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Background Constipation is a common problem in children with spastic cerebral palsy(sCP)with a prevalence that reaches 75％.We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care.Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP.Methods A prospective,double-blinded randomized control trial was carried out involving 100 children aged 2-12 years with sCP(level Ⅲ-Ⅴ of the Gross Motor Functional Classification system)and chronic constipation.They were followed up in the Pediatric neurology clinic,Children's hospital,Ain Shams University,May 2017-January 2019.The intervention group(O-Mg)received oral magnesium sulfate 1 mL/kg/day daily for 1 month compared to the placebo.Outcome measures were constipation improvement and decrease in bowel evacuation time after 1 month.Results Initially,weekly bowel movements,constipation scores and stool consistency were comparable in both groups.After 1 month of regular administration of oral magnesium sulfate,the constipation score,stool frequency and consistency improved compared to the placebo group(P＜0.001).Effective safe treatment was achieved in 31(68％)and 4(9.5％)patients in the O-Mg and placebo groups,respectively(RR,2.95;95％CI 2.0-4.5)(P＜0.001).Painful bowel evacuation attempts spent by mothers decreased from 25(55.6％)of the cases initially to 10(22％)cases after one month in the O-Mg group(P=0.001).In contrast,in the placebo group,the decrease went from 21(50％)cases initially to 18(42.9％)after 1 month and was not significant(P=0.5).Conclusions Oral magnesium sulfate seems effective in alleviating chronic constipation and pain experience in children with sCP.Consequently,saving maternal time spent in daily bowel evacuation attempts.