Dis-impaction: 50 - 70% of children with functional constipation have impacted stool at presentation. Impacted stool is diagnosed by digital rectal examination (hard stool in rectum) or palpable fecolith on abdominal examination. Dis-impaction is must in all patient with impacted stool for good outcome. It is done with Polyethylene glycol (PEG) .
Hospital based dis-impaction with PEG solution(made with 137.15 gm in 2 litres water) in dose of 25 mL/ kg/ h oral or by nasogastric tube if patient not able to take orally.
Home based dis-impaction can be done in older child with PEG in a dose of 1.5-2 gm/ kg/ d in two divided doses for 3-6 days.
After dis-impaction child should be put on maintenance therapy which should be continued for at least 3 to 6 months.
Lactulose (1-2 ml/kg/day of 20%) is the drug of choice in children less than 1 year and PEG(dose 0.8 to 1 gm/kg/day), in more than 1 year of age is the drug of choice for maintenance therapy.
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