From the Guidelines
For a 6-month-old infant with constipation, I recommend first assessing the infant's diet and ensuring adequate fluid intake, and considering the introduction of high-fiber foods like pureed prunes, pears, or peaches if the infant has started solids, as suggested by the pediatric health guidelines 1. The infant's diet should be evaluated to ensure it is in line with the recommended guidelines for infants, which include sustained breastfeeding, avoidance of bottle propping, and introduction of complementary foods at around 6 months, with a focus on iron-rich or fortified foods 1. Some key points to consider in the diet of a 6-month-old infant with constipation include:
- Ensuring adequate fluid intake, with 2-4 ounces of water daily if the infant is already on solids
- Introduction of high-fiber foods like pureed prunes, pears, or peaches if the infant has started solids
- Avoiding foods high in sodium or with added sugars or artificial sweeteners
- Limiting 100% fruit juice, and avoiding cow's milk, plant-based milk alternatives, honey, and unpasteurized foods and beverages 1. For immediate relief, gentle belly massage in a clockwise direction or bicycle leg movements can help stimulate bowel movements. If these measures don't work within 2-3 days, a small amount of apple, pear, or prune juice (1-2 ounces diluted with water) may help, as the malabsorption of carbohydrate in juice can help increase the frequency and water content of stools for infants with constipation 1. However, it's essential to note that infant stool patterns vary widely, and true constipation involves hard, dry stools that are difficult to pass, often accompanied by discomfort. If the infant shows signs of significant distress, has blood in the stool, or if constipation persists despite these interventions, medical evaluation is necessary to rule out underlying conditions like Hirschsprung's disease or hypothyroidism.
From the Research
Constipation in Infants
- Constipation is a common pediatric problem, and treatment is often delayed, leading to psychosocial and digestive consequences 2.
- For infants under 6 months, lactulose/lactitol-based medications are authorized and effective 2.
- The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition has formulated a clinical practice guideline for the management of pediatric constipation, including evaluation, initial treatment, and follow-up management 3.
Treatment Options
- Hyperosmotic mineral water, diet, and endoanal medications are not treatments for established constipation, whatever the age 2.
- Polyethylene-glycol is effective for infants over 6 months 2.
- Mineral oil is less prescribed 2.
- Fecal disimpaction using a high dose of PEG or repeated phosphate enemas may be necessary in case of fecal impaction with or without fecal incontinence 2.