Functional Constipation In Infants Research Articles

The Effect of Bifidobacterium on Antibiotics and Its Impact on Infant Intestines

This study presents the benefits of Bifidobacterium longum in countering the negative effects of antibiotics, caesarean delivery, and formula feeding on infant gut microbiota. Antibiotics, often used post-caesarean to prevent infections, can impede the development of neonatal microbiota, reducing bacterial diversity and altering gut structure. The microbiota of caesarean-delivered infants exhibits less diversity, a problem that can be mitigated by probiotic supplementation. Breastfeeding, rich in human milk oligosaccharides (HMO), is shown to be critical for early gut flora compared to formula feeding, which lacks these beneficial components and delays microbiota maturation. Bifidobacterium longum, essential for infant gut health, adapts genetically to metabolize HMOs, promoting gut development and microbial cross-feeding, essential for producing health-promoting short-chain fatty acids (SCFAs). It repairs antibiotic-induced intestinal damage and helps maintain a balanced gut microbiota. Additionally, B. longum offers therapeutic potential for treating colitis and functional constipation in infants and may be an effective treatment for inflammatory bowel disease (IBD), fostering immune homeostasis and intestinal health recovery. The probiotic role of B. longum in early life could have lasting health implications.

Early-Life Gut Health Indicators and Reported Prevalence of Infant Functional Constipation by Healthcare Professionals

A healthy gut during early childhood is important. However, it seems that there are no standard indicators used to assess it. Healthcare professionals (HCPs) were asked via an electronic survey question about gut health indicators (GHIs) for infants and toddlers, in addition to an estimated prevalence of infant's functional constipation (FC) and its management. HCPs from eight countries participated in the survey (Russia (66.0%, 1449), Indonesia (11.0%, 242), Malaysia (6.0%, 132), Mexico (5.7%, 125), KSA (5.1%, 113), Turkey (3.0%, 66), Hong Kong (2.2%, 49), and Singapore (1.0%, 23)). The 2199 participating respondents were further classified into three continents (Asia (20.2%), Europe (68.8%), and others (11.0%)). Most of them were pediatricians (80.3%), followed by pediatric gastroenterologists (7.0%), general practitioners (6.4%), and others (6.3%). The top three preferred GHIs were similar for infants and toddlers: an absence of gastrointestinal (GI) symptoms, effective digestion/absorption as assessed by normal growth, and a general feeling of well-being. The absence of GI-related infection was the least preferred indicator. Most of the respondents reported the prevalence of FC among infants was less than 5%, with the peak incidence between the ages of 3 and 6 months. The reported choices of intervention to manage FC in infants were a change to a specific nutritional solution from a standard formula (40.2%), parental reassurance (31.7%), and lactulose (17.0%). Conclusion: The HCPs in the eight countries preferred the absence of GI symptoms, normal growth for effective digestion and absorption, and general well-being as the gut health indicators in infants and toddlers. The reported prevalence of FC in infants was less than 5%.

Using QI to break bad habits

When you take your car to Meineke, chances are you will get a muffler. Well, it seems when you take children to the emergency department or an urgent care center for abdominal pain due to constipation, chances are they will get an abdominal x-ray (AXR). Children discharged with a diagnosis of constipation account for up to 25% of cases seen in some emergency departments or urgent care centers, and as many as 30%-90% will have an AXR as part of their evaluation. Evidenced-based guidelines for the “Evaluation and Treatment of Functional Constipation in Infants and Children” published jointly by the North American and European Societies for Pediatric Gastroenterology, Hepatology and Nutrition, state the diagnosis of functional constipation is based on history and examination and, in the absence of alarm signs and symptoms, routine use of an AXR has no role in the diagnosis. Therefore, it appears many children with functional constipation are being exposed to unnecessary irradiation and the use of AXRs is adding nothing to management but is simply adding to the already high costs of health care in the US. How then can we break some bad habits? One way would be to develop a quality improvement (QI) program aimed at reducing the number of unnecessary AXRs in emergency departments and urgent care clinics. In this volume of The Journal, Moriel et al demonstrate just how effective such a program can be. Using Plan-Do-Study-Act cycles they were able to reduce the use of AXRs for functional constipation from 43% to 21% by emergency department attendings and fellows and from 31% to 16.5% by urgent care clinic pediatricians and pediatric nurses. Together this translated into a reduction of unnecessary AXRs from 36% to 18% with no increase in missed diagnoses or other adverse outcomes. QI activities can be highly effective means of changing practice. Two keys to success in this program were the presence of a “champion” and the provision of individualized data reports to the providers. As physicians we are all somewhat competitive so comparing our individual results to those of our peers can serve as a powerful motivating factor to do better. Hopefully, this report will spur others to design similar projects to decrease unnecessary testing in children seeking health care in the future. Article page 109 ▸ Reducing Abdominal Radiographs to Diagnose Constipation in the Pediatric Emergency DepartmentThe Journal of PediatricsVol. 225PreviewTo determine the frequency of abdominal radiographs obtained in healthy children aged 6 months to 18 years to diagnose constipation in a pediatric emergency department, and evaluate the impact of quality improvement (QI) interventions on their use. Full-Text PDF

