In a retrospective chart review conducted at Wright State University School of Medicine and The Children’s Medical Center in Dayton, Ohio, researchers evaluated the safety, efficacy, and optimal dose of polyethylene glycol (PEG) for treatment of constipation in children younger than 18 months. PEG is an osmotic agent shown to have minimal systemic absorption.1 The medical records of 28 patients, who were less than 18 months old (range 7 weeks to 17 months, including 3 aged 0–5 months) and who were treated for constipation with PEG 3350 (trade name MiraLax) for an average of 6.2 months (range 3–21 months), were reviewed. Constipation, defined as 2 weeks of hard stools (the majority of stools), or firm stools 2 or fewer times per week, was relieved in 97.6% of treated patients at a mean effective maintenance dose of PEG 3350 of 0.78 g/kg/day. Side effects included increased gas per rectum in 1 patient and transient diarrhea in 4 infants that resolved with adjustment of the medication dose. While the authors conclude that PEG 3350 is an effective treatment for constipation in children younger than 18 months with similar side effects as seen in older children, they also note that larger studies are needed to further assess its safety in infants younger than 6 months.
Constipation is a common problem, accounting for up to 5% of all visits to pediatricians and approximately 25% of referrals to pediatric gastroenterologists.2 It can have a significant effect on the everyday lives of children and their caregivers by causing a delay in toilet training.3 Treatment of childhood constipation includes medications as well as dietary and behavioral modifications. A PEG preparation without electrolytes is available, which appears to have a satisfactory safety profile, is highly palatable, and has been shown to soften stools, significantly increase bowel movement frequency, and decrease soiling frequency in older children.4–,6 In this study, the authors concluded that this same medication, PEG 3350, can be used safely in patients younger than 18 months.
A history of delayed passage of meconium, failure to thrive, recurrent infections, or lack of response to conventional therapy suggests a pathologic cause of childhood constipation. In the absence of any structural-intestinal or neurologic, endocrinologic, or metabolic causes of constipation, PEG 3350 is a medication that can be used safely by pediatricians in children. However, additional studies are needed to establish the safety and efficacy of PEG for children < 6 months of age.
This study’s results are best regarded as very preliminary findings. Since there was no control treatment group, the efficacy of PEG compared to other, or no, medications cannot be assessed. With a sample size of only 28 children, a clinically important side effect occurring in up to 10% of treated patients might go undetected. Clearly, a larger randomized controlled trial is...
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