Candy, D., & Belsey, J. (2009). Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: A systematic review. Archives of Disease in Childhood, 94, 156–160.

To determine whether more precise guidance can be given regarding use of osmotic laxatives, and to assess the evidence for their use in children with constipation.

Databases searched were PubMed, Embase, the Cochrane Library, and Google Scholar. Reference lists were also hand searched.

Search keywords were polyethylene glycols, lactulose, senna, bisacodyl, picosulphate, constipation, defecation, cathartics, infant, child, preschool, adolescent, and clinical trial.

Studies were included in the review if they

• Were a randomized clinical trial of osmotic laxative versus placebo or an active comparison
• Reported on patients aged younger than 18 years with a diagnosis of constipation of more than three months in absence of structural, endocrine, or metabolic disease
• Recorded a quantitative effect on constipation
• Were published in a peer-reviewed journal.

Initial searching provided 100 clinical trials and 71 review articles. A final group of seven trials was identified for consideration in this review.

The seven final studies encompassed data on 594 patients.

• A consensus appears to exist among studies that PEG is more effective than lactulose.
• One systematic review in 2006 found no evidence to support use of stimulant laxatives or bulk-forming agents among children.
• One study compared PEG 3550 with milk of magnesia. No difference existed between groups regarding bowel movements; however, more children refused treatment with milk of magnesia than with PEG (35% versus 5%, p < 0.001).

The review highlights the necessity of considering what treatment children will accept in managing symptoms.

This review was done in children with functional constipation, so findings may not be clearly applicable in children with constipation related to cancer treatment. PEG may be helpful and more effective than lactulose in the management of constipation in children with cancer, and may be more accepted than milk of magnesia.