Evaluating high dose laxatives via nasogastric tube versus enemas in children with severe constipation: a prospective cohort study

Children with severe constipation often require disimpaction when standard treatments fail, typically involving high doses of oral laxatives or rectal enemas. Practice guidelines for nurses lack clear directives. This study compared the effectiveness of nasogastric laxatives versus rectal enemas in children aged 0-18 years and aimed to assess the pain and burden experienced by children and parents.

A prospective cohort study was conducted between December 2018 and June 2022 at a Dutch pediatric outpatient clinic. Of 111 children with severe constipation, 70 participated: 51 (73%) received rectal enemas and 19 (27%) received nasogastric laxatives. Treatment choice was made by the pediatrician in consultation with the parents and, when possible, the child.

After eight weeks, 98% (50/51) of enema-treated children and 89% (17/19) of those receiving nasogastric laxatives achieved effective stool consistency (Bristol Stool Scale 3-5), with no significant difference in overall effectiveness (p = 0.177). Pain scores were higher for children treated with nasogastric laxatives, but not statistically significant. No significant differences were found in the reported burden for children or parents. Fecal incontinence was lower in the enema group (33% vs. 47%) but not statistically different.

Both nasogastric laxatives and rectal enemas were effective for disimpaction in children with severe constipation, with no significant difference in efficacy. Although enemas appeared to cause less pain and burden in children under twelve, this was not statistically significant. Further research is needed to address the effect of interprofessional approach and education on compliance and admission of this specific population.