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Oral medications for childhood constipation

Laxatives are always first line management of acute and chronic constipation in children. Follow our handy guide to understand the different types of laxative medications your child might be prescribed, how they work and where to find further information if required.

What are laxatives?

Laxatives are medications used to treat constipation. They are the recommended first line treatment for childhood constipation and they need to be prescribed by your child’s doctor.

There are various types of laxatives which can be summarised by the following diagram:

Diagram with types of laxatives

Laxatives need to be given correctly for them to work properly. The type of laxative your child is given will depend on their symptoms. The next section explains more about the different types of laxatives available for children.

It is important that you follow your doctor’s instructions about how much to give.

Types of laxatives

1. Osmotic laxatives

Osmotic laxatives act by delivering water to the large bowel, softening the poo and causing the gut muscle to squeeze.

(a).Macrogols e.g. Movicol, Cosmocol, Laxido, Strigol

Macrogols are the first line treatment for constipation in children. This means that they are considered the best option available and should be considered for the initial treatment of childhood constipation.
Macrogol laxatives work by ‘binding with’ water and delivering it to the large bowel. It is therefore essential to mix it with the correct amount of water or it will not work. This water cannot be absorbed through the bowel wall due to the size of the molecules. It stays in the bowel and combines with the poo to hydrate it, break up any hard lumps and soften it.
Macrogols add water to the stool which bulks it up. This has a naturally stimulating effect -it moves the poo along the bowel.
The macrogol water is drunk, goes through the gut and comes out the other end completely unchanged. On the way it does a good job of softening the poo and moving it along.
For more details on how to give macrogol laxatives see How to use macrogol laxatives.

(b).Lactulose

Lactulose is made up of complex sugar chains which the body can't break down, so it reaches the large bowel undigested. The body then tries to break it down by drawing water in, softening the stool.
BUT it can only draw in very small amounts of water, so is only helpful in constipation which is very mild/caught very early.
Lactulose is ineffective if the child is not drinking enough – it can't draw water into the bowel if there is not enough in the circulating bloodstream.
As Lactulose is effectively liquid sugar, it is important to brush your child’s teeth after every dose. It may also increase wind, leading to an uncomfortable tummy.
Lactulose can be useful in combination with other laxatives for children who will not take - but need - higher doses of macrogols.

2. Stimulant laxatives e.g.Senna, Sodium Picosulfate, Bisacodyl

Stimulant laxatives act on the nerves in the gut, causing the gut muscles to rhythmically squeeze and relax, pushing the poo through the gut.

They are not recommended as first line treatment as they can cause tummy pain if they squeeze on poo which is stuck, and maybe hard. A stool softener should be taken first - ideally a macrogol, but otherwise Lactulose or Docusate Sodium.
They have a timed mode of action taking between 6 and 12 hours to work. Look at the patient information leaflet to find out the expected timescale for each particular medicine.
They are usually initially prescribed at night so any discomfort will not bother the child; the child will then be expected to poo in the morning. Once a child is used to taking stimulants some people choose to swap to taking them in the morning, if an evening poo is more convenient.
Stimulants are available in different formats – tablets, liquids and capsules, dependent on dose and age.

3. Stool softeners (Docusate sodium)

These decrease the surface tension of the poo which lets water into the poo, softening it and bulking it up. This bulking causes the gut to squeeze.
They are not first line treatment due to the limited dose range, but can be useful for some children.
They are available in a liquid, capsule or enema, dependent on dose and age.

How much laxative does my child need to take?

Constipation often fluctuates and therefore it can often be necessary to vary the amount of laxative you give your child. Laxatives have a dose range, so it may be useful to look at this so that you can discuss the right dose for your child with your doctor, should you feel the prescribed dose is not enough/too much.

Your doctor will work out the range of the dose that is right for your child. This range of doses will be shown on the medicine label. It may initially need to be increased to clear out any backlog of poo, then adjusted until your child passes a soft stool every day. Your doctor will advise you on this.

