Rational use of laxatives in children

In both the public mind and in professional circles, the safety of laxative agents frequently comes up as a topic of concern. As a group of therapeutic agents, modern laxatives are quite safe to use. Even with chronic use, severe reactions are rarely reported, although annoying side effects may occur with some frequency. The stimulant laxatives are an interesting group of agents in that although they are among the therapeutically most potent, they exhibit the fewest number of side effects. The stimulant laxatives are among the safest of drugs that physicians may recommend. Among the agents classified as lubricants, emollients, and fibers, direct toxicity is low. Severe side effects are generally the result of therapeutic misadventure. Except in very large doses, these agents are generally less helpful in the initial phase of treatment for severely constipated children. Since the osmolar agents have a relatively weak stimulatory response, people have mistakenly thought of them as a relatively "safe" class of laxatives. Although they do not purge, they often cause considerable gas and cramping. Most reports of adverse reactions involve the use of enemas, often in a patient who receives a customary dosage but retains the hypertonic or osmotic fluids until significant systemic absorption occurs.