What are the treatment options for infant constipation?

Treatment Options for Infant Constipation

For infants with constipation, prune, pear, and apple juices are recommended first-line treatments due to their sorbitol and carbohydrate content that helps increase stool frequency and water content. 1

Dietary Interventions

• Fruit juices containing sorbitol (prune, pear, and apple juices) can help increase stool frequency and water content in infants with constipation 1
• For breastfed infants with constipation, continue breastfeeding on demand while potentially implementing a maternal exclusion diet (restricting milk and eggs) for 2-4 weeks 1
• For formula-fed infants, consider switching to lactose-free or lactose-reduced formulas if symptoms persist 1
• Full-strength formulas should be administered immediately upon rehydration in bottle-fed infants with constipation 1
• Avoid foods high in simple sugars and fats in older infants who have started solid foods 1

Medication Options

For Infants Under 6 Months

• Lactulose is authorized and effective for infants under 6 months of age 2
• Initial daily oral dose in infants is 2.5 mL to 10 mL in divided doses 3
• If the initial dose causes diarrhea, reduce the dose immediately; if diarrhea persists, discontinue lactulose 3

For Infants Over 6 Months

• Polyethylene glycol (PEG) is recommended for infants over 6 months of age 2
• Other options include:
  • Magnesium hydroxide (milk of magnesia) 4
  • Mineral oil (less commonly prescribed) 2
  • Lactulose (8% of cases) 4

Treatment Algorithm

1. First-line approach: Try dietary modifications

   • For breastfed infants: Continue breastfeeding, consider maternal dietary changes 1
   • For formula-fed infants: Consider lactose-free formulas 1
   • