What is the treatment for constipation in infants?

Treatment of Constipation in Infants

For infants with constipation, dietary modifications should be the first-line treatment, with judicious use of lactulose for infants under 6 months and polyethylene glycol for those over 6 months when dietary changes are insufficient. 1

Diagnosis and Assessment

• Constipation in infants is characterized by:

  • Hard, dry stools
  • Infrequent bowel movements
  • Signs of discomfort during defecation
  • Straining during bowel movements

• Red flags requiring immediate medical attention:

  • No bowel movement for more than 5-7 days
  • Abdominal pain or distension
  • Vomiting
  • Blood in stool
  • Failure to gain weight

Treatment Algorithm

For Breastfed Infants

1. Continue breastfeeding - Breast milk provides optimal hydration and nutrition 1
2. Increase breastfeeding frequency to ensure adequate hydration
3. Maternal diet modifications - Eliminate potentially constipating foods from mother's diet 1
4. If no improvement, consider small amounts of prune, apple, or pear juice for infants over 4 months 1

For Formula-Fed Infants

1. Ensure proper formula preparation - Follow exact mixing instructions 1
2. Adequate hydration - Ensure infant is receiving sufficient fluids
3. Consider switching formulas if constipation persists

Non-Pharmacological Interventions

• Gentle abdominal massage
• Bicycle leg movements
• Warm baths to relax abdominal muscles 1
• Increased fluid intake (particularly important as mild dehydration is a risk factor for constipation) 2

Pharmacological Interventions

1. For infants under 6 months:

   • Lactulose/lactitol-based medications (2.5-10 mL daily in divided doses) 3, 4
   • Reduce dose immediately if diarrhea occurs 3
   • Discontinue if diarrhea persists 3

2. For infants over 6 months:

   • Polyethylene glycol (PEG) is the preferred medication 4
   • Lactulose can also be used (40-90 mL total daily dose for older children) 3

3. For fecal impaction:

   • High-dose PEG for the first few days
   • Or repeated phosphate enemas 4

Special Considerations

Monitoring

• Monitor for signs of dehydration or electrolyte disturbances, especially with lactulose use 3
• Infants receiving lactulose may develop hyponatremia and dehydration 3

Duration of Treatment

• Treatment should be maintained for a sufficient duration
• Long-term therapy may be required as relapse of functional constipation is common 5
• Despite treatment, only 50-70% of children with functional constipation demonstrate long-term improvement 5

Cautions

• Avoid antacids concurrently with lactulose as they may inhibit the desired effect 3
• Use lactulose with caution in infants with diabetes as it contains small amounts of galactose and lactose 3
• Avoid other laxatives during initial phase of therapy 3

When to Refer

• If constipation persists despite appropriate management
• If red flags are present suggesting an organic cause
• If there is suspicion of Hirschsprung's disease or other anatomic abnormalities 6, 5

Remember that functional constipation is common in infants, but treatment should be prompt to avoid psychosocial and digestive consequences 4.