A 6-year-old boy with two weeks of constipation and hard stools every 3-4 days, with food and fluid intake decreasing. Select the most appropriate laxative.

A 6-year-old boy with two weeks of constipation and hard stools every 3-4 days, with food and fluid intake decreasing. Select the most appropriate laxative.

• A. Lactulose
• B. Docusate
• C. Macrogol
• D. Senna

Answer: (C)

In children with functional constipation, the best first-line option is an osmotic laxative that softly and safely increases water content in the stool to produce regular, comfortable bowel movements. Macrogol (polyethylene glycol) does this effectively by holding water in the stool, which makes the stool softer and easier to pass. It is not absorbed into the bloodstream, has a strong safety profile in kids, and can be used long enough to manage ongoing constipation if needed. For a child with reduced intake, choosing a laxative that doesn’t cause unnecessary dehydration or electrolyte disturbance is important, and macrogol fits that need well because it works primarily by osmotic effects with minimal systemic effects. Lactulose also acts osmotically but often causes gas, bloating, and discomfort, which can worsen poor intake in a child. Docusate is a stool-softening agent that may help milder cases but tends to be less effective for established pediatric constipation. Senna is a stimulant laxative that can produce cramping and bowel movements quickly, but it carries a higher risk of cramping and dependence with long-term use, so it’s not preferred as initial therapy in a young child.

In children with functional constipation, the best first-line option is an osmotic laxative that softly and safely increases water content in the stool to produce regular, comfortable bowel movements. Macrogol (polyethylene glycol) does this effectively by holding water in the stool, which makes the stool softer and easier to pass. It is not absorbed into the bloodstream, has a strong safety profile in kids, and can be used long enough to manage ongoing constipation if needed. For a child with reduced intake, choosing a laxative that doesn’t cause unnecessary dehydration or electrolyte disturbance is important, and macrogol fits that need well because it works primarily by osmotic effects with minimal systemic effects.

Lactulose also acts osmotically but often causes gas, bloating, and discomfort, which can worsen poor intake in a child. Docusate is a stool-softening agent that may help milder cases but tends to be less effective for established pediatric constipation. Senna is a stimulant laxative that can produce cramping and bowel movements quickly, but it carries a higher risk of cramping and dependence with long-term use, so it’s not preferred as initial therapy in a young child.