Poop Sheet - Constipation Management Guide — Constipation Management Guide

Evidence-based strategies and weight-based PEG 3350 dosing for constipation in children, based on SickKids AboutKidsHealth, CHEO, and CPS guidelines.

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What is Constipation?

Clinical Definition

Bristol 1–2 Constipation
Bristol 3–4 Ideal
Bristol 6–7 Diarrhea
Constipation is defined as fewer than 2 bowel movements per week, or stools that are hard, dry, and painful to pass (Bristol types 1–2). Bristol types 3–4 are the target consistency. Types 6–7 indicate diarrhea. Constipation is extremely common in children and is usually not serious.

Red Flag Symptoms — Seek Medical Attention

  • Blood in the stool
  • Ribbon-like or pencil-thin stools
  • Severe abdominal distension
  • Vomiting with constipation
  • No meconium passed within 48 hours of birth
  • Constipation beginning in the first month of life
  • Neurological symptoms (weakness, decreased tone)
PEG 3350 Dosing Calculator

About PEG 3350

PEG 3350 is sold in Canada as Lax-A-Day and RestoraLAX (and generically). It is an osmotic laxative — tasteless and odourless. Suitable for children ≥ 6 months. One standard sachet or one full RestoraLAX cap = 17 g.
Phase 1 — Disimpaction
Disimpaction Dose
—
1.5 g/kg/day · max 100 g/day
Duration
3–6 days
Until disimpaction confirmed
Daily Maximum
100 g / 10 caps
Physician guidance required

Disimpaction Dose — Calculated

Single Daily Dose
Daily dose (g)
—
—
Daily dose (caps)
—
17 g per cap
Split — Twice Daily (each dose)
Split dose (g)
—
—
Split dose (caps)
—
17 g per cap
Physician guidance required. Confirm impaction before starting. Give 1.5 g/kg/day for 3–6 days. May be given as a single daily dose or split into two doses. Once disimpaction is confirmed (soft stool passed, abdomen soft), stop and transition immediately to maintenance dosing below. Maximum 100 g/day (10 caps).
Phase 2 — Maintenance
Low End
—
0.4 g/kg/day
High End
—
0.8 g/kg/day
Duration
Weeks–months
Until regular habits established
Daily Maximum
17 g
1 standard sachet / 1 full cap

Maintenance Dose — Calculated

Low end (g/day)
—
—
High end (g/day)
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—
Cap measure (low)
—
of a 17 g cap
Cap measure (high)
—
of a 17 g cap
Start at the low end and titrate upward to achieve one soft stool per day. Effects may take 2–3 days. Maximum is 17 g/day (one standard Lax-A-Day / RestoraLAX sachet or one full cap). May be given as a single daily dose or split into two. Continue for weeks to months until regular bowel habits are well established before gradually weaning.

How to Mix PEG 3350 (Lax-A-Day / RestoraLAX)

Mix the powder in 250 mL (1 cup) of water, juice, or milk. Stir until fully dissolved — it is tasteless and odourless. Can be mixed into a child's favourite drink. Do not mix with carbonated beverages. Suitable for children ≥ 6 months.

Other Evidence-Based Strategies

Dietary Fibre

  • Target: child's age in years + 5 g/day (e.g. a 4-year-old needs ~9 g/day)
  • High-fibre foods: pears, prunes, apples (with skin), berries, broccoli, carrots, peas, oatmeal, whole wheat bread, bran cereals, beans, lentils
  • Avoid excessive dairy (milk, cheese) — can worsen constipation
  • Introduce fibre gradually to avoid gas and bloating

Fluid Intake

Age Target / day
1–3 years ~4 cups (1 L)
4–8 years ~5 cups (1.2 L)
9–13 years ~7–8 cups (1.7 L)
  • Water and milk are best; limit juice to ≤ 125 mL/day for toddlers
  • Prune juice has evidence for mild constipation: 60–120 mL/day for infants >1 month; 125 mL/day for toddlers

Toilet Routine

  • Scheduled sitting after meals — gastrocolic reflex is strongest 20–30 min after eating
  • Sit for 5–10 minutes; avoid rushing or pressuring the child
  • Use a footstool so knees are above hips — squatting position relaxes the puborectalis muscle
  • Positive reinforcement — praise the attempt, not just success

Physical Activity

  • Regular physical activity stimulates bowel motility
  • Aim for 60 minutes of moderate activity per day for school-age children
  • Even short walks after meals can help

Behavioural Strategies

  • Keep a stool diary to track frequency, consistency, and any pain
  • Reward charts for toilet sitting (not for producing a stool — reduces performance anxiety)
  • Avoid punishing accidents — withholding is often involuntary and not deliberate
  • For toilet-training age children: ensure readiness before training; regression during training is common with constipation
When to Seek Medical Attention

When to Seek Medical Attention

Go to the Emergency Department if:
  • Blood in stool (significant amount)
  • Severe abdominal pain or distension
  • Bilious (green) vomiting with constipation
  • Child appears very unwell or lethargic
See your doctor or nurse practitioner if:
  • No bowel movement for more than 1 week despite home management
  • Constipation has been present since birth or early infancy
  • Child is losing weight or not growing well
  • Painful anal fissures or rectal prolapse
  • Urinary symptoms: recurrent UTIs or daytime wetting
  • You are concerned for any reason