For a 4-year-old girl with constipation, what is the next appropriate step in management?

In managing constipation in a 4-year-old girl, the use of polyethylene glycol is considered an appropriate next step. Polyethylene glycol (PEG) is an osmotic laxative that is effective in softening stools and facilitating bowel movements. It is safe and well-tolerated in children, making it a preferred option for initial treatment of functional constipation.

Utilizing PEG can help to restore normal bowel function through the promotion of regular bowel movements, which is crucial for a child experiencing constipation. The treatment protocol commonly involves starting with a higher dose initially, followed by tapering to a maintenance dose once regular bowel habits are established.

The other choices, while relevant in different contexts, do not serve as the immediate appropriate management step. For instance, an abdominal X-ray could provide information on stool burden and confirm constipation but is not a necessary or first-line intervention for typical cases. A barium enema is more invasive and generally unnecessary for straightforward cases of constipation in children; it’s usually reserved for specific diagnostic purposes when other causes need to be ruled out. Senna, a stimulant laxative, can also be used but is typically not the first choice in young children due to the potential for abdominal cramping and its use should be reserved for cases where osmotic