Propulsid Effective in Treating Constipated Children
Jan. 25, 2000 (Eugene, Ore.) -- Even as the FDA issues a warning about the drug Propulsid (cisapride), researchers have discovered it is effective in treating children with constipation. The results of their study appear in this month's Journal of Pediatrics.
Childhood constipation is a common problem, says Alan Meyers, MD, associate professor of pediatrics at Boston University School of Medicine/Boston Medical Center. "In every school, you find one or two kids with this problem, and they become social pariahs, because no one wants to be around them." While data on the problem are scarce, one estimate is that constipation and similar problems account for 3-5% of all visits to pediatricians.
Even though Propulsid is effective in treating constipated children, it's not the first course of treatment to try, the study authors emphasize. They believe commonly used laxatives such as mineral oil, milk of magnesia, or lactulose, which have been shown to be safe and effective in a significant number of children with constipation, should continue to be the first-line drugs for this condition.
However, quite a few children don't respond to conventional treatments, and they may benefit from treatment with Propulsid. Children who received Propulsid during the study used fewer laxatives, had less soiling, and an increased number of normal bowel movements. The medicine doesn't have an immediate effect; most children were on it for about nine weeks before these results were evident.
In a related article in the same journal, Carlo Di Lorenzo, MD, associate professor of pediatrics at the University of Pittsburgh, notes that childhood constipation most often occurs when a child has a painful or frightening bowel movement, and therefore attempts to delay the next bowel movement. This means successful treatments should use positive reinforcement as well as stool softeners. "The authors of [this article] need to be congratulated for addressing the common but poorly studied subject of childhood constipation in a scientifically sound way," he writes. Di Lorenzo is also the director of the Pediatric Gastroenterology Mobility Center at Children's Hospital of Pittsburgh.
Samuel Nurko, MD, the principal author of the Propulsid study, agrees that behavioral treatment is a key to success. "It's important for both parents and children to understand constipation is not something the child is doing on purpose. That takes a lot of the guilt away," he tells WebMD. "With very young children, it's important not to punish them during toilet training, but praise them at appropriate times. With older kids, I explain how constipation develops, and give them tips about forming new habits. For example, they should sit on the toilet every day." Stool softeners make it easier for the child to form new habits and develop control again, says Nurko, who is assistant professor of pediatrics at Harvard Medical School and a gastroenterologist at Children's Hospital in Boston.