What is the recommended management for a 7-month-old infant with constipation who hasn't had a bowel movement in a week and 4 days?

Management of Constipation in a 7-Month-Old Infant

For a 7-month-old infant who hasn't had a bowel movement in 11 days, immediate intervention is necessary with glycerin suppositories followed by maintenance therapy with appropriate dietary modifications and possibly osmotic laxatives.

Initial Assessment and Intervention

Rule Out Serious Causes

• Check for:
  • Abdominal distension
  • Vomiting
  • Poor feeding
  • Failure to thrive
  • Delayed passage of meconium at birth (could suggest Hirschsprung's disease)
  • Abnormal anal position or structure

Immediate Intervention

1. Disimpaction:
   • Administer glycerin suppository to stimulate bowel movement 1
   • If unsuccessful, consider a small volume mineral oil retention enema

Maintenance Therapy

Dietary Management

• For breastfed infants: Continue nursing on demand 1
• For formula-fed infants:
  • Consider switching to full-strength lactose-free formula if symptoms persist 1
  • Ensure adequate fluid intake to prevent dehydration 2
• For infants on solids:
  • Increase dietary fiber through pureed fruits (especially prunes, pears)
  • Avoid foods high in simple sugars and fats 1
  • Ensure adequate fluid intake - mild dehydration can worsen constipation 2

Medication Options

1. First-line medication:

   • Lactulose: 2.5-10 mL daily in divided doses 3, 4
   • Titrate dose to achieve 1-2 soft bowel movements daily
   • Reduce dose if diarrhea occurs 3

2. Alternative options if lactulose is ineffective:

   • Polyethylene glycol (without electrolytes) - age-appropriate dosing
   • Milk of magnesia - 1-3 mL/kg/day divided into 1-2 doses 4

Monitoring and Follow-up

Short-term Follow-up

• Monitor bowel movements (frequency, consistency)
• Watch for signs of abdominal pain or discomfort
• Ensure adequate fluid intake and output (wet diapers)

When to Seek Immediate Medical Attention

• Bilious vomiting
• Severe abdominal distension
• Blood in stool
• Fever
• Lethargy or irritability

Common Pitfalls to Avoid

1. Delayed intervention: Constipation lasting more than 11 days requires prompt medical attention to prevent impaction and complications

2. Inadequate disimpaction: Complete disimpaction must occur before maintenance therapy can be effective 4

3. Premature discontinuation of treatment: Maintenance therapy may be needed for weeks to months to prevent relapse 4

4. Insufficient fluid intake: Ensuring adequate hydration is critical for preventing and treating constipation in infants 2

5. Overlooking dietary factors: In formula-fed infants, consider formula intolerance as a potential contributing factor 1

Remember that constipation in infants this young can be challenging to treat and may require prolonged support and monitoring. Consistency in the treatment approach is key to successful management.