Role of daily anal stimulation for intractable functional constipation in infants.

Functional constipation is one of the most common problems in pediatric gastroenterology. The aim of the present study was to evaluate the effectiveness of daily anal stimulation in infants with intractable functional constipation (IFC). Our evaluation was based on clinical improvement and on changes in manometric parameters through time. Infants with IFC treated between January 2018 and December 2019 were included in this retrospective study. Treatment processing included daily anal stimulation for infants and psychological counseling for parents. All cases underwent a complete intervention program and were evaluated for improvement in symptoms and for changes in anorectal manometry within 1 year of follow-up. A total of 161 patients were included in this study. Positive response was achieved in all patients. Frequency of defecation, change in stool form and decrease in the defecatory pain were significantly relieved in all infants after intervention. On anorectal manometry, no significant difference was found in the peristaltic frequency of distal rectum before and after treatment. There was a significant increase in the mean amplitude of peristalsis and improvement in the rhythm after intervention. In the 1 year of follow-up, three patients had recurrence of constipation requiring colectomy. In terms of the high clinical efficacy and limited side effects, daily anal stimulation may be included in the initial part of an intervention program for IFC in infants.

PEG 3350 Versus Lactulose for Treatment of Functional Constipation in Children: Randomized Study.

The aim of this study was to compare the clinical efficacy and tolerance of polyethylene glycol 3350 (PEG) and lactulose for the treatment of functional constipation in infants and children. This randomized, multicenter study covered 12 weeks of treatment and 4 weeks of follow-up of patients with functional constipation. Patients were randomized (central randomization) to receive either PEG or lactulose. The primary end points were the number of defecations per week after 12 weeks of treatment and improvement in stool consistency of at least 2 points in the Bristol scale. The secondary end point was the presence of adverse events. Bowel movements ≥3 per week and stool consistency ≥2 (Bristol scale) were considered as successful treatment. We enrolled 102 patients (M 57, F 45) aged 3.62 ± 1.42 years and 88 completed the study. At week 12, good clinical outcome was achieved in 98% (PEG) and 90% (lactulose). The PEG group had more defecations per week compared with the lactulose group (7.9 ± 0.6 vs 5.7 ± 0.5, P = 0.008) and both groups had similar frequency of defecation with pain (5% vs 5%, P = 0.9), stool retention (7% vs 10%, P = 057), large volume of stools (30% vs 31%, P = 0.9) and hard stools (7% vs 13%, P = 0.58). There were more patients with side effects in the lactulose group (15 vs 23, P = 0.02), mostly bloating and abdominal pain. PEG 3350 is more effective and causes fewer side effects than lactulose in the treatment of constipation in infants and children.

The Magnesium-Rich Formula for Functional Constipation in Infants: a Randomized Comparator-Controlled Study.

