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

From the Guidelines

For an 8-month-old infant with constipation, the most effective treatment option is to introduce high-fiber foods like pureed prunes, pears, or apples, and consider small amounts of fruit juices like prune or pear juice (1-2 ounces diluted with water) to help soften stools, as recommended by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1. To address constipation in an 8-month-old infant, it's essential to start with dietary changes and increased fluid intake.

• Ensure the baby is well-hydrated by offering more breast milk, formula, or water if they've started solids.
• Introduce high-fiber foods like pureed prunes, pears, or apples, which act as natural laxatives.
• For infants already eating solids, include whole grain cereals and pureed vegetables.
• Small amounts of fruit juices like prune or pear juice (1-2 ounces diluted with water) can help soften stools, as the sorbitol and other carbohydrates in these juices can increase the frequency and water content of stools 1. Additionally, gentle remedies like belly massage in a clockwise direction or bicycle leg movements can stimulate bowel activity. If these measures don't work within a few days, it's crucial to consult a pediatrician before using any over-the-counter remedies, as they may recommend a glycerin suppository (infant size) for occasional use or a small amount of infant-specific osmotic laxative like Miralax (polyethylene glycol 3350), typically starting at 1/2 to 1 teaspoon mixed in formula or juice 1. It's vital to note that adult laxatives or enemas should never be given to an infant without medical supervision, as they can cause dangerous electrolyte imbalances in babies. The study from Pediatrics 1 provides the most recent and highest quality guidance on this topic, and its recommendations should be prioritized when treating constipation in an 8-month-old infant.

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. Infants receiving lactulose may develop hyponatremia and dehydration.

The treatment option 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. However, it's crucial to monitor the infant for potential side effects such as hyponatremia and dehydration 2.

• Key considerations:
  • Dosage: 2.5 mL to 10 mL in divided doses
  • Potential side effects: hyponatremia, dehydration
  • Monitoring: closely monitor the infant's condition 2, 2

From the Research

Treatment Options for Constipation in 8-Month-Old Infants

• The treatment of functional constipation in infants involves disimpaction using oral or rectal medication, with polyethylene glycol being effective and well-tolerated 3.
• Maintenance medications may be required for months to years, including mineral oil, lactulose, milk of magnesia, polyethylene glycol powder, and sorbitol 3.
• Education of the family and, when possible, the child is instrumental in improving functional constipation, with behavioral education improving response to treatment 3.
• Adding fiber to the diet may improve constipation, and a trial of withholding cow's milk may be considered if it is thought to be promoting constipation 3.

Dietary Interventions

• Prunes (dried plums) are high in fiber and may promote healthy gastrointestinal function, with some studies suggesting they can improve stool frequency and consistency in constipated individuals 4.
• Prune juice containing sorbitol, pectin, and polyphenol may ameliorate subjective complaints and hard feces while normalizing stool in chronic constipation 5.

Medical Management

• The administration of lactulose or polyethylene glycol is the preferred medical management for constipation in infants, in case nutritional management does not result in sufficient improvement 6.
• There is limited evidence to support the addition of magnesium to infant formula to treat constipation, and the efficacy of pro-, pre- and/or synbiotics in constipated infants is disappointing 6.