Children’s Hospital of Colorado has a great educational on how constipation can become complicated and, in general terms, how it can be treated.
Treating Complicated Pediatric Constipation
One of the most difficult medication regimens in pediatrics is a clean-out for the treatment of complicated constipation. Unfortunately, there really isn’t any other method for resolving long-standing, complicated constipation.
The method below is Panda’s standard cleanout. This regimen may be altered by your pediatrician while treating this problem depending on your child’s age and personal health issues.
Confirmatory abdominal X-Ray
Before beginning a difficult cleanout, your doctor will confirm this is necessary by getting an X-Ray at an imaging center. Once you receive a call from our office confirming this treatment is necessary, you can move to the subsequent steps.
Clear Liquid Diet (see below)
To speed the cleanout and improve your chances of success, your child needs to be on a clear liquid diet during this process, see below for further details.
Cleanout: Day 1-2
Your child will receive a pediatric fleets enema once daily on day 1 and 2 of the cleanout. Additionally, your child drinks as many glasses of miralax as possible, at least 4 glasses per day. Miralax is given by 1 capful (from the bottle) in 8 ounces of clear fluid, typically an electrolyte solution such as gatorade. Lastly, they will receive a chocolate tablet called Senna at night before bed.
Cleanout: Day 3-5
Your child drinks as many glasses of miralax as possible, at least 4 glasses. Lastly, they will receive a chocolate tablet called Senna at night before bed.
Second abdominal X-Ray
Obtain the second X-Ray for the following reasons:
> Your child has three poops that are clear or yellow water in a row
> On cleanout day 5, you haven’t seen three clear poops yet
> If your child can no longer tolerate the cleanout
Call the office (785-842-4477)
Once the X-Ray is completed, call the office to get the X-Ray results, these should be available within the hour. If getting the X-Ray outside of our business hours you may need to wait until our office is open to have them read. After confirming the cleanout is complete, you may move to the maintenance plan.
Clear Liquid Diet
A clear liquid diet consists of liquids which are transparent (you can see through them when held up to the light) and are liquid at body temperature. A clear liquid diet is easily digested and leaves no undigested residue in your intestinal tract.
Foods and liquids allowed on the clear liquid diet include popsicles, clear juice without pulp, plain gelatin, ice chips, water, sweetened tea or coffee (no creamer), clear broths, carbonated beverages, and flavored water. It is important you do not consume any liquids with red dye or coloring as it may give misleading test or procedure results.
Specific liquids or foods allowed are:
Water, plain or flavored. Standard or sparkling.
Drinks made from powdered drink mixes (such as Kool Aid and Crystal Light – no red)
Fruit juices – apple or grape
Lemonade – no pulp
Broth (bouillon or consommé) – beef, chicken or vegetable
Carbonated beverages without red dye
Plain gelatin – lemon or lime
Sports drinks without red dye
Popsicles without fruit pulp – banana, lemon or lime (No red)
Tea or coffee without creamer
Sugar or sugar substitute
Once a cleanout is complete, this last plan is meant to ensure the constipation does not quickly return and that your child can completely discontinue all medications. It is easier than the cleanout, but requires lots of consistency, however it’s important to finish it for successful treatment of your child’s problem.
Move back to a normal diet
You can stop the clear liquid diet and return to your child’s normal diet. Diets that are high in carbohydrates or dairy products may increase the chance that your child becomes constipated again. Ask your provider if you need help with dietary manipulation.
Stop all constipation medications except Miralax
At this point you should be done with Fleets Enemas, Senna, and Electrolyte Solutions (such as gatorade). Miralax dosing will now decrease to an amount that causes your child to have a once daily soft stool, roughly the diameter of a quarter. You may from time to time, need to adjust the medication up or down in dose to keep to this goal. We recommend mixing Miralax from here on out with 2 ounces of juice and 6 ounces of water. A child should never have more than 4 ounces of juice per day.
Maintain a daily stooling habit
Your child should sit on the toilet for 5 to 10 minutes, twice daily, after meals to build the habit of daily stooling. Your child should stool like they brush teeth, they have to do it, even if they don’t feel like they need to. It is not important that they always go, only that they maintain this habit.
When you have kept your child’s stool at goal (step 2) and maintained a stool habit (step 3) for 6 months, you can stop Miralax. No weaning is necessary from the medication. Continue the habit poop, at least once daily, after dinner is an ideal time. Most children no longer need a habit after 7 years of age, but this habit will ensure this problem never arises again.