# Functional Constipation in Children - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Macrogol 3350 — oral.liquid - Referral & safety-netting (no drug therapy) - Lactulose — oral.liquid - Docusate sodium — oral.liquid - Bisacodyl — 5 mg — oral.solid - Glycerin — rectal ## Complete treatment card ```text FUNCTIONAL CONSTIPATION IN CHILDREN 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 against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Parents often describe stools as small, hard little pellets, or as infrequently passed but very large - Bright red blood on hard, large stools points to an anal fissure caused by straining - Weakness in the legs should raise concern for a neurologic cause rather than simple functional constipation [leg weakness] SIGNS - what you find (3) - A fecal mass felt on abdominal palpation indicates impaction - The lower back is checked for hair tufts, hemangiomas, or dimples that could signal an underlying spinal defect - Eye bulging, lid lag, or an abnormal thyroid exam point toward hypothyroidism as the underlying cause TESTS (4) - Typical history and exam findings mean no specific testing is usually needed to diagnose functional constipation - A TSH screens for hypothyroidism and a lead level is checked when lead toxicity is a concern - A contrast enema, with biopsy if needed, helps exclude Hirschsprung disease as the cause - Abdominal X-ray can confirm impaction when the exam is hard to interpret, though it is not done routinely IF NOT THIS - what else fits (4) - Hirschsprung disease deserves special consideration in young, atypical, or persistent presentations - Symptom onset before 1 month old, delayed meconium passage, or failure to thrive are red flags for an organic cause rather than functional constipation - Botulinum toxin exposure via honey, or opiate medications, can cause constipation and belongs on the differential - Irritable bowel syndrome is a differential to consider in older children with constipation Source StatPearls "Pediatric Functional Constipation" - disease-level clinical article Status traced to the source above Rx: Main treatment | Stool softener | Stimulant laxative - short rescue course MAIN TREATMENT - choose one, plus any add-on marked below 1. MACROGOL 3350 [1st line] Adult Not applicable - a paediatric entry; the adult product is a different sachet strength - Prolonged period (at least 6 – 12 months) Peds 1 to 6 years: 1 sachet daily for maintenance 7 to 11 years: 2 sachets daily for maintenance; adjust to produce 1 to 2 soft stools daily (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) Source Movicol Paediatric Plain 6.9 g SmPC sections 4.2-4.4 (eMC product 52) Why First-line osmotic laxative recommended by NICE and ESPGHAN for childhood constipation disimpaction and maintenance Caution 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). Egypt MOVICOL PAEDIATRIC 30 SACHETS NORGINE LIMIT... 221.00 EGP -> ! also contains potassium chloride, sodium chloride, sodium hydrogen carbonate 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Pediatric Functional Constipation - disease-level clinical article (pediatric- constipation-functional-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution 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. 3. LACTULOSE [2nd line] Adult 15-30 mL daily Peds Under 1 year: Up to 5 mL daily 1 to 6 years: 5 to 10 mL daily 7 to 14 years: 15 mL daily to start, then 10 to 15 mL daily. Adjust to produce a soft stool without diarrhoea. (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.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (lactulose monograph) Why Second-line osmotic laxative when Macrogol is not tolerated or unavailable Caution May cause flatulence, belching, and abdominal cramps. Lactulose is an alternative osmotic laxative. Egypt FARCOLAC 667GM/L SYRUP 120 ML PHARCO 7.50 EGP LACTOLINE 50% SYRUP 200ML ALEXANDRIA 9.25 EGP LAEVOLAC 67GM/100ML SYRUP 120 ML SIGMA > FRESE... 12.00 EGP SEDALAC 3.35GM/5ML SYRUP 120ML SEDICO 20.00 EGP LAXOLAC 3.35GM/5ML SYRUP 300ML MUP 40.00 EGP LAXOLAC 3.35GM/5ML SYRUP 120ML MUP 50.00 EGP DUPHALAC 667GM/L SYRUP 200ML ABBOTT LABORA... 143.00 EGP LACTULOSE-AUG PHARMA 3.35GM/5ML SYRUP 320ML AUG PHARMA 170.00 EGP VILLAPURG 67% SYRUP 120 ML AL ESRAA PHAR... 12.00 EGP -> ? strength differs, ? different route - not oral liquid VILLAPURG 67% SYRUP 200 ML AL ESRAA PHAR... 17.75 EGP -> ? strength differs, ? different route - not oral liquid 4. GLYCERIN [add-on - not a substitute] Adult 4 g suppository as needed - the adult size, for reference; a child does not take this one - Single acute rescue dose Peds Infants: 1 g suppository as needed; Children: 2 g suppository as needed for acute fecal impaction Source Glycerin Suppositories BP SmPC section 4.2 (eMC products 4897 adult, 4857 child, 4876 infant) Why 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. Caution 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. Egypt GLYCERIN ADULT 6 SUPP. (EL-NILE) EL NILE. 11.00 EGP (1.83/unit) GLYCERIN INFANTILE 10 SUPP. (GLAXO) GLAXO SMITHKLINE 19.00 EGP (1.90/unit) GLYCERIN ADULT 10 SUPP. (GLAXO) SMITHKLINE BE... 22.00 EGP (2.20/unit) GLYCERIN INFANTILE 6 SUPP. (EL-NILE) EL NILE. 14.00 EGP (2.33/unit) STOOL SOFTENER 5. DOCUSATE SODIUM [2nd line] Adult Solution: 100 to 150mg three times daily, followed by plenty of water or a flavored drink. x 3-6 months Peds 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. Source Egyptian National Drug Formulary (endf-git.txt) Why Stool-softener laxative that lowers surface tension to promote water and lipid penetration into hard impacted stool. Caution Contraindicated in abdominal pain, intestinal obstruction, nausea, and vomiting. Docusate sodium should not be taken concurrently with mineral oil. Egypt EGYCUSATE 12.5 MG/5 ML PEDIATRIC SYRUP 100ML EGPI 16.00 EGP EGYCUSATE 20 MG/5 ML SYRUP 100ML EGPI 25.00 EGP EGYCUSATE 50 MG/5 ML SYRUP 100ML EGPI 31.50 EGP WAX OUT 5GM/100ML EAR DROPS 15 ML HI-PHARM 10.50 EGP -> ? strength differs, ? different route - not oral liquid STIMULANT LAXATIVE - SHORT RESCUE COURSE 6. BISACODYL [2nd line] Adult 5 to 10 mg once daily before bedtime - Short-term treatment Peds Age restriction: minimum 48 months 13 years and over: 5 to 10 mg once daily before bedtime (oral) (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.) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bisacodyl monograph) Why The disease article names stimulant laxatives for short-course rescue therapy; the card's only rescue option was rectal glycerin. Caution 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. Egypt CONSTACODYL 5 MG 10 ENTERIC COATED TAB. SIGMA 2.25 EGP DULCOLAX 5MG 20 SUGAR COATED TAB.. CID > SANOFI 3.00 EGP ABILAXINE 5 MG 20 COATED TAB. GLAXO SMITHKLINE 4.50 EGP BISADYL 5 MG 30 E.C.TABS. AMRIYA 28.50 EGP BISADYL 10MG/37ML ENEMA AMRIYA 6.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)