Over-the-Counter Medications for Kids – Part 2: Constipation, Gas/Indigestion And Probiotics

In a previous blog (A Parent’s Guide to Over-the-Counter Medications), parents were given some important tips to help them safely navigate their way through the children’s pharmacy aisle.  In addition to fever, allergy, and cold medications (seen in part one, here) parents can also find a variety of over-the-counter (OTC) drugs for stomach aches, gas/indigestion, and constipation. Because it’s oftentimes difficult for parents to know whether or not a more serious illness is occurring, they should always speak with their pediatrician or a healthcare provider prior to starting over-the-counter medications.

Constipation Medications: Children who are constipated typically have painful, difficult-to-pass, and infrequent stools (or “poop”).  Although parents should increase their child’s fiber and fluid intake and schedule toilet time after meals, children may need additional therapy to improve their symptoms. Medications that help relieve constipation are called laxatives, and they are available in oral (liquid and tablets) and rectal (suppository and enema) forms. Four different types of laxatives are commonly used: stool softeners, osmotic laxatives, lubricant laxatives, and stimulant laxatives.  Stool softeners add moisture to the stool to allow strain-free bowel movements, osmotic laxatives increase the amount of water in the intestines to allow easier passage of stool, lubricant laxatives coat the stool to make it more slippery and easier to pass, and stimulant laxatives stimulate the rectal muscles to help push the stool out.  Although stool softeners and laxatives may have different active ingredient(s), multiple laxatives should not been given together unless approved by a pediatrician or pediatric gastrointestinal subspecialist.

Typically, stool softeners and osmotic laxatives are the first-line medications used for treating short and long-term constipation in healthy children.  Although docusate and magnesium hydroxide can be taken with few side effects, polyethylene glycol tends to be the preferred choice due to its imperceptible taste, texture, and odor.  The medications’ dose is dependent on the child’s age, weight, and constipation severity, and can be adjusted as symptoms improve or worsen.  Glycerin suppositories can be safely used in infants and children, but should be used infrequently due to rectal and skin irritation and medication tolerance. Stimulant laxatives, such as senna and bisacodyl, are usually reserved for children with more severe constipation who do not respond to high-fiber diets and osmotic laxatives.  Under the guidance of a pediatrician or pediatric gastroenterologist, these medications are commonly used in combination with stool softeners or lubricant laxatives.  Because stimulant laxatives may cause cramping, dehydration, and fluid and electrolyte imbalances, these medications should not be used for long periods of time.

Gas and Indigestion Medications: Gas and indigestion (“heartburn”) can present in many ways, including excessive crying, back arching, abdominal bloating and/or discomfort, and decreased appetite.  Causes, such as swallowing too much air, overeating, drinking soda or other carbonated beverages, lactose (or other food) intolerance, acid reflux, constipation, and viral illnesses, are commonly seen in children. Unfortunately, symptomatic treatment with over-the-counter medications may provide little beneficial effect.

Simethicone, an active ingredient found in Infants’ Mylicon®, Little Remedies® for Tummys Gas Relief, and numerous antacid medications, dissolves gas bubbles and prevents gas pockets in the stomach and intestine.  Although generally safe, there is little evidence to support its use in the treatment of gas, bloating, and colic.  Similarly, gripe water, an herbal remedy that is not regulated by the Food and Drug Administration (FDA), has no proven, beneficial effect in the treatment of hiccups, gas, and colic. Antacid preparations are appropriate for short-term relief of indigestion in older children and adolescents with infrequent symptoms.  Maalox®, Mylicon®, and Children’s Pepto® are some of the most well-known, over-the-counter antacid medications available today.  Active ingredients, such as aluminum hydroxide, magnesium hydroxide, simethicone, and calcium carbonate, either alone or in combination, are found in all of these brand-named medications. The difference between each brand (and their multiple products) lies in the “recipe” of active ingredients found in each medication.  For example, Mylicon® offers 4 antacid products, Regular Strength, Maximum Strength, Ultimate Strength, and Supreme, and each of these products has different active ingredients in varying amounts. Of importance, bismuth subsalicylate, an active ingredient similar to aspirin, is used in Pepto-Bismol® (versus Children’s Pepto®) and Maalox® Total Relief (versus Maalox® Regular and Advanced Regular/Max Strength) medications.  Aspirin and aspirin-containing medications should not be used in children under 16 years of age with fever or viral symptoms, for it may cause Reye Syndrome, a serious and potentially life-threatening illness.

Probiotics: Probiotics, or microorganisms which may help re-establish the normal physiologic environment of the intestinal tract, are mainly derived from food sources such as cultured milk products.  Numerous microorganisms, both alone and in combination, are available in many probiotics and dairy products (i.e., yogurt), but none of these preparations are regulated by the FDA.

Although more research is needed to clarify the role of different probiotics in treating certain illnesses, Lactobacillus GG and Saccharomyces boulardii have been shown to reduce the duration and frequency of infectious diarrhea in healthy children with normal immune systems. These microorganisms can be found in over-the-counter children’s probiotics, such as Culturelle® and Florastor® Kids, and may be given once or twice a day for a week. If chosen and used appropriately, common, childhood symptoms and illnesses can be safely treated with over-the-counter medications.  However, if your child has a chronic, medical illness or severe and persistent symptoms, you should always speak with your pediatrician or pediatric gastrointestinal doctor prior to starting any new medications.  If your child accidentally takes too much medication or the wrong medication, call the Poison Control Hotline at 1-800-222-1222, but if he/she becomes unresponsive, stops breathing and turns blue, develops seizure-like activity, or appears very ill, call 911 and seek medical care immediately.