For most children, laxative medication is an essential tool in the treatment of chronic constipation, but it isn’t meant to last forever. Many parents wonder when to start tapering (decreasing) medication, and how to do it safely. This this video offers recommendations.
A full transcript of the video appears below.
Hello, my name is Kelly Savitri, and I am a nurse with the Vermont Continence Project. Throughout this series, we’ve been talking about constipation treatment, and its importance in toilet learning. In this short video, I’m going to offer you some ideas about how to know when your child is ready to start tapering off laxative medications and tips for how to do it successfully.
So what does it mean to taper off a medication? It means slowly decreasing the medication over time. When a child has been receiving treatment with laxatives for an extended period of time, we always advise to taper the medication, rather than stopping it abruptly.
So how do you know when it’s time to taper medication? The most common mistake that families make is to stop medication too soon. There’s no standard timeframe about how long a child needs maintenance treatment for functional constipation. It really depends on the individual. But it’s safe to say that the absolute minimum would be about two months for a mild case. Six months is more likely a timeframe, for most cases.
This is highly dependent on how severe the constipation was and how long it went on for. It also depends on how consistently your child received their maintenance medication. If your child has had relapse episodes of constipation, then they will probably have to be on laxatives for a longer amount of time. A relapse is when your child has an episode of constipation. Many doctors say that a relapse is almost like starting the treatment clock all over again.
Remember from our previous videos that the purpose of using laxatives is to interrupt the constipation cycle by making bowel movements soft and painless, and to prevent constipation from happening so that your child’s muscles and stretch receptors have time to heal and regain their normal function. Before we taper laxatives, we want to make sure that both the physical and the behavioral symptoms associated with incontinence have resolved.
It is important that your child is free of symptoms for at least one month before tapering their medication. The first thing you want to establish is whether their physical symptoms have completely healed. Are they having any pain or strain during bowel movements? Are they able to fully empty their bowel in one sitting? If you haven’t been noticing these things lately, pay attention for a week or two. Maybe even take some data. Remember that while the major criteria are bowel movement, frequency, consistency, and size, other signs like gassiness and bloating are also important. Revisit our bowel symptom checklist as a refresher.
Because the time of toilet learning is the most likely time for a child to become constipated, you want to make sure that they’re successful and well-established with their toileting skills before you start tapering their medication. Some things to consider are, are they participating and sitting willingly on the toilet? How frequently are they having accidents? Do you need to carry extra clothes for your child when you’re out in the community, or is that no longer a concern? You want to make sure that your struggles with your child’s toileting are a thing of the past before you start tapering.
Also consider whether there are major changes coming up. Big changes in routine like summer vacation or moving to a new house or new school can be triggers for constipation, so it’s better to wait until they’re settled in the new routine before making medication changes. The last thing to consider is whether you have made progress in addressing any diet and lifestyle factors that may have contributed to your child’s constipation.
The maintenance phase of treatment is the ideal time to build increases in hydration, fiber, and exercise into your routines. Since your child’s body will have a harder time stooling with less medication, it’s important that their body has all the help they can get. Revisit positioning, breathing, and relaxation techniques that have helped your child so that transition is easier. It’s also helpful if there’s a consistent time of day when your child usually has a bowel movement. Again, you want these things to be well established so that your child doesn’t get constipated again when they’re no longer taking laxatives.
Alright, if you’ve considered all those things I just mentioned and you’re feeling like the time is right to start tapering your child’s medication, start by talking to your child’s PCP. They were the one who created the treatment plan, so they should be the one to make the changes to it. Ask the provider to make changes to the traffic lights action plan with new dosage recommendations. Follow your PCPs instructions but keep in mind that slow incremental changes are ideal. Tapering can take anywhere from two to even 12 months. The most important thing is to keep monitoring your child’s bowel movements so that you’re ready to act if they start getting constipated again.
Maintaining healthy bowel function is a lifelong effort. Some people are just more prone to constipation than others, so occasional episodes of it can be expected throughout childhood and even into adulthood. Please watch our video called, “Planning for Setbacks” for a more detailed discussion of how to anticipate and respond to these events. For now, just remember that the most common causes of setbacks are major changes in routine and dehydration. Some causes of dehydration are fever, hot weather, and vigorous activity such as sports. If you can identify and respond to constipation quickly, one or two doses of an over-the-counter laxative may be enough to resolve it without having to do long-term management again. If it goes unidentified and untreated for too long, you may end up back where you started, and another clean out followed by maintenance treatment might be necessary.
Please reach out to your healthcare provider if you have any questions or concerns about giving your child medication after their maintenance treatment has ended.
Thank you for taking the time to watch this. The information contained in this video is for informational purposes only. It is not a substitute for professional health or medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider.