PurposeTo compare the effectiveness of the magnesium (Mg)-enriched formula vs. control formula in constipated infants.MethodsAn open-label, interventional, and the comparator-controlled study was conducted to evaluate the effectiveness of the Mg-enriched formula in formula-fed infants ≤6 months old presenting with functional constipation according to modified Rome IV criteria. Infants were randomized 1:1 to intervention or control formula for 30 days. Parents recorded stool consistency (hard, normal, or watery) and frequency on days 1–7 and 23–29. Physicians recorded patient baseline characteristics and performed the clinical examination at the time of three patient visits (baseline, day 8, and 30).ResultsOf the 286 recruited infants, 143 received the Mg-rich formula and 142 received the control formula. After 7 days, significantly more infants had stools with normal consistency with the Mg-rich formula compared to the infants fed with the control formula (81.8% vs. 41.1%; p<0.001). The number of infants passing one or more stools per day was increased at day 7 in the Mg-rich formula group (86.7% vs. 68.2%; p<0.001). At days 7 and 29, >25% of infants responded completely to the Mg-rich formula compared to <5% of infants fed with the control formula (p<0.001). Parents of infants in the Mg-rich formula group were very satisfied with the treatment (80.8% vs. 10.2%), with the majority willing to continue treatment after 30 days (97.9% vs. 52.6%; p<0.001).ConclusionThe Mg-rich formula significantly improved stool consistency and frequency compared to the control formula in constipated infants.

Chronic Functional Constipation in Infants and Children.

Functional constipation is a common problem among children. The prevalence worldwide is about 3% and it is accounting for about 3-5% of all visits to pediatricians implicating a significant impact on health care cost. In most children presenting with the symptom constipation no underlying medical disease responsible for the symptom can be found; this is the so-called functional constipation. Functional constipation is characterized by infrequent bowel movements, hard and/or large stools, painful defecation, sometimes in combination with fecal incontinence, and is often accompanied by abdominal pain, without evidence of a structural or biochemical explanation.The recommendation for the management of FC includes a normal intake of fibers and fluids, normal physical activity, and an additional pharmacologic treatment for fecal disimpaction followed by a pharmacologic maintenance therapy.In infants constipation is treated somewhat differently as compared with children. When constipation presents early in life, the risk of an underlying organic disease is increased compared to older children.

Diagnostic and treatment of functional constipation in infant

Infant functional constipation is one of the common clinical symptoms in infancy stage, so far we do not have a specific diagnostic criteria and treatment for infant functional constipation. In this paper, we reviewed the diagnostic methods, clinical evaluation, differential diagnosis, and treatment recommendations according to recent research results for infant functional constipation. Key words: Constipation/DI/TH; Infant; Review

Functional constipation in children: challenges and solutions.

This review intends to update what is known about and what is still a challenge in functional constipation (FC) in children regarding epidemiology, pathophysiology, diagnosis, and management. Although FC is a common childhood problem, its global burden remains unknown as data from parts of the world are missing. Another problem is that there is a large variation in prevalence due to differences in study methods and defining age groups. The pathophysiology of FC remains unclear to date but is probably multifactorial. Withholding behavior is likely to be the most important factor in toddlers and young children. Genetics may also play a role since many patients have positive family history, but mutations in genes associated with FC have not been found. Over the past years, different diagnostic criteria for FC in infants and children have been proposed. This year, Rome IV criteria have been released. Compared to Rome III, it eliminates two diagnostic criteria in children under the age of 4 who still wear diapers. Physical examination and taking a thorough medical history are recommended, but other investigations such as abdominal radiography, transabdominal recto-ultrasonography, colonic transit time, rectal biopsies, and colon manometry are not routinely recommended. Regarding treatment, guidelines recommend disimpaction and maintenance therapy with polyethylene glycol (PEG) with or without electrolytes. But experience shows that acceptability, adherence, and tolerance to PEG are still a challenge. Counseling of parents and children about causes of FC is often neglected. Recent studies suggest that behavior therapy added to laxative therapy improves the relief of symptoms. Further homogeneous studies, better-defined outcomes, and studies conducted in primary care are needed.

Using the Bristol Stool Scale and Parental Report of Stool Consistency as Part of the Rome III Criteria for Functional Constipation in Infants and Toddlers

To evaluate among parents of infants and toddlers the agreement between parental report and the Bristol Stool Scale (BSS) in assessing stool consistency and the effect of both methods on determining the prevalence of functional constipation (FC) according to the Rome III criteria. Parents of children ≤48 months of age who were seen for a well-child visit completed a questionnaire about their child's bowel habits during the previous month. Cohen kappa coefficient (κ) was used to measure intrarater agreement between parental report of stool consistency ("hard," "normal," "soft/mucous/liquid") and the BSS (types 1-2, hard; types 3-5, normal; types 6-7, loose/liquid). The prevalence of FC was assessed based on the questionnaire according to the Rome III criteria, comparing both methods of stool consistency assessment. Parents of 1095 children (median age, 15 months; range, 1-48) were included. Only fair agreement existed between the 2 methods of stool consistency assessment (κ = 0.335; P < .001). According to the Rome III criteria, using parental report the prevalence of FC was 20.5% and using the BSS the prevalence was 20.9% (P = .87). The agreement between these 2 methods for assessing the prevalence of FC was excellent (κ = 0.95; P < .001). Only fair agreement exists between the BSS and parental report of stool consistency among parents of infants and toddlers. Different methods of stool consistency assessment did not result in a difference in the prevalence of FC.

