{ "schema_version": 1, "kind": "condition", "id": "pediatric-constipation-functional", "name": "Functional Constipation in Children", "category": "chronic", "sources": "NICE Guideline CG99: Constipation in children and young people 2017 · ESPGHAN/NASPGHAN Pediatric Constipation Guidelines 2014 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Glycerin Suppositories BP SmPC section 4.2 (eMC products 4897 adult, 4857 child, 4876 infant) · Movicol Paediatric Plain 6.9 g SmPC sections 4.2-4.4 (eMC product 52) · Pediatric Functional Constipation - disease-level clinical article (pediatric-constipation-functional-clinical.txt) · Egyptian National Drug Formulary (endf-git.txt) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph)", "review_status": "reviewed", "verified_against": "Movicol Paediatric Plain 6.9 g SmPC sections 4.2-4.4 (eMC product 52) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) · Glycerin Suppositories BP SmPC section 4.2 (eMC products 4897 adult, 4857 child, 4876 infant) · Pediatric Functional Constipation - disease-level clinical article (pediatric-constipation-functional-clinical.txt) · Egyptian National Drug Formulary (endf-git.txt) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph)", "verified_date": "2026-08", "treatments": [ { "id": 1396, "generic": "Macrogol 3350", "line": 1, "is_adjunct": false, "form": "oral.liquid", "strength_mg": null, "adult_dose": "Not applicable - a paediatric entry; the adult product is a different sachet strength", "adult_duration": "Prolonged period (at least 6 – 12 months)", "dose_source": "Movicol Paediatric Plain 6.9 g SmPC sections 4.2-4.4 (eMC product 52)", "rationale": "First-line osmotic laxative recommended by NICE and ESPGHAN for childhood constipation disimpaction and maintenance", "cautions": [ "Mix each sachet thoroughly in 62.5 mL water or juice.", "Ensure adequate daily fluid and dietary fiber intake.", "Macrogol 3350 with electrolytes, in the 6.9 g paediatric sachet - NOT macrogol 4000. The only macrogol 4000 product registered here is FORTRANS, a colonoscopy bowel preparation at 74 grams a sachet. Confusing the two turns a child's daily sachet into a daily sachet of bowel prep.", "Dissolve each sachet in 62.5 mL of water - a quarter glass. Made-up solution keeps 6 hours in a fridge.", "Disimpaction is a different, escalating course: for 5-11 year olds it climbs from 4 sachets on day 1 to 12 on day 7, split across a 12-hour period, and stops as soon as a large stool is passed. Seven days is the limit.", "Not in intestinal obstruction or perforation, ileus, toxic megacolon, or active Crohn's or ulcerative colitis.", "CONTINUE MAINTENANCE FOR AT LEAST 6-12 MONTHS: Treatment of children with chronic constipation needs to be for a prolonged period (at least 6 – 12 months)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Maintenance dose: 1-6 years: 1 sachet daily; 7-11 years: 2 sachets daily; adjust to produce 1-2 soft stools daily. Disimpaction regime requires escalating daily sachets over 1 week", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "1 to 6 years", "age_min_months": 12, "age_max_months": 83, "dose_text": "1 sachet daily for maintenance" }, { "label": "7 to 11 years", "age_min_months": 84, "age_max_months": 143, "dose_text": "2 sachets daily for maintenance; adjust to produce 1 to 2 soft stools daily" } ], "peds_doses": null, "brands": [ { "trade_name": "MOVICOL PAEDIATRIC 30 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NORGINE LIMITED > ACINO", "price_egp": 221.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": "potassium chloride, sodium chloride, sodium hydrogen carbonate" } ], "condition_id": "pediatric-constipation-functional" }, { "id": 1399, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Pediatric Functional Constipation - disease-level clinical article (pediatric-constipation-functional-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Have the family come back for reassessment if there is no response after 2 days of disimpaction treatment, or if there is significant abdominal discomfort or persistent vomiting.", "RED FLAG - Features concerning for an organic disorder rather than functional constipation: systemic symptoms (fever, abdominal distension, weight loss or poor weight gain, decreased appetite, bloody diarrhoea), onset before 1 month of age, delayed passage of meconium, failure to thrive, intermittent diarrhoea with explosive stools, an abnormal neurological examination (low tone, loss of the cremasteric reflex, decreased lower-limb reflexes), or no response to treatment. Any of these calls for further testing rather than routine laxative treatment." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "pediatric-constipation-functional" }, { "id": 1397, "generic": "Lactulose", "line": 2, "is_adjunct": false, "form": "oral.liquid", "strength_mg": null, "adult_dose": "15-30 mL daily", "adult_duration": null, "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph)", "rationale": "Second-line osmotic laxative when Macrogol is not tolerated or unavailable", "cautions": [ "May cause flatulence, belching, and abdominal cramps.", "Lactulose is an alternative osmotic laxative." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Infant under 1 year: up to 5 mL daily. Child 1-6 years: 5-10 mL daily. Child 7-14 years: start 15 mL daily, maintenance 10-15 mL daily. Adjust to produce a soft stool without diarrhoea.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "Under 1 year", "age_min_months": 0, "age_max_months": 11, "dose_text": "Up to 5 mL daily" }, { "label": "1 to 6 years", "age_min_months": 12, "age_max_months": 83, "dose_text": "5 to 10 mL daily" }, { "label": "7 to 14 years", "age_min_months": 84, "age_max_months": 179, "dose_text": "15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea." } ], "peds_doses": null, "brands": [ { "trade_name": "FARCOLAC 667GM/L SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 7.5, "pack_count": null, "unit_price": null, "strength_mg": 667000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LACTOLINE 50% SYRUP 200ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA", "price_egp": 9.25, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAEVOLAC 67GM/100ML SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > FRESENIUS KABI", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 67000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SEDALAC 3.35GM/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 20.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAXOLAC 3.35GM/5ML SYRUP 300ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 40.