This knowledge will empower them to make better food choices when they are away from home.

Offer Small, Regular Meals

If your child has a poor appetite or is a picky eater, try offering small, regular meals and snacks. This can help ensure they get enough fiber and fluids throughout the day.

Remember, it is always best to consult with a healthcare professional before making any significant dietary changes or if you have concerns about your child's health. They can provide personalized advice and guidance based on your child's specific needs.

Natural laxatives

If your child is constipated, it is important to consult a healthcare professional for advice. They may recommend natural laxatives, such as:

• Prunes, apples, and pears. These fruits contain sorbitol, a sugar that draws water into the bowels and softens the stool.
• Abdominal massage and bicycling the legs can help infants and small children pass stools.
• Water. Aim for the following daily water intake: 4 to 8 oz for 6 to 12-month-olds, about 4 cups for 1 to 3-year-olds, about 5 cups for 4 to 8-year-olds, and about 8 cups for 8 years and older.
• High-fibre foods. Aim for five servings of fruits and vegetables per day.
• Reduced dairy. Many children have a sensitivity to the proteins found in cow's milk, which can cause constipation.

Other natural remedies that may be recommended by a healthcare professional include:

• Probiotics. These can help keep good bacteria in the stomach and promote bowel regularity.
• Suppositories and enemas. These can be uncomfortable for the child and must be done correctly.
• MiraLAX. This is a good medication for constipation when used correctly in children over one year old.

How long should my child take laxatives?

It is important to remember that laxatives are meant to be used for as long as it takes for your child to develop a normal habit of pooing regularly. This could be months to years rather than weeks. The aim is for your child to be able to manage a daily soft poo that is not painful to pass without the help of laxatives. You may need to adjust the dose over time, but it is important to continue the laxative treatment.

Children often get sick of taking medicine or dislike the taste. To make the medicine taste better, you can try putting it with milk or juice, or ask your doctor or nurse about an alternative laxative. Incentive or 'star charts' can also be a good way of encouraging your child to take medicine regularly.

It is recommended that you work with your child's pediatrician to determine whether your child needs a stool softener and for how long. Changes in diet can also help treat constipation. If dietary changes do not work or are not an option, then consider your other options. There are other stool softeners available, but remember that all medications have potential risks. Work with a physician to determine the best time to wean your child off the laxative.

Frequently asked questions