Table 4 Results of the included studies used in our review
Study (quality)InterventionControl interventionOutcome measureResultsEfficacy
a: PEG compared to placebo
Thomson et al 200742 (HQ)PEG+E, starting dose: <7 yrs 6.9 g/day, 7–11 yrs 13.8 g/dayPlaceboMean defecation frequency/weekMean (SD) I: 3.12 (2.05). Mean (SD) C: 1.45 (1.2) (p<0.001)More effective ns
Faecal incontinenceMean (SD) I: 4.70 (6.3). Mean (SD) C: 4.85 (7.9)
b: PEG compared to lactulose
Candy et al 200620 (HQ)PEG+E, starting with half the dosage required for disimpaction/dayLactulose, starting with half the dosage required for disimpaction/dayMean defecation frequency/weekMean (SD) I: 9.4 (4.6). Mean (SD) C: 5.9 (4.3) (p = 0.007)More effective
Voskuijl et al 200446 (HQ)PEG 3350, starting dose <6 yrs 2.95 g/day, >6 yrs 5.9 g/dayLactulose, starting dose <6 yrs 6 g/day, >6 yrs 12 g/dayMean defecation frequency/weekMean (SD) I: 7.1 (5.1). Mean (SD) C: 6.4 (5.2) (p = 0.505)ns
Treatment success (⩾3 BMs/week and no soiling)I: 31/50 (63%). C: 23/50 (47%) (p = 0.013)More effective
Dupont et al 200523 (LQ)PEG 4000, starting dose 4 g/dayLactulose, starting dose 3.33 g/dayMedian defecation frequency/weekI: 8.5 (range 7.5–12.5) in babies, 7 (5–8) in toddlers. C: 11.5 (9–13) in babies, 6 (4–7) in toddlersns
Children with soft/normal stoolsI: 44/47 (93.6%). C: 29/40 (72.5%) (p = 0.008)More effective
Gremse et al 200225 (LQ)PEG 3350, 10 g/m2/dayLactulose, 1.3 g/kg/dayMean defecation frequency/2 weeksMean (SD) I: 14.8 (1.4). Mean (SD) C: 13.5 (1.5) (p<0.05)More effective
Global assessment of treatment successI: 31/37 (84%). C: 17/37 (45.9%) (p = 0.002)More effective
Wang et al 200748 (HQ)PEG 4000, 20 g/dayLactulose, 15 g/dayMedian defecation frequency/weekI: 7. C: 6. I: 76/105 (72%)ns
Children in clinical remission of constipationC: 45/111 (41%) (p<0.01)More effective
c: PEG compared to other laxatives
Tolia et al 199343 (LQ)PEG 3350, 20 ml/kg/hMineral oil, 30 ml/10 kgChildren with >1 BM after treatmentI: 17/19 (89%). C: 12/17 (71%) (p<0.005)More effective
Loening-Baucke 200229 (LQ)PEG 3350, starting dose 0.5 or 1 g/kg/dayMilk of magnesia, starting dose 1 or 2.5 ml/kg/dayTreatment success (⩾3 BMs/week and ⩽2 soiling episodes per month)I: 17/28 (61%). C: 14/21 (67%) (p = 0.67)ns
Loening-Baucke et al 200631 (LQ)PEG 3350, 0.7 g/kg body weight PEG dailyMilk of magnesia, 2 ml/kg body weight dailyImprovement (⩾3 BMs/week and ⩽2 soiling episodes/month; no abdominal pain)I: 24/39 (62%). C: 17/40 (43%) (p = 0.086)ns
d: Lactulose compared to other laxatives
Perkin 197737 (LQ)Lactulose, 10–15 ml/daySenna, 10–20 ml/dayMean defecation frequency/weekMean (SD) I: 18.1 (2.0). Mean (SD) C: 17.1 (1.5) (p = 0.075)ns
Urganci et al 200544 (LQ)Lactulose, starting dose 1 ml/kg twice/dayLiquid paraffin, starting dose 1 ml/kg twice/dayMean defecation frequency/weekMean (SD) I: 12.3 (6.6). Mean (SD) C: 16.1 (2.2) (p<0.05)less effective
e: Cisapride
Halabi et al 199926 (LQ)CisapridePlaceboMean defecation frequency/weekMean (SD) I: 6.7 (0.9). Mean (SD) C: 1.3 (0.9) (p<0.0001)More effective
Ni et al 200134 (LQ)Cisapride, 0.2 mg/kg 3 dd + MgO 125 or 250 mg 3 times/dayMagnesium oxide, 125 or 250 mg 3 times/dayChildren with ⩾3 BMs/weekI: 40/44 (91%). C: 27/40 (67%) (p = 0.013)More effective
Nurko et al 200036 (HQ)Cisapride, 0.2 mg/kg/dose 3 times/dayPlaceboMean defecation frequency/weekMean (SD) I: 4.1 (1.1). Mean (SD) C: 2.2 (0.6) (p>0.05)ns
f: Senna
Berg et al 198316 (LQ)Senna, starting dose one tabletPlacebo (C1), starting dose one tablet. No medication (C2)Relief of soiling (on a 4-point scale indicating frequency of soiling)I: 5/14 (55%). C1: 7/11 (64%) p = 0.16. C2: 6/15 (66%) (p = 0.81)ns