Functional constipation in infants: Diagnosis and therapy in practice

As of now, constipation in children, especially in babies during the first years of life, is a common complaint during a visit to a pediatrician and a gastroenterologist. Despite the fact that the current guidelines for the management of this patient group have been elaborated, there has been no consensus of opinion among parents and specialists regarding the therapy and prevention of constipation in children so far. The article discusses the diagnosis and treatment of functional constipation in children. The authors give their own observations and experience with the rectal suppositories Glycelax® pediatric in the therapy of proctogenic and mixed constipation in infants.

Reporting outcome measures of functional constipation in children from 0 to 4 years of age.

Functional constipation (FC) often begins in the first year of life. Although standard definitions and criteria have been formulated to describe FC, these are rarely used in research and clinical practice. The aim of the study is to systematically assess how definitions and outcome measures are defined in therapeutic randomized controlled trials (RCTs) of infants with FC. PubMed, EMBASE, and Cochrane databases were searched. Studies were included if it was a (systematic review of) therapeutic RCT, children ≤4 years old, they had FC, a clear definition of constipation was provided, and were written in English. Quality was assessed using the Delphi list. A total of 1115 articles were found; only 5 studies fulfilled the inclusion criteria. Four different definitions were used, of which only 2 used the internationally accepted Rome III criteria. Defecation frequency was used as primary outcome in all included trials and stool consistency in 3 trials. Two trials involving infants investigated new infant formulas, whereas the third RCT evaluated the efficacy of a probiotic strain. The 2 trials including infants up to 4 years of age compared polyethylene glycol without electrolytes (PEG4000) with lactulose and milk of magnesia. All of the trials used nonvalidated parental diaries. Different definitions and outcome measures for FC in infants are used in RCTs. Disappointingly, there is a lack of well-designed therapeutic trials in infants with constipation. To make comparison between future trials possible, standard definitions, core outcomes, and validated instruments are needed.

FUNCTIONAL DIGESTIVE DISORDERS IN INFANTS

The article presents generalized information about functional digestive disorders in infants. It reflects epidemiology, causes, clinical manifestations and diagnostic criteria for regurgitation, colics and functional constipation in infants. Special attention is given to medicamental and diet correction of the mentioned pathology in children during their first year of life. The practical application of the proposed recommendations for breeding of children with functional digestive disorders during their first year of life will make it possible to arrest clinical manifestations of the illness not resorting to medicamental treatment.

Do Probiotics Prevent Fussy Babies?

