The efficacy and safety of polyethylene glycol 3350 in the treatment of constipation in children

Pediatric Nursing, May-June, 2004 by Margo A. Kinservik, Margaret M. Friedhoff

In addition to laxative therapy, the position statement of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition recommends educating families about the pathophysiology of constipation and encopresis, advising a balanced diet that includes whole grains, fruits and vegetables, adequate fluids, and implementing behavior modification (Baker et al., 1999). Behavior modification techniques include toilet sitting after each meal and maintaining a stooling diary. Reward systems are sometimes helpful. Dietary advice is more helpful if it includes specific examples rather than just a general statement about increasing fiber and fluids in the child's diet. Laxatives are often necessary while theses changes in lifestyle take place, but the importance of the changes in lifestyle should never be overlooked, or the child will return repeatedly for treatment.

The cost of treatment always needs to be taken into account in this age of soaring medical costs. PEG 3350 is a prescription drug and costs more than some of the older, over-the-counter laxatives. Large deductibles and lack of health insurance may make this laxative too costly for some families. This information should be discussed with families before ordering a laxative. However, because of the acceptability of this laxative, some families may be willing to pay the price.

PEG 3350 is one of the newest therapies for the treatment of constipation. The studies reviewed were a good start and speak to the short-term safety of this medication in children. However, before this medication is given to children long-term, more studies need to be conducted including those that look at its effectiveness and safety over time. Double blinded, randomized studies with a placebo control group, or those that compare it to another medication, would also add to the knowledge of the effectiveness of PEG 3350. It needs to be known that children who are growing and developing will not be affected adversely by the use of PEG 3350. This is especially important for children with chronic constipation who may be on laxatives for years.

If this laxative is used, it is important to keep in mind that the youngest child in all of these studies was 18 months old. It may be prudent to avoid using PEG 3350 in younger children until more research is conducted. PEG 3350 offers health care practitioners and families another choice in the treatment of constipation. Will it be the "miracle" laxative as some suggest or just another choice in our arsenal of laxative therapy for childhood constipation? The answer to this question requires more evidence.

Glossary of Terms

Comparison study--a study that compares the outcome of one group of subjects to those of another group of subjects.

Convenience sample--the use of the most readily available subjects for a study.

Crossover design--a study in which the same subjects are exposed to more than one treatment.

Double-blind study--a study in which neither the subjects nor the investigators know which treatment the subjects are receiving until the experiment is over.