A 12-year-old boy undergoing treatment for acute lymphoblastic leukaemia has been receiving oral morphine for pain. He has constipation that is refractory to high-dose osmotic and stimulant laxatives and weaning of the morphine led to an increase in pain. You are aware of the use of peripheral acting mu-opioid receptor antagonists (PAMORA) in treating adults with opioid-induced constipation and wonder whether they could be used effectively in children.

In children (population), are peripheral acting mu-opioid receptor antagonists (intervention) effective in treating opioid-induced constipation? (outcome)?

All searches were performed in October 2023. PubMed, MEDLINE and Embase were searched using the following search terms: (child* OR paediatric OR pediatric) AND (naloxegol OR naltrexone OR naldemedine OR peripheral opioid receptor antagonist) AND (constipation OR dysmotility). A total of 23 unique articles were identified. Exclusion criteria included adult study population, case reports and reviews. Five articles were identified that were relevant to the clinical question and were not disqualified by the exclusion criteria. These articles have been summarised in table 1.

Similar search terms were used to search the Cochrane Library; this identified one article which was excluded as the study population were adults.

Summary of studies

Constipation is a common cause of morbidity among children, with a global prevalence of 0.7–29.6% (median 12%) and a prevalence of 10–20% in the UK and the USA.1 As well as pain and discomfort it can be a significant source of emotional distress for children and their carers, particularly when associated with involuntary soiling, and can lead to behavioural problems, self-esteem issues and school absenteeism. A 2019 …