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LAXOLAC 3.35GM/5ML SYRUP 120ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUPHALAC 667GM/L SYRUP 200ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ABBOTT LABORATORIES", "price_egp": 143.0, "pack_count": null, "unit_price": null, "strength_mg": 667000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 170.0, "pack_count": null, "unit_price": null, "strength_mg": 3350.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VILLAPURG 67% SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "VILLAPURG 67% SYRUP 200 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL ESRAA PHARMACEUTICAL OPTIMA", "price_egp": 17.75, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "pediatric-constipation-functional" }, { "id": 1400, "generic": "Docusate sodium", "line": 2, "is_adjunct": false, "form": "oral.liquid", "strength_mg": null, "adult_dose": "Solution: 100 to 150mg three times daily, followed by plenty of water or a flavored drink.", "adult_duration": "3-6 months", "dose_source": "Egyptian National Drug Formulary (endf-git.txt)", "rationale": "Stool-softener laxative that lowers surface tension to promote water and lipid penetration into hard impacted stool.", "cautions": [ "Contraindicated in abdominal pain, intestinal obstruction, nausea, and vomiting.", "Docusate sodium should not be taken concurrently with mineral oil." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Infants ≥6 months: 12.5 mg three times daily. Children: 12.5 mg – 25 mg three times daily. Dilute in a glass of fruit juice or milk.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "EGYCUSATE 12.5 MG/5 ML PEDIATRIC SYRUP 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI", "price_egp": 16.0, "pack_count": null, "unit_price": null, "strength_mg": 12.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EGYCUSATE 20 MG/5 ML SYRUP 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI", "price_egp": 25.0, "pack_count": null, "unit_price": null, "strength_mg": 20.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EGYCUSATE 50 MG/5 ML SYRUP 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI", "price_egp": 31.5, "pack_count": null, "unit_price": null, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WAX OUT 5GM/100ML EAR DROPS 15 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 10.5, "pack_count": null, "unit_price": null, "strength_mg": 5000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "pediatric-constipation-functional" }, { "id": 1401, "generic": "Bisacodyl", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "5 to 10 mg once daily before bedtime", "adult_duration": "Short-term treatment", "dose_source": "Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph)", "rationale": "The disease article names stimulant laxatives for short-course rescue therapy; the card's only rescue option was rectal glycerin.", "cautions": [ "Ileus or intestinal obstruction", "Acute abdominal conditions, including appendicitis", "Acute inflammatory bowel diseases", "Severe abdominal pain associated with nausea and vomiting", "Bisacodyl suppositories should not be used when anal fissures or ulcerative proctitis with mucosal damage are present.", "The ENDF gives no oral dose under 12 years - below that age it gives the rectal route only, so the oral strength shown here is not for a younger child." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "ENDF: oral bisacodyl is given only to children over 12 years (5 to 10 mg once daily before bedtime). For children 4 to 10 years the ENDF gives the RECTAL route only, 5 mg daily for immediate effect. The ENDF states no oral dose below 12 years and none at all below 4 years, so none is given here.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 48.0, "peds_age_max_months": null, "peds_age_bands": [ { "label": "13 years and over", "age_min_months": 156, "age_max_months": 216, "dose_text": "5 to 10 mg once daily before bedtime (oral)" } ], "peds_doses": null, "brands": [ { "trade_name": "CONSTACODYL 5 MG 10 ENTERIC COATED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA", "price_egp": 2.25, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DULCOLAX 5MG 20 SUGAR COATED TAB..", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID > SANOFI", "price_egp": 3.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ABILAXINE 5 MG 20 COATED TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 4.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BISADYL 5 MG 30 E.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 28.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BISADYL 10MG/37ML ENEMA", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 6.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "pediatric-constipation-functional" }, { "id": 1398, "generic": "Glycerin", "line": 2, "is_adjunct": true, "form": "rectal", "strength_mg": null, "adult_dose": "4 g suppository as needed - the adult size, for reference; a child does not take this one", "adult_duration": "Single acute rescue dose", "dose_source": "Glycerin Suppositories BP SmPC section 4.2 (eMC products 4897 adult, 4857 child, 4876 infant)", "rationale": "Glycerin suppositories act as a local osmotic and lubricant stimulant to trigger evacuation; they are used as an occasional rescue for painful fecal impaction alongside the child's regular maintenance laxative, not as the primary long-term treatment.", "cautions": [ "Use ONLY as acute rescue for painful fecal impaction; do NOT use routinely for maintenance.", "Moisten tip with water before insertion.", "Three separate products, not one cut down: 1 g for infants, 2 g for children, 4 g for adults. The label says outright that the adult suppository is not suitable for a child.", "Dip it in water before insertion." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Infants: 1 g suppository as needed; Children: 2 g suppository as needed for acute fecal impaction", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "GLYCERIN ADULT 6 SUPP. (EL-NILE)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 11.0, "pack_count": 6, "unit_price": 1.83, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLYCERIN INFANTILE 10 SUPP. (GLAXO)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 19.0, "pack_count": 10, "unit_price": 1.9, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLYCERIN ADULT 10 SUPP. (GLAXO)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SMITHKLINE BEECHAM > GLAXO SMITHKLINE", "price_egp": 22.0, "pack_count": 10, "unit_price": 2.2, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GLYCERIN INFANTILE 6 SUPP. (EL-NILE)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 14.0, "pack_count": 6, "unit_price": 2.33, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "pediatric-constipation-functional" } ] }