Information on all the medications discussed, including the dose ranges can be found here:

BNFC (British National Formulary for Children) | NICE

Medicines For Children – We provide practical and reliable advice about giving medicine to your child

This table gives you a guide to the range of doses of the various laxatives that your doctor may prescribe.

It is important that you follow your doctor’s instructions about how much to give.


Medicine	Age																				Dose																				Comments
Macrogol (maintenance)	1-11 months																				½-1 sachet																				Paediatric sachets
Powder for solution	1- 5years																				1-4 sachets																				Paediatric sachets
	6-11 years																				2-4 sachets																				Paediatric sachets
	12-18 years																				2 sachets 1-3 times per day for up to 2 weeks then 2 sachets 1-2 times per day																				Adult sachets
Macrogol (disimpaction) Powder for solution	1-11 months																				Day 1: ½ -1 sachet Day 2: ½-1 sachet Day 3: ½-1 sachet Day 4: ½-1 sachet Day 5: ½-1 sachet Day 6: ½-1 sachet Day 7: ½-1 sachet																				Paediatric sachets Day 7 dose should be continued daily until disimpaction achieved. If not achieved after 2 weeks, add a stimulant
	1-5 years																				Day 1:2 sachets Day 2: 4 sachets Day 3: 4 sachets Day 4: 6 sachets Day 5: 6 sachets Day 6: 8 sachets Day 7: 8 sachets																				Paediatric sachets Day 7 dose should be continued daily until disimpaction achieved. If disimpaction not achieved after 2 weeks, add a stimulant.
	6-11 years																				Day 1: 4 sachets Day 2: 6 sachets Day 3: 8 sachets Day 4: 10 sachets Day 5: 12 sachets Day 6: 12 sachets Day 7: 12 sachets																				Paediatric sachets Day 7 dose should be continued daily until disimpaction achieved. If disimpaction not achieved after 2 weeks, add a stimulant.
	Over 12 years																				Day 1: 4 sachets Day 2: 6 sachets Day 3: 8 sachets Day 4: 8 sachets Day 5: 8 sachets Day 6: 8 sachets Day 7: 8 sachets																				Adult sachets Day 7 dose should be continued daily until disimpaction achieved. If disimpaction not achieved after 2 weeks, add a stimulant.
Lactulose Syrup	1 month-11 months																				2.5 mls																				Twice daily
	1 year – 4 years																				2.5mls-10mls																				Twice daily
	5 years – 18 years																				5- 20 mls																				Twice daily
Senna	1 month- 3 years																				3.75-15mg																				Once daily
Syrup or tablets	4 years – 17 years																				3.75-30mg																				Once daily
Sodium Picosulfate	1 month- 3 years																				2.5mg-10mg																				Once daily
Syrup	4 years- 17 years																				2.5mg – 20mg																				Once daily
Bisacodyl tablets	4 – 17 years																				5-20mg																				Once daily
Docusate Sodium Liquid or capsules	6 months – 23 months																				12.5mg																				Three times a day (paediatric solution)
	2 years – 11 years																				12.5-25 mg																				Three times a day (paediatric solution)
	12 years – 17 years																				100mg 3 times per day																				(Up to 500mg daily) In divided doses

You may see from the leaflet provided with the medication, that the product you have been given does not appear to be licensed for children your child’s age. However, lots of medicines are used ‘off-licence’ in childhood – the lack of licence does not mean they are in any way unsafe.

For further explanation and information please see Unlicensed medicines - Medicines For Children

How do I get my child to take their laxatives if they are reluctant?

Sometimes children do not like the taste or texture of medication, and they cannot always understand why they need to take it.

