What are the treatments for constipation in infants?

From the Guidelines

For constipation in infants, the most effective treatment is to start with simple non-medication approaches, including offering small amounts of fruit juice like prune or apple juice, as recommended by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1. When treating constipation in infants, it is essential to prioritize non-medication approaches before considering medications.

Initial Steps

• Ensure proper hydration by offering extra water between feedings for babies over 6 months, or additional breast milk or formula for younger infants.
• For babies on solid foods, increase dietary fiber by offering pureed prunes, pears, or other high-fiber fruits.
• Gentle belly massage in a clockwise direction and bicycle leg exercises can help stimulate bowel movements.

Dietary Changes

• For formula-fed babies, consider switching formulas after consulting with a healthcare provider.
• Small amounts of fruit juice (1-2 ounces) like apple or prune juice can be effective for babies over 4 months, as the sorbitol and other carbohydrates contained in these juices can help increase the frequency and water content of stools 1.

Medication Options

• Glycerin suppositories can provide quick relief but should be used occasionally.
• Oral medications like Miralax (polyethylene glycol) may be prescribed by doctors at a dose of 0.5-1.5 g/kg/day mixed in formula or juice, but should only be used under medical supervision. It is crucial to note that constipation in infants is often related to dietary changes, formula issues, or the transition to solid foods, and most cases resolve with simple interventions.

When to Seek Medical Attention

• Contact a healthcare provider if constipation persists, is accompanied by other symptoms like vomiting or blood in stool, or if the infant appears to be in pain.

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 infants 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

Treatments for Constipation in Infants

• The treatment for constipation in infants is well codified and effective, with lactulose/lactitol-based medications authorized and effective before 6 months of age, and polyethylene-glycol for infants over 6 months 3
• Mineral oil is less prescribed, and the rule for treatment is a sufficient dose for a long time 3
• In case of fecal impaction with or without fecal incontinence, the first stage is fecal disimpaction, using a high dose of PEG the first few days, or repeated phosphate enemas 3
• Education regarding the adaptation of toilets and a daily bowel movement should restore colic motility and avoid relapses when the treatment is discontinued 3
• Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, remain the most effective and safe therapy for both long and short term treatment of pediatric functional constipation 4
• Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories make excellent choices for adjunct therapies in specific clinical scenarios 4

Dietary Interventions

• Dietary interventions are not recommended as first-line treatment for constipation in infants 5
• Solid foods should be introduced around six months of age, when the infant is developmentally ready 5
• Insufficient fluid intake can cause constipation, and should be managed medically 5

Behavioral Interventions

• Behavioral modification is an important part of the treatment of constipation in infants and children 6
• Education regarding the adaptation of toilets and a daily bowel movement should restore colic motility and avoid relapses when the treatment is discontinued 3
• Behavioral management is essential for fussy eating in toddlers 5