Functional constipation in children: What physicians should know

Table 5 Laxatives used for functional constipation in children[1,6,37,58]

Agent	Child’s age	Dosage	Side effects
Osmotic laxatives
PEG	Any age	0.4-0.8g/kg per day for maintenance; 1-1.5g/kg per day for fecal disimpaction	Diarrhea, bloating, flatulence, nausea, vomiting, abdominal cramps
Lactulose (70% solution)	Any age	1 mL/kg once or twice daily (max 120 mL per day)	Bloating, flatulence, abdominal cramps, fecal, incontinence
Sorbitol (70% solution)	1-11 yr	1 mL/kg once or twice daily (max 30 mL per day)	Bloating, abdominal cramps
	> 12 yr	15-30 mL once or twice daily
Milk of magnesium	> 2 yr	1-3 mL/kg per day once or twice daily	Abdominal pain, fecal incontinence, hypermagnesaemia, hypocalcaemia, hypophosphataemia (with excess use in children with renal disease)
Stimulant laxatives
Senna (antraquinone)	> 2 yr	7.5-15 mg/kg per day once daily	Abdominal cramps, idiosyncratic hepatitis, melanosis coli in prolong used, nephropathy, neuropathy, hypertrophic osteoarthropathy
Bisacodyl	> 2 yr	5-10 mg per day once daily	Diarrhoea, abdominal cramps
Sodium picosulphate	4-5 yr	3 mg per day	Nausea, vomiting, bloating, abdominal cramps, diarrhea, headache, taste impairment
	> 6 yr	4-6 mg per day
Glycerine suppository	< 1 yr	Half for pediatric suppository once daily	Rectal irritation, bloating, abdominal cramps, diarrhea
Rectal laxatives/enemas
Sodium phosphate	> 1 yr	2.5 mg/kg	Rectal discomfort, diarrhea, abdominal cramps, electrolyte imbalance
Bisacodyl	2-12 yr	5 mg/dose once daily	Rectal discomfort, diarrhea, abdominal cramps, hypokalemia
	> 12 yr	5-10 mg/dose once daily
Saline enema	Neonate	< 1 kg: 5 mL, > 1 kg: 10 mL	Rectal discomfort, bloating
	> 1 yr	6 mL/kg once or twice daily
Lubricant
Mineral oil	> 1 yr	1-2 mL/kg daily (max 90 mL per day)	Rectal discomfort, lipoid pneumonitis

PEG: Polyethylene glycol.