What is the treatment for constipation in an 8-month-old infant?

From the Guidelines

For constipation in an 8-month-old infant, the most effective treatment approach is to start with dietary changes, focusing on increasing fluid intake and offering high-fiber foods like pureed prunes, pears, or apricots, which act as natural laxatives, as recommended by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1.

Key Considerations

• Increase fluid intake, especially water if the baby is already eating solids.
• Ensure proper formula preparation to avoid excess concentration for formula-fed babies.
• If dietary changes don't help after a few days, a small amount of apple or prune juice (1-2 ounces daily) may be effective, considering the carbohydrate absorption process and the role of sorbitol in increasing stool frequency and water content 1.
• For more persistent constipation, consult a pediatrician who might recommend an infant-appropriate osmotic laxative or glycerin suppositories for immediate relief.

Additional Recommendations

• Avoid mineral oil, adult laxatives, or enemas unless specifically prescribed by a doctor.
• Gentle belly massage or bicycle leg movements can help stimulate bowel movements.
• It's essential to follow current pediatric health behavior guidelines, which emphasize dietary intake, sleep, physical activity, and restrained time for infants, as outlined in the integration of time-based recommendations with current pediatric health behavior guidelines 1.

Dietary Guidance

• Complementary feeding should begin around 6 months, introducing one new food at a time, with foods introduced first being iron-rich or fortified.
• By 8-9 months, the diet should include breast milk or infant formula, whole grain cereals, vegetables, meats, eggs, fruits, and nut butters, distributed among 3 meals, avoiding foods high in sodium or with added sugars or artificial sweeteners, 100% juice, cow’s milk, plant-based milk alternatives, honey, and unpasteurized foods and beverages 1.

From the FDA Drug Label

Pediatric: ...the recommended initial daily oral dose in infants is 2.5 mL to 10 mL in divided doses. The treatment for constipation in an 8-month-old infant is lactulose with a recommended initial daily oral dose of 2.5 mL to 10 mL in divided doses 2.

• 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.

From the Research

Treatment for Constipation in an 8-Month-Old Infant

The treatment for constipation in an 8-month-old infant can be approached through various methods, including dietary changes, medication, and education.

• For infants over 6 months, polyethylene-glycol is an effective treatment option 3, 4, 5, 6.
• Lactulose/lactitol-based medications are also authorized and effective for infants under 6 months, but for an 8-month-old, polyethylene-glycol is more suitable 3.
• In cases of fecal impaction, a high dose of polyethylene-glycol or repeated phosphate enemas may be used for disimpaction 3, 4.
• Maintenance therapy is crucial to prevent relapses, and medications such as polyethylene glycol powder, mineral oil, lactulose, and sorbitol can be used 4, 6.
• Education on adapting toilets and promoting daily bowel movements is essential for restoring colic motility and preventing future constipation 3, 6.
• Dietary changes, such as adding fiber to the diet, may also help improve constipation 4.
• It is also important to evaluate and address any psychological concerns that may be contributing to the constipation 3.