What is the best treatment for infant constipation?

Best Treatment for Infant Constipation

For infants with constipation, the best first-line treatment is adequate fluid intake with small amounts of pasteurized prune, pear, or apple juices to increase stool frequency and water content, followed by lactulose if needed at a dose of 2.5-10 mL daily in divided doses for infants. 1

Initial Assessment and Non-Pharmacological Approaches

For Breastfed Infants:

• Avoid overdiagnosing constipation in breastfed infants with infrequent stools 1
• Look for hard stool consistency, signs of discomfort during defecation, and abdominal distension rather than just decreased frequency 1
• Continue breastfeeding as breast milk is well tolerated even during digestive issues 1
• For persistent constipation, 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
• Ensure adequate fluid intake is maintained 1
• Position with slight elevation of the head to help alleviate both constipation and reflux symptoms 1

Dietary Interventions

• Small amounts of pasteurized prune, pear, or apple juices can increase stool frequency and water content 1
• For older infants, increasing dietary fiber may be beneficial 2
• Consider evaluating for milk protein allergy as a potential cause of constipation-like symptoms 1

Pharmacological Management

First-Line Medication:

• Lactulose is recommended for infants with an initial daily oral dose of 2.5 mL to 10 mL in divided doses 1, 3
• Monitor for side effects like bloating and flatulence 1
• If the initial dose causes diarrhea, reduce the dose immediately; if diarrhea persists, discontinue lactulose 3

For Infants Over 6 Months:

• Polyethylene glycol (PEG) can be used for infants over 6 months of age 4
• PEG is effective and well-tolerated for maintenance therapy 5

Management of Severe Constipation

• For fecal impaction, consider higher doses of PEG for the first few days or phosphate enemas 4
• Aggressive management is crucial as constipation may be linked to other conditions 1
• Monitor for signs of dehydration, electrolyte imbalances, excessive gas, abdominal distension, or discomfort 1

Important Considerations

• Treatment often needs to be continued long-term as relapse is common 5
• Only 50-70% of children with functional constipation demonstrate long-term improvement despite treatment 5
• Be alert for red flags that may indicate serious organic causes of constipation (Hirschsprung's disease, spinal cord abnormality, hypothyroidism, etc.) 5

Common Pitfalls to Avoid

• Delaying treatment can lead to psychosocial and digestive consequences 4
• Hyperosmotic mineral water and endoanal medications are not appropriate treatments for established constipation in infants 4
• Insufficient dosing or premature discontinuation of treatment often leads to relapse 4
• Overlooking the possibility of milk protein allergy as a cause of constipation 1