1. Disimpaction (if needed): If stools are hard and impacted, consider a high-dose polyethylene glycol (PEG) regimen for disimpaction. May require enema if oral disimpaction fails — under medical supervision. 2. Maintenance Therapy: Continue osmotic laxatives like PEG or lactulose daily at appropriate doses. Treatment should continue for several months, not stopped suddenly. 3. Scheduled Toilet Time: Encourage sitting on the toilet twice daily, especially after meals (gastrocolic reflex). Use visual timers or reward charts to help a child with ADHD stay on track. 4. Proper Toilet Posture: Use footrest or step stool to support legs and maintain squatting posture. 5. Diet and Fluids: High-fiber diet: fruits, vegetables, whole grains. Adequate water intake throughout the day 6. Behavioral Support: Use positive reinforcement (not punishment) for sitting on the toilet or any success. Occupational therapy may help with sensory issues if present. Coordinate with a child psychologist or developmental pediatrician if needed.

Red flags: Weight loss Blood in stools Severe abdominal pain Suspected Hirschsprung disease (if never passed normal stools)

To consider adequate vegetable and fruits rich in fibre

Constipation here more of functional and with appropriate laxatives it can be effectively treated