To the Editor:
As someone who treats a lot of children with constipation and encopresis, I found the May 1999 issue interesting. I mentioned the topic of the issue to the mother of a child I treat and she expressed interest in looking at the journal herself. I hesitated to pass it along to her, however, because of contradictory information one might glean from the articles.
In the article, "To Do or Not to Do? That Is the Question," Dr. Parker writes die following in reference to laxatives:
It is important to stress that these are both safe and not associated with laxative dependency. Most parents are legitimately concerned about their child becoming dependent on laxatives and it is essential to allay these fears, especially when you remind them of the need for many months of treatment, (p. 287)
I agree with him on both of these points. Yet, in the article "Movers and Shakers: A Clinician's Guide to Laxatives," Drs. Lowe and Parks conclude the following:
The judicious use of laxatives is occasionally necessary. Their chronic use is rarely indicated except in exceptional circumstances, (p. 310)
I feel that the use of laxatives in the treatment of constipation and encopresis is almost always necessary and that their chronic use is more the norm than the exception. Do Drs. Lowe and Parks have any data to support their assertion?
Randy Rockney, MD
Department of Pediatrics
Hasbro Children's Hospital
Providence, Rhode Island
The authors' response:
We regret any confusion that our statement concerning the chronic use of laxatives may have caused. It was intended to refer only to the use of stimulants on a long-term basis. We strongly agree that the use of osmotic laxatives is often necessary and not associated with any deleterious effects. We thank Dr. Rockney for calling this to our attention and hope this clarifies the situation.