Which preparation is most suitable for a 3-year-old with constipation?

• A. Lactulose solution
• B. Macrogol sachets
• C. Senna tea
• D. Bisacodyl suppositories

Answer: (B)

When addressing constipation in a 3-year-old, start with an osmotic laxative that is well tolerated and effective in young children: macrogol sachets (polyethylene glycol). This type of laxative works by holding water in the stool, softening it and increasing stool volume, which helps establish regular bowel movements without causing significant cramping or electrolyte imbalances. It has a strong evidence base in preschool children and is considered a safe, first-line option for functional constipation in this age group. Dosing is straightforward—typically a daily sachet dissolved in water or a drink, with adjustment based on stool softness and frequency to achieve regular, soft stools.

Lactulose is another osmotic option, but in practice it can cause more bloating and cramping and may have a less predictable response in young children, making it a less favored first choice when macrogol is available. Stimulant laxatives like senna or bisacodyl (whether as tea or suppositories) are generally reserved for situations where osmotic laxatives do not achieve relief, because they can cause abdominal cramping and may be harder for a young child to tolerate or adhere to over time.

In short, macrogol sachets are preferred for a 3-year-old due to effective stool softening, good tolerability, and an established safety profile in early childhood, with other options considered if the response is inadequate or not tolerated.