Disimpaction

Oral

15–20 mL/year of age (maximum 240 mL/day) for 3 days or until stool appears

Fecal incontinence, malabsorption of fat-soluble vitamins (if treatments are repeated)

25 mL/kg/hour (maximum 1000 mL/hour) by nasogastric tube until stool appears or 20 mL/kg/hour for 4 hours/day

Nausea, vomiting, cramping, bloating, diarrhea, fecal incontinence

1–1.5 g/kg dissolved in 10 mL/kg water once/day for 3 days

Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating

Rectal

Infants and older children: 1/2–1 suppository once/day for 3 days or until stool appears

None

2–11 years: 2. 66 mL (one prepackaged pediatric enema) once/day for 3 days or until stool appears

≥ 12 years: 133 mL (one prepackaged adult enema) once/day for 3 days or until stool appears

Fecal incontinence, mechanical trauma

Rectal phosphate sodium enema

2– 4 years: 33 mL (one half prepackaged pediatric enema) once/day for 3 days or until stool appears

5–11 years: 66 mL (one prepackaged pediatric enema) once/day for 3 days or until stool appears

≥ 12 years: 133 mL (one prepackaged adult enema) once/day for 3 days or until stool appears

Mechanical trauma, hyperphosphatemia

Maintenance agents

Oral osmotic and lubricant laxatives

1 mL/kg 1 or 2 times a day (maximum 60 mL/day)

Abdominal cramping, flatus, diarrhea

1–2 mL/kg once/day

If overdose, risk of hypermagnesemia, hypophosphatemia, or secondary hypocalcemia

< 1 year or in neurologically impaired children to avoid aspiration)

1–3 mL/kg once/day

Fecal incontinence

1–18 months: 1/4 packet powder (4.25 g) in 60 mL (2 oz) water once/day

> 18 months–3 years: 1/2 packet powder (8.5 g) in 120 mL (4 oz) water once/day

≥ 3 years: 1 packet (17 g) in 240 mL (8 oz) water once/day

Fecal incontinence, diarrhea, nausea, vomiting, cramping, bloating

Oral stimulant laxatives (to be used for a limited period of time)

2–11 years: 1–2 tablets once/day

≥ 12 years: 1–3 tablets once/day

Fecal incontinence, hypokalemia, abdominal cramps

> 1 year: 1.25 mL once/day up to 2.25 mL 2 times a day

2–5 years: 2.5 mL once/day up to 3.75 mL 2 times a day

6–11 years: 5 mL once/day up to 7.5 mL 2 times a day

≥ 12 years: 1 tablet once/day up to 2 tablets 2 times a day

Abdominal cramping, melanosis coli

Maintenance diet supplements

Dietary fiber supplements

< 6 years: 0.5–1 g once/day

6–11 years: 1 g 1–3 times/day

≥ 12 years: 2 g 1–3 times/day

Less bloating than other fiber supplements, cramping, flatus

6–11 years: 1.25–15 g 1–3 times/day

≥ 12 years: 2.5–30 g 1–3 times/day

Bloating, cramping, flatus

Infants and older children: 30 to 120 mL (1–4 oz)/day

Flatus, cramping, bloating

2–20 years: 5 g plus 1 g for each year of age once/day

Bloating, cramping, flatus