Source: Indrio F, DiMauro A, Riezzo G, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized trial. JAMA Pediatr. 2014; 168(3): 228– 233; doi: 10.1001/jamapediatrics.2013.4367Investigators from Italy aimed to determine whether early supplementation for newborns with the probiotic Lactobacillus reuteri reduces the occurrence of colic, gastroesophageal reflux, and constipation during the first 3 months of life. The investigators recruited healthy term infants <1 week old from 9 Italian pediatric centers over a period of 2 years. The infants were randomly assigned to receive drops containing L reuteri DSM 17938 or placebo for 90 days during the first 3 months of life. Both parents and investigators were blinded to the group assignments and interventions. The placebo solution was identical to the probiotic solution with the exception of live bacteria, and both were provided by BioGaia, manufacturer of L reuteri, and sponsor of the study. Parents were asked to record each day the number of episodes of regurgitation, duration of each episode of inconsolable crying, and number of bowel movements for 3 months. Data on health care utilization and parental work loss were also collected to assess the cost-effectiveness of treatment.A total of 554 newborns were enrolled in the study; data were analyzed on 238 randomized to the probiotic and 230 placebo recipients (85% of those enrolled). At the end of the trial, the mean daily duration of crying (38 vs 71 minutes; P < .01), mean number of regurgitations per day (2.9 vs 4.6; P < .01), and mean number of bowel movements per day (4.2 vs 3.6; P < .01) significantly favored the L reuteri group compared to the placebo group. The use of the study probiotic resulted in an estimated mean savings of US$118.71 per patient for the family and an additional US$140.30 for the community.The authors conclude that the prophylactic use of L reuteri in the first 3 months of life reduced the amount of inconsolable crying, regurgitation, and functional constipation in infants, and reduced costs for managing these conditions.Drs Cerezo and LeLeiko have disclosed no financial relationship relevant to this commentary. The commentary does not contain a discussion of an unapproved/investigative use of a commercial product/deviceInfant colic, regurgitation or reflux, and constipation are common and usually benign conditions. Despite their self-limiting nature, however, these conditions may lead to parental anxiety, frustration, and frequent visits to the pediatrician or emergency department. Previous studies have demonstrated that the composition of the infant intestinal microbiota, specifically the absence of lactobacilli species, is an independent risk factor for the development of colic.1 Two recent meta-analyses concluded that L reuteri may be effective prevention and treatment for infant colic in exclusively breastfed infants but that the evidence is weak for any benefit in formula-fed infants.2,3We are not, however, rushing to prescribe prophylactic L reuteri for our patients.We are skeptical about the authors’ assertion that “low-grade mucosal inflammation…” is a common finding in babies with colic, regurgitation, and constipation, or that a probiotic could offer a role in controlling this inflammation. The authors cite the loss to follow-up of 15% of the cohort as a limitation of their study and comment on the risk of overtreating normal neonates. The double-masked, placebo-controlled randomized study design did not make up for the fact that the analysis does not separate the effects of the probiotic in babies who were breastfed versus those not breastfed. Their hypothesis rests on the proposition that promoting bacterial colonization of the gut may increase intestinal health. These colonizing lactobacilli might already be present in the exclusively breastfed infants.Probiotics are undoubtedly here to stay, and will be important in managing a number of diseases, especially those with gastrointestinal symptoms. It is possible that the current findings will be replicated in a more convincing fashion. But we are not ready to endorse the use of prophylactic probiotics in otherwise healthy infants. We would want more clear evidence of efficacy and safety before considering this a reasonable addition to the neonate’s diet.There are several problems with this study. The authors excluded data on infants who received drugs such as antacids and proton-pump inhibitors; however, these are likely the infants with the most significant symptoms and excluding them may have biased the results. The adequacy of blinding wasn’t assessed, and the study was industry-sponsored. That being said, the results, particularly reduction in inconsolable crying, are compelling. Any promising treatment for infant colic is worthy of further study.

Evaluation and Treatment of Functional Constipation in Infants and Children

Constipation is a pediatric problem commonly encountered by many health care workers in primary, secondary, and tertiary care. To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. Nine clinical questions addressing diagnostic, therapeutic, and prognostic topics were formulated. A systematic literature search was performed from inception to October 2011 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. For therapeutic questions, quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation system. Grading the quality of evidence for the other questions was performed according to the classification system of the Oxford Centre for Evidence-Based Medicine. During 3 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation. This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. This document is intended to be used in daily practice and as a basis for further clinical research. Large well-designed clinical trials are necessary with regard to diagnostic evaluation and treatment.

Polyethylene glycol 4000 without electrolytes versus milk of magnesia for the treatment of functional constipation in infants and young children: a randomized controlled trial.

Background: Functional constipation is a common pediatric problem. Polyethylene glycol and milk of magnesia are osmotic agents used to treat constipation. There were few studies comparing the two laxatives for the treatment of functional constipation in infants and young children. Objective: To compare two laxatives, polyethylene glycol 4000 without electrolytes (PEG) and milk of magnesia (MOM), by evaluating the effectiveness, adverse effects, and patient compliance. Materials and methods: A randomized controlled trial was performed in 94 patients aged one-four years who attended at the pediatric outpatient clinic of Bhumibol Adulyadej Hospital and met the Rome III criteria for functional constipation receiving either PEG or MOM for four weeks. The primary outcome evaluation was the improvement rate. The secondary outcomes included the improvement of stool frequency, adverse effects, and compliance rate. Results: Eighty-nine patients completed the study, including 46 in the PEG group and 43 in the MOM group. Baseline characteristics of age, body weight, sex, initial stool frequency, and duration of constipation were similar between groups. At the four week follow-up visit, 91% of PEG-treated patients and 65% of the MOM-treated patients exhibited improvement (p=0.003). Patients in the PEG group had greater increase of stool frequency after treatment than patients in the MOM group. Overall, adverse effects were mild, transient and not different among groups, but there was more diarrhoea in MOM treated patients. No serious adverse effects were observed. Compliance rates were 89% for PEG and 72% for MOM (p=0.041). Conclusion: PEG was more effective and had greater patient compliance than MOM for the management of functional constipation in infants and children aged one-four years.

Functional Constipation in Infants: A Follow-Up Study

Our objective of this study was to describe the clinical course of severe functional constipation in early childhood. Eligible patients were 47 children (60% boys; median age, 3.5 months) who had constipation in their first year of life. Follow-up data were obtained through a standardized questionnaire. Success was defined as a period of at least 4 weeks with > or =3 painless bowel movements per week. Six months after initial evaluation, 69% of the children were recovered. After initial success, a relapse occurred in 15% of the children within 3 years. A duration of symptoms <3 months before referral correlated significantly with better outcome. We conclude that most infants with severe constipation evaluated at a tertiary center are recovered after 6 months. Early therapeutic intervention may beneficially contribute to the resolution of constipation.

Polyethylene Glycol 3350 Without Electrolytes for the Treatment of Functional Constipation in Infants and Toddlers

ABSTRACTObjectives:We have recently reported the safety and efficacy of polyethylene glycol 3350 without electrolytes (PEG) for the daily treatment of constipation in older children. Because there are very few data available on the use of PEG in infants and toddlers, we evaluated the efficacy and safety of PEG for the treatment of constipation in children &lt;2 years of age.Methods:This is a retrospective chart review of 75 constipated children &lt;2 years of age at start of PEG therapy. PEG was started at an average dose of 1 g/kg body weight/d and parents were asked to adjust the dose to yield 1 to 2 soft painless stools/d. Data from the history and physical examination were collected initially and at short‐term (≤4 months) and long‐term (≥6 months) follow‐up.Results:75 otherwise healthy children received PEG for functional constipation. The mean age was 17 months (range, 1 to 24 months) and the mean duration of constipation was 10 months (range, 0.5 to 23 months). The mean duration of short‐term follow‐up was 2 months and mean duration of long‐term follow‐up was 11 months. The mean effective short‐term PEG dose was 1.1 g/kg body weight/d and the mean long‐term dose was 0.8 g/kg body weight/d. Constipation was relieved in 85% with short‐term and in 91% with long‐term PEG therapy. Adverse effects were mild and included diarrhea, which disappeared with lowering the dose. No subjects stopped PEG because of adverse effects.Conclusion:PEG is effective, well tolerated and appeared safe for the treatment of functional constipation in children &lt;2 years of age.

Polyethylene Glycol 3350 Without Electrolytes for the Treatment of Functional Constipation in Infants and Toddlers

We have recently reported the safety and efficacy of polyethylene glycol 3350 without electrolytes (PEG) for the daily treatment of constipation in older children. Because there are very few data available on the use of PEG in infants and toddlers, we evaluated the efficacy and safety of PEG for the treatment of constipation in children <2 years of age. This is a retrospective chart review of 75 constipated children <2 years of age at start of PEG therapy. PEG was started at an average dose of 1 g/kg body weight/d and parents were asked to adjust the dose to yield 1 to 2 soft painless stools/d. Data from the history and physical examination were collected initially and at short-term (<or=4 months) and long-term (>or=6 months) follow-up. 75 otherwise healthy children received PEG for functional constipation. The mean age was 17 months (range, 1 to 24 months) and the mean duration of constipation was 10 months (range, 0.5 to 23 months). The mean duration of short-term follow-up was 2 months and mean duration of long-term follow-up was 11 months. The mean effective short-term PEG dose was 1.1 g/kg body weight/d and the mean long-term dose was 0.8 g/kg body weight/d. Constipation was relieved in 85% with short-term and in 91% with long-term PEG therapy. Adverse effects were mild and included diarrhea, which disappeared with lowering the dose. No subjects stopped PEG because of adverse effects. PEG is effective, well tolerated and appeared safe for the treatment of functional constipation in children <2 years of age.