Pediatric Constipation

Maintenance Plan:

1. Educated family on importance of healthy diet.
2. Reviewed diagnosis of constipation and its implications.
3. Reviewed stooling habits, protected time for BM, and rewards system.
4. Begin polyethylene glycol (Miralax) therapy:
   1.  1 capful mixed in 8 oz. clear fluid given daily/BID.
5. Consider adding Senna to help with stool softening:

• Ages 2-6: 8.8 mg sennosides/5 ml; give 2.5 - 7.5 ml daily
• Ages 6-11: 15 mg sennosides/chocolate square; give 1 square daily
• Age 12+: give 2 squares daily

Disimpaction Plan:

1. Educated family on importance of healthy diet.
2. Reviewed diagnosis of constipation and its implications.
3. Reviewed stooling habits, protected time for BM, and rewards system.
4. Begin disimpaction protocol:

• <5 years or mild symptoms: 
  • 8 capfuls polyethylene glycol (Miralax) mixed in 64 oz. liquid
  • Administer 8 oz. every 15 min. until finished
• >5 years or severe symptoms:
  • 16 capfuls polyethylene glycol (Miralax) mixed in 64 oz. liquid
  • Administer 8 oz. every 15 min. until finished

      5. Consider adding Senna to help with stool softening:

• Ages 2-6: 8.8 mg sennosides/5 ml; give 2.5 - 7.5 ml daily
• Ages 6-11: 15 mg sennosides/chocolate square; give 1 square daily
• ​Age 12+: give 2 squares daily

Follow-up Text:

1. Continue to provide a balanced diet with plenty of whole grains, fruits, vegetables
   1. Your child should be getting _ servings of fruits or vegetables per day.
   2. Make sure your child is staying hydrated with plenty of water intake.
2. Continue to work on the behavioral parts of constipation:
   1. Have your child sit on the toilet at least 2 to 3 times per day for 5 to 10 minutes with protected toileting time.
   2. You should never punish your child for not having a bowel movement or having an accident.

We will begin to treat with Miralax as outlined here:

1. Maintenance:

• 1 to 2 capfuls of Miralax mixed in 8 oz of clear liquid per day.

1. Disimpaction:

• < 5 yrs or mild symptoms:
  • 8 capfuls polyethylene glycol (Miralax) mixed in 64 oz. liquid
  • Administer 8 oz. every 15 min. until finished
• >5 years or severe symptoms:
  • 16 capfuls polyethylene glycol (Miralax) mixed in 64 oz. liquid
  • Administer 8 oz. every 15 min. until finished

1.  It may be best to start the treatment on a Friday as your child will be going to the bathroom frequently.