How to treat constipation in a 2-month-old infant with incessant crying, despite using infant colic (gripe water) drops?

From the Guidelines

For a 2-month-old infant with constipation and incessant crying, despite using infant colic drops, it is crucial to consult a pediatrician before attempting any treatments, as the most recent and highest quality study from 1 suggests that pediatricians play a central role in guiding infant nutrition and health. The infant's condition may be related to constipation, which can be treated with gentle methods such as belly massage or bicycling motions with the legs.

• A warm bath can help relax the abdominal muscles and stimulate bowel movement.
• Small amounts of apple, pear, or prune juice (1-2 teaspoons) mixed with breast milk or formula may help soften stools, but this should only be done with medical approval, as noted in 1.
• Rectal stimulation with a clean thermometer tip lubricated with petroleum jelly may provide temporary relief but should not be done regularly.
• For formula-fed babies, the doctor might recommend switching formulas.
• It is essential to avoid using adult laxatives, mineral oil, or enemas, as these can be harmful to infants.
• The current pediatric health behavior guidelines from 1 emphasize the importance of dietary intake, sleep, and physical activity in infants, but do not directly address constipation treatment.
• Given the potential for underlying medical issues, professional evaluation is essential, especially if the baby seems unusually distressed, has blood in the stool, or shows signs of dehydration.
• Gripe water is primarily for colic and gas, not constipation, which explains why it hasn't helped with this particular issue, and therefore, the most appropriate course of action is to consult a pediatrician for personalized advice on treating the infant's constipation.

From the FDA Drug Label

Pediatric: Very little information on the use of lactulose in young children and adolescents has been recorded. As with adults, the subjective goal in proper treatment is to produce 2 or 3 soft stools daily. On the basis of information available, the recommended initial daily oral dose in infants is 2. 5 mL to 10 mL in divided doses. The recommended initial daily oral dose of lactulose for a 2-month-old infant is 2.5 mL to 10 mL in divided doses.

• The dose may be adjusted to produce 2 or 3 soft stools daily.
• If the initial dose causes diarrhea, the dose should be reduced immediately.
• If diarrhea persists, lactulose should be discontinued 2.

From the Research

Treatment Options for Constipation in Infants

• For a 2-month-old infant with constipation, lactulose-based medications are authorized and effective, as stated in 3 and 4.
• According to 4, lactulose has been shown to be effective and safe in infants younger than 6 months who are constipated.
• If the infant's constipation persists, a partially hydrolyzed infant formula with prebiotics and β-palmitate may be considered as a dietary intervention, as suggested in 4.

Management of Infantile Colic

• For infantile colic, a partially hydrolyzed infant formula with galacto-oligosaccharides/fructo-oligosaccharides and added β-palmitate may be of benefit in reducing symptoms, as stated in 4.
• If cow's milk protein allergy is suspected, an extensively hydrolyzed infant formula for a formula-fed baby or a cow's milk-free diet for a breastfeeding mother may be beneficial, as suggested in 4.

Additional Considerations

• Education regarding the adaptation of toilets and a daily bowel movement should restore colic motility and avoid relapses when the treatment is discontinued, as stated in 3.
• Behavioral modifications, such as ensuring adequate fluids and fiber intake, and use of stool softeners or laxatives, may also be helpful in managing constipation, as suggested in 5 and 6.
• The administration of lactulose or polyethylene glycol is the preferred medical management if nutritional management does not result in sufficient improvement, as stated in 7.