Here are our top tips for encouraging your child to take their medication:

Take time to sit down with your child and explain what the medication is for and what it is supposed to do.
Check with your doctor or pharmacist to see if there are any different flavour options for the medication your child has been prescribed e.g. Movicol is available in chocolate flavour!
Check with your doctor or pharmacist to see if the medication is available in a different format (e.g. tablets instead of liquid) and whether they can be crushed or mixed with food.
Try giving your child something cold to eat prior to taking the medication – this may change the taste of the medication.
Try using a syringe or dropper to give liquid medication and place at the back of the tongue or side of the cheek.
Try to give your child some choice over how they take the medication if you can (e.g. spoon or syringe, flavour).
Practice pill swallowing once you feel your child is old enough. There are lots of good ideas in this resource: Helping your child to swallow tablets – new resources from Kidzmed – Medicines For Children
Have a consistent routine with medication if possible. Plan for a quiet time with minimal stress and have distractions available for afterwards.
Stay positive! Use lots of praise to build your child’s confidence.
Learn through play – use teddies/dolls/ stories, to help your child understand what the medication is for and to work through any fears.

FAQs

I’m worried about giving my child laxatives. Is there any other way to treat their constipation?

How do I manage my child’s toileting when they are on laxatives? Do I need to put them in a nappy or pull-up to avoid accidents?

A regular, effective toileting routine will help to ensure we get as much poo as possible in the loo. Further information about this is available in our constipation advice sheet.

Whilst undergoing disimpaction to clear out a backlog of poo, soiling can increase and children may not have full control over their bowel movements as the poo becomes very loose and watery. Some parents choose to put their children into nappies/pull-ups during this time.

Why are there different types of laxatives and how do I know which one is right for my child?

Different types of laxatives work in different ways – e.g. some soften the poo, some stimulate the gut to squeeze.

Your doctor or nurse will guide you as to which laxative they feel is most appropriate for your child, based on their symptoms.

Sometimes, children are prescribed more than one laxative at the same time. This is safe as long as it is prescribed and explained by your child’s doctor or nurse.

Will my child be hurt by taking laxatives for too long?

My child is absolutely refusing to take their laxatives, no matter what I do. What do I do now?

How do I know if the laxatives are working? What should the poos look like?

My child has been on the laxatives for a while and it’s working. When can I stop giving it to them?

How do I manage my child’s laxatives when they are at nursery/school?

During disimpaction, your child may not be able to go to nursery/school because of all the pooing and the possible discomfort. It may be that you can wait for the next school holiday. If not, you may like to ask your doctor or nurse for a letter to explain your child’s absence.

When giving laxatives routinely in a maintenance dose, your child will be able to attend school/nursery. There is no need for them to take their laxatives at school – they can be given at home in the morning and/or evening. Communicate with the school/nursery to ensure you have a plan in place for managing your child’s condition. This may include a toileting and drinking routine and/or support with toileting and drinking.

My child is taking laxatives and is having loose poos – should I stop them?

There may be more than one reason for your child having loose poos whilst on laxatives. Keeping a poo diary can help work out the best course of action.

It may be that the loose poo is what is called ‘overflow’ - this is the looser poo from higher up in the bowel by-passing the stuck poo. In this case the laxatives need to be increased rather than decreased, to clear out all the stuck poo. Overflow is often described as being dark, sticky, gritty and foul smelling – but every child is different.
It may be that your child is on too high a dose of laxative and that you need to reduce this gradually. In this case the poo is often described as being lighter, fresher and easier to wipe away – but again, every child is different.
It may be that actually the laxative is doing its job, but there is a lot of poo in there which needs clearing out.

Using our poo checker and looking at your child to see if they have other symptoms of constipation will help to decide. Discuss with your child’s nurse/doctor if you are unsure.

My child has been prescribed Lactulose and it is not working – what should I do?

Lactulose works by drawing water into the bowel to soften the poo, but it can only draw in very small amounts of water, so is only helpful in constipation which is very mild/caught very early. It is also ineffective if the child is not drinking enough. It may be that another laxative would work better. Macrogol laxatives such as Movicol, Laxido, Strigol and Cosmocol are made up with water and deliver this to the bowel. They are the recommended first line treatment for children with constipation.

More info

Last Reviewed: October 2025

Next Review: October 2028

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