| Infants (younger than 1 year) |
| Glycerin suppositories | No side effects |
| Enema: 6 mL (0.2 oz) per kg (maximum: 135 mL [4.5 oz]) | If needed, administer the first enema in the physician’s office. |
| Children (1 year and older) |
| Rapid disimpaction |
| Enemas: 6 mL per kg (maximum: 135 mL) every 12 to 24 hours one to three times | Invasive, risk of mechanical trauma |
| | Mineral oil | Feces may not return after administration. |
| | Lubricates hard impaction |
| | For large impaction, administer a normal saline or phosphate enema one to three hours after the mineral oil enema. |
| | Normal saline | Abdominal cramping |
| | May not be as effective as hypertonic phosphate enema |
| | Hypertonic phosphate | Abdominal cramping |
| | Risk of hyperphosphatemia, hypokalemia, and hypocalcemia, especially in children with Hirschsprung’s disease or renal insufficiency, or if the hypertonic phosphate solution is retained |
| | Some experts do not recommend phosphate enemas for children younger than 4 years; others do not recommend the enemas for children younger than 2 years. | |
| | Milk and molasses (1:1) | Used for impactions that are difficult to clear |
| Combination treatment: enema, suppository, and oral laxative |
| Day 1: enema every 12 to 24 hours | See enema section above |
| Day 2: bisacodyl suppository (10 mg) every 12 to 24 hours | Abdominal cramping, diarrhea, hypokalemia |
| Day 3: bisacodyl tablet (5 mg) every 12 to 24 hours | Abdominal cramping, diarrhea, hypokalemia |
| Repeat three-day cycle one or two times if necessary. | |
| Oral or nasogastric polyethylene glycol electrolyte solution: 25 mL (0.8 oz) per kg per hour (maximum: 1,000 mL [33.3 oz] per hour) for four hours | Nausea, cramping, vomiting, bloating, aspiration |
| Large volume of solution to be given |
| Administration usually requires hospitalization and use of nasogastric tube. |
| Slower disimpaction |
| Oral high-dose mineral oil: 15 to 30 mL (0.5 to 1.0 oz) per year of child’s age per day (maximum: 240 mL [8 oz]) for three or four days | Risk of lipoid pneumonia |
| Give chilled. | |
| Oral senna: 15 mL every 12 hours for three doses | Abdominal cramping |
| May not see output until dose two or three |
| Oral magnesium citrate: 1 oz per year of child’s age per day (maximum: 300 mL [10 oz]) for two or three days | Hypermagnesemia |
| Maintenance medications (see Table 6) | Maintenance medications also may be used for disimpaction. |