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

Two of the studies (Loening-Baucke, 2002, and Pashankar et al., 2001) used the behavior modification technique of having the child sit on the toilet for 5 minutes after each meal. This technique is important in the treatment of constipation (Baker et al., 1999) and could have helped to improve the frequency of the child's stooling. None of the studies look at the child's diet or asked the families to make any dietary modifications.

Implications for Practice

The studies reviewed in this article can assist providers in the treatment of constipation in children. No significant adverse effects were reported in any of the studies. Loening-Baucke (2002) followed the children for 1 year and noted that all the children continued to grow appropriately in height and weight during that time and none of them became dehydrated. This is an important consideration when giving medications to children. Adult studies are not able to indicate how the growth and development of children will be affected by a medication.

The study by Pashankar et al. (2003) reported no adverse effect on fluid and electrolyte balance in children who received PEG 3350 for a mean of 8.7 months. This is a key finding, since PEG 3350 acts as an osmotic agent in the bowel.

Acceptability of PEG 3350 was universal in all five studies. This is important since getting a child to take medication that has an adverse taste is difficult. Compliance with medication decreases if the parents have to struggle with the child to administer it. Laxatives have a history of being rather unpalatable, and some children with chronic conditions may require laxatives for years. Since PEG 3350 was accepted by children in all five studies, it will probably become the laxative of choice for children that have refused other laxatives.

The dose of PEG 3350 was reported in all reviewed studies. A wide range of doses was reported effective for maintenance. Loening-Baucke (2002) reported an effective dose of 0.5 to 1 g/kg/day, Pashankar et al. (2001) reported an effective dose of 0.84g/kg/day with a range of 0.27 to 1.42 g/kg/day, and Gremse et al. (2002) reported an effective dose of 0.3 g/kg/day in their 14-day study. In laxative therapy, the dose of the laxative may need to be titrated to produce daily soft stools, and parents should be given clear written directions on how to titrate the dose. Since PEG 3350 is normally mixed 17 grams per 8 ounces of clear fluid, titration will involve accurate measuring by the family.

The study by Youssef et al. (2002) presents information that should be useful in disimpacting children. The North American Society of Gastroenterology, Hepatology, and Nutrition, in their 1999 position statement of the treatment of constipation in children, recommend fecal disimpaction before the initiation of maintenance laxative therapy. Traditional disimpaction or "clean-out" has involved rectal medications like enemas and suppositories and/or strong stimulants and osmotic laxatives. This tends to be an uncomfortable procedure that few children tolerate well. The idea that a "clean-out" can be accomplished without rectal and/or strong oral medication has positive implications for the treatment of childhood constipation. Youssef et al. (2002) found that a dose of 1.0 to 1.5 g/kg/day for 3 days provided an effective "clean-out" in 95% of the children in their study. The adverse effects of nausea, vomiting, flatulence, cramping, and diarrhea can also occur with other disimpaction methods. If further experience with this method of disimpaction continues to provide positive outcomes, PEG 3350 could become the treatment of choice for disimpacting children.