August 2025
| Laxative | Dose (oral, except as noted) | Onset (hours) |
| Osmotic and lubricant laxatives | ||
| PEG 3350 powder (MiraLax, GlycoLax)*¶ | 24 to 96 | |
| Children and adolescents (weight-based dosing) | 0.4 to 0.8 g/kg per dayΔ; maximum 17 g per day for starting dose | |
| Children (age-based dosing) | ||
| 6 to 18 months | 0.5 to 1 level teaspoon (approximately 2 to 3 g) once per dayΔ | |
| 18 months to 3 years | 2 to 3 level teaspoons (approximately 7 to 10 g) once per dayΔ | |
| Older than 3 years | 2 to 4 level teaspoons (approximately 7 to 13 g) once per dayΔ | |
| Adolescents and adults | 17 g (approximately 1 heaping tablespoon, 1 cap measure, or 1 packet) once per day in 8 oz of beverageΔ | |
| Lactulose (10 g/15 mL solution) | 24 to 48 | |
| Children | 1 mL/kg (0.67 g/kg) once or twice per day (maximum 60 mL per day for starting dose) | |
| Adults | 15 to 30 mL (10 to 20 g) once or twice per day | |
| Sorbitol (syrup, 70% solution) | 24 to 48 | |
| 1 to 11 years | 1 mL/kg once or twice per day (maximum 60 mL per day for starting dose) | |
| 12 years to adults | 15 to 30 mL once or twice per day | |
| Mineral oil | 6 to 8 | |
| Caution – Should not be used in individuals at risk for aspiration, including infants; neurologically impaired children; or patients with nausea, vomiting, or marked gastroesophageal reflux | ||
| Children >1 year to adults | Liquid (non-emulsion): 1 to 2 mL/kg per day, once or divided (maximum 45 mL per day for starting dose) | |
| Magnesium hydroxide (milk of magnesia) | 0.5 to 6 | |
| 1 to 11 years | 1 to 3 mL/kg per day of 400 mg/5 mL suspension (maximum 30 mL per day for starting dose in single or divided doses) | |
| 12 years to adults | 400 mg/5 mL suspension: 30 to 60 mL per day in single or divided doses 800 mg/5 mL suspension: 15 to 30 mL per day in single or divided doses | |
| Stimulant laxatives◊ | ||
| Senna (syrup 8.8 mg sennosides/5 mL or tablets 8.6 mg sennosides/tab)§¥ | 6 to 12 | |
| 2 to 6 years‡ | 2.5 to 3.75 mL (or one-half to 1 tab) once or twice per day | |
| 6 to 12 years | 5 to 7.5 mL (or 1 to 2 tabs) once or twice per day | |
| 12 years and older | 5 to 15 mL (or 1 to 3 tabs) once or twice per day | |
| Bisacodyl¥ | ||
| Oral (5 mg tablets) – Must be able to swallow tablet whole; tablet cannot be crushed | 6 to 12 | |
| Children 3 to <10 years | 5 mg (1 tablet) once per day | |
| Children ≥10 to <12 years | 5 to 10 mg (1 to 2 tablets) once per day | |
| Children ≥12 years and adolescents | 5 to 15 mg (1 to 3 tablets) once per day | |
| Rectal (10 mg suppositories) | 0.25 to 1 | |
| Children 2 to <10 years | 5 mg (one-half suppository†) once per day | |
| Children ≥10 years and adolescents | 5 to 10 mg (one-half† to 1 suppository) once per day | |
| Glycerin (glycerol) rectal suppositories** | 0.25 to 0.5 | |
| Children 2 to 5 years | 1 pediatric suppository (1.2 g) rectally once per day | |
| Children 6 years to adult | 1 adult suppository (2 g) rectally once per day | |
NG: nasogastric; OTC: over-the-counter (ie, available without prescription); PEG: polyethylene glycol.
* PEG 3350 is also known as PEG without electrolytes and macrogol. We suggest dissolving PEG powder in palatable beverages such as fruit juices, sports drinks, soda, or milk using 4 to 8 oz (120 to 240 mL) fluid for each 17 g dose (milk should not be used if PEG is given for colonoscopy preparation). Trade names shown are for OTC products available in the United States and some other countries.
¶ For fecal disimpaction with PEG 3350 in outpatients, doses of 1 to 1.5 g/kg (maximum 100 g) per day may be used for up to 6 consecutive days. For inpatients, a PEG-electrolyte solution may be used (eg, 25 mL/kg per hour up to a maximum of 400 mL per hour generally by NG tube administration).
Δ PEG 3350 may be given in divided doses to improve tolerability. Titrate the dose every 2 to 3 days to achieve passage of soft stools, ideally once per day. Maintenance doses may be as high as 1.5 g/kg per day (maximum approximately 34 g per day) for some patients[1].
◊ Stimulant laxatives are typically used for brief periods when needed as add-ons to an osmotic laxative (ie, rescue therapy) or as part of a maintenance regimen. When stimulant laxatives are used without an osmotic laxative, they may be combined with a stool softener (eg, docusate).
§ Several types of senna products are available and multiple formulations exist that are not equivalent; pay close attention to the product description and concentration when ordering or administering. Dosing listed above is for total sennosides in OTC medications available in North America. In the United Kingdom and other areas, products typically express doses according to sennoside B content only (which comprise approximately 40 to 60% of total sennosides), thus lower mg doses are used. Senna pod concentrate and senna leaf extract are dietary supplements and are not interchangeable on a mL-to-mL (or mg-to-mg) basis with other senna products that contain sennosides.
¥ For children with refractory constipation, chronic administration of high-dose stimulant laxatives (either senna or bisacodyl) may be appropriate. For this group, the suggested dose of sennosides is 1 to 2 mg/kg (maximum 120 mg) orally at bedtime[2]. For bisacodyl, the suggested dose is 0.2 mg/kg (maximum 20 mg) orally at bedtime. These patients should generally be managed by a specialist in pediatric gastroenterology or by a multidisciplinary team.
‡ Senna has also been used successfully for short-term treatment of constipation in infants and young children. A reasonable dose for those age <2 years is 1.25 to 2.5 mL of 8.8 mg/5 mL syrup (ie, 2.2 to 4.4 mg) once per day for up to 3 months. However, use with caution in this age group because senna may cause perianal skin breakdown and blistering if the stool is left in contact with the skin for a prolonged time and/or if high doses are given.
† Suppositories should be cut in half lengthwise (rather than crosswise) to ensure even distribution of the drug between the 2 suppository halves.
** Glycerin rectal suppositories have also been used for short-term (eg, up to 3 days) treatment of constipation in infants and young children. Glycerin suppositories should not be used frequently, because infants may become behaviorally conditioned to depend on rectal stimulation to initiate stooling. In addition, glycerin may irritate the anus or rectal mucosa, causing symptoms to become chronic.
Adapted from: Tabbers MM, Dilorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014; 58:258.
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