What is the treatment for constipation in infants under one year old?

Treatment of Constipation in Infants Under One Year Old

For infants under one year of age with constipation, the first-line treatment should focus on dietary modifications, adequate hydration, and gentle stimulation techniques, with medication reserved only for cases that don't respond to these interventions.

Dietary Management

For Breastfed Infants

• Continue breastfeeding as breast milk is well tolerated and advantageous even during digestive issues 1
• A 2-4 week trial of maternal exclusion diet (restricting at least milk and egg) may be considered if constipation persists 1

For Formula-Fed Infants

• Consider switching to formulas specifically designed for constipation - those enriched with high β-palmitate and increased magnesium content may help soften stools 2
• If using standard formula, consider:
  • Full-strength, lactose-free formulas which can be safely introduced 1
  • Formulas containing sorbitol (found in pear, apple, and prune juices) may help increase stool frequency and water content 1
  • Avoid formulas high in simple sugars which can worsen digestive issues 1

Fruit Juice Intervention

• Small amounts of certain fruit juices (10 mL/kg body weight) containing sorbitol can help with constipation:
  • Prune, pear, and apple juices are recommended by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition for constipation management 1
  • Ensure juices are pasteurized to avoid pathogen exposure 1

Hydration

• Adequate fluid intake is crucial as dehydration is a significant risk factor for constipation 3
• For formula-fed infants, ensure appropriate volume and frequency of feeds
• Consider offering small amounts of water to infants over 6 months if recommended by healthcare provider

Physical Techniques

• Gentle abdominal massage in a clockwise direction
• Bicycle leg movements to stimulate bowel activity
• Positioning with slight elevation of the head may help with both constipation and reflux symptoms 1

Medication (For Resistant Cases Only)

• Lactulose: For infants, the recommended initial daily oral dose is 2.5 mL to 10 mL in divided doses 4
  • If diarrhea occurs, reduce the dose immediately
  • If diarrhea persists, discontinue lactulose 4
• Polyethylene glycol is effective and well-tolerated for disimpaction when needed 5

Red Flags Requiring Further Evaluation

• Delayed passage of meconium (>48 hours after birth)
• Ribbon-like or pellet stools
• Failure to thrive
• Abdominal distension
• Blood in stool
• Vomiting
• Family history of Hirschsprung's disease 5, 6

Important Considerations

• Constipation in infants is usually functional and self-limiting
• Treatment may be required for months as relapse is common 5
• Parent education is instrumental in improving outcomes 5
• Avoid using multiple laxatives simultaneously 4
• Monitor for electrolyte disturbances, especially hyponatremia and dehydration, in infants receiving lactulose 4

Remember that constipation management in infants requires patience, as resolution may take time. Regular follow-up is essential to monitor progress and adjust treatment as needed.