Perkin 197737 (LQ)Senna, 10–20 ml/dayLactulose, 10–15 ml/dayMean defecation frequency/weekMean (SD) I: 17.1 (1.5). Mean (SD) C: 18.1 (2.0) (p = 0.075)ns
Sondheimer et al 198140 (LQ)Senna, in doses sufficient to induce 1 BM/dayMineral oil, twice/day in doses sufficient to induce loose stools rectal oil leakageChildren with daily BMsI: 9/18 (50%). C: 16/19 (89%) (p<0.05)Less effective
g: Mineral oil
Sondheimer et al 198140 (LQ)Mineral oil, twice/day in doses sufficient to induce loose stools rectal oil leakageSenna, in doses sufficient to induce 1 BM/dayChildren with daily BMsI: 16/19 (89%). C: 9/18 (50%) (p<0.05)More effective
Tolia et al 199343 (LQ)Mineral oil, 30 ml/10 kgPEG 3350, 20 ml/kg/hChildren with >1 BM after treatmentI: 12/17 (71%). C: 17/19 (89%) (p<0.005)Less effective
Wald et al 198747 (LQ)Mineral oil 1–4 tablespoons/dayBiofeedbackChildren with <1 soiling episode/weekI: 13/26 (50%). C: 14/24 (60%) (p = 0.47)ns
h: Fibre
Castillejo et al 200621 (HQ)Cocoa husk supplement (fibre), 3–6 yrs: two sachets ( = 8 mg)/day; 7–10 yrs: four sachets ( = 16 mg)/dayPlacebo, 3–6 yrs: two sachets/day; 7–10 yrs: four sachets/dayMean defecation frequency/weekMean (SD) I: 6.2 (3.3). Mean (SD) C: 5.1 (2.1) (p = 0.78)ns
Loening-Baucke et al 200430 (LQ)Glucomannan (fibre), 100 mg/kg/dayPlacebo (maltodextrins), 100 mg/kg/dayMean defecation frequency/weekMean (SD) I: 4.5 (2.3). Mean (SD) C: 3.8 (2.2) (p = 0.139)ns
i: Laxatives investigated in one single study
Banaszkiewicz et al 200514 (HQ)Lactobacillus GG, 109 colony-forming units twice/day +70% lactulose 1 ml/kg/dayPlacebo +70% lactulose, 1 ml/kg/dayMean defecation frequency/week at 12 weeksMean (SD) I: 6.1 (1.8). Mean (SD) C: 6.8 (3.1) (p = 0.5)ns
Bellomo-Brandao et al 200315 (LQ)Erythromycine estolate, 20 g/kg/dayPlaceboImprovement of constipation (based on stool frequency, soiling, faecal impaction, faecal consistency and pain at stool passage)End phase 1: mean (SD) E-P: 2.2 (1.0). Mean (SD) P-E: 2.9 (2.8). End phase 2: mean (SD) E-P: 4.3 (2.3). Mean (SD) P-E: 2.4 (2.1) (E vs P: p = 0.006)More effective
Bongers et al 200717 (HQ)New formula with high concentration of sn-2 palmitic acid, a mixture of prebiotic oligosaccharides and partially hydrolysed whey protein (Nutrilon Omneo)Standard formula (Nutrilon 1)Mean defecation frequency/weekMean (SD) I: 5.6 (2.8). Mean (SD) C: 4.9 (2.5) (p = 0.36)ns
Improvement of hard to soft stoolsMean (SD) I: 9/10 (90%). Mean (SD) C: 5/10 (50%) (p = 0.14)ns
Bu et al 200719 (HQ)Lactobacillus casei rhamnosus (Lcr35), 8×108 colony-forming units/dayMagnesium oxide (C1), 50 mg/kg/day. Placebo (C2)Mean defecation frequency/dayMean (SD) I: 0.6 (0.2). Mean (SD) C1: 0.5 (0.1) (p = 0.77). Mean (SD) C2: 0.4 (0.1) (p = 0.006)ns
More effective
Chao et al 200722 (LQ)Magnesium-enriched infant formula (Novalac-IT)20%-strengthened infant formulaImprovement of constipation (based on stool consistency, frequency and volume, and defecation difficulties)I: 42/47 (89%). C: 25/46 (54%) (p<0.001)More effective
Nolan et al 199135 (LQ)Senna and/or bisacodyl and/or agarolStandard paediatric behaviour modificationTreatment succesI: 42/83 (51%). C: 31/86 (36%) (p = 0.079)ns
Zoppi et al 199850 (LQ)Calcium polycarbophil, 0.62/g 3 times/dayPlaceboChildren with disappearance of constipation (1 BM/day, soft stools)I: 6/14 (43%). C: 0/14 (0%) (p⩽0.01)More effective
  • BM, bowel movement; C, control intervention; HQ, high methodological quality; I, intervention under study; LQ, low methodological quality; ns, not significant.