Treatment of Infant Constipation
For infant constipation, first-line treatment includes dietary modifications, adequate fluid intake, and if necessary, lactulose for infants under 6 months and polyethylene glycol for those over 6 months of age. 1, 2
Diagnosis and Assessment
Before initiating treatment, properly identify true constipation:
- Evaluate for hard stool consistency
- Look for signs of discomfort during defecation
- Check for abdominal distension
- Note that infrequent stools alone in breastfed infants may be normal 1
Treatment Algorithm
Step 1: Dietary Management
For breastfed infants:
- Continue breastfeeding on demand 1
- If constipation persists, consider a 2-4 week trial of maternal exclusion diet (restricting at least milk and egg) 1
For formula-fed infants:
- Consider switching to lactose-free or lactose-reduced formula 1
- Full-strength lactose-free formulas can be safely introduced immediately after rehydration therapy 1
Step 2: Increase Fluid Intake
- Ensure adequate fluid intake for all infants
- Consider administering small amounts of pasteurized prune, pear, or apple juices to increase stool frequency and water content 1
Step 3: Medication (if dietary changes are insufficient)
For infants under 6 months:
- Lactulose: Initial daily oral dose of 2.5 mL to 10 mL in divided doses 1, 3
- Monitor for side effects like bloating and flatulence 3
For infants over 6 months:
- Polyethylene glycol is effective and well-tolerated 2, 4
- Mineral oil is an alternative but less commonly prescribed 2
Step 4: For Severe Cases with Fecal Impaction
- High-dose polyethylene glycol for the first few days
- Or repeated phosphate enemas 2
Important Considerations
- Positioning with slight elevation of the head may help alleviate both constipation and reflux symptoms 1
- Aggressive management is crucial, as constipation may be linked to other conditions like dysfunctional voiding 1
- Monitor for signs of dehydration, electrolyte imbalances, excessive gas, abdominal distension, or discomfort 1, 3
Red Flags Requiring Further Evaluation
Be alert for signs that may indicate serious organic causes of constipation:
- Delayed passage of meconium (>48 hours after birth)
- Failure to thrive
- Bilious vomiting
- Bloody stools
- Severe abdominal distension
- Abnormal positioning of the anus 4
Common Pitfalls
- Overdiagnosing constipation in breastfed infants with infrequent stools 1
- Overlooking milk protein allergy as a potential cause of constipation-like symptoms 1
- Using inappropriate solutions like homemade oral rehydration solutions or fizzy drinks 5
- Discontinuing treatment too early (maintenance therapy may be required for months) 4
- Failing to recognize that breast-feeding serves as a protective factor against constipation 6
Treatment duration should be sufficient, as relapse of functional constipation is common. Despite appropriate treatment, only 50-70% of children with functional constipation demonstrate long-term improvement 4.