The third step in my Six Step Treatment Program for treating functional constipation is to slowly decrease and then end stool withholding. It requires that you find the maintenance laxative(s) and dosage(s) that keep stools soft enough over a period of months to prevent a reoccurence of dry hard stools. (See Chapter 11). There is no standard laxative maintenance dose for children. The dose must be determined for each child individually starting on the day immediately following the last day of the cleanout. On the last day of a successful cleanout a child's stool should be close to a clear liquid. As stated in an earlier post, a cleanout is usually accomplished be giving higher than usual doses of a water retention laxative such as Miralax.
The procedure for determining the correct maintenance dose is to gradually begin decreasing the cleanout dose until the consistency of the child's stool is like pudding (not formed) or applesauce but not watery or liquid. For example, if the cleanout required 5 teaspoons of Miralax a day, you begin the process of determining the correct maintenance dose by lowering the cleanout dose by 1 teaspoon a day for three days to determine the effect of 4 tsp on stool consistency. If it is still too loose/watery you again lower the dose by 1 teaspoon and wait another three days to determine the effect of 3 tsp on stool consistency and so on until the desired consistency has been achieved.
Some children are especially sensitive to small increases or decreases of water retention laxatives. Therefore, you may have to "fine tune" the dose by 1/2 a teaspoon up or down in order to achieve the desired pudding or applesauce consistency. For example, a dose of 3 teaspoons may be too high whereas 2 1/2 teaspoons may be just right. (Think "Goldilocks and the Three Bears"!)
(You may have correctly noticed that the pudding consistency I talk about is not one of the 7 stool types on the Bristol Stool Chart in the Appendix of my book. I think of pudding as between a Type 4 and a Type 5 on the Chart or Type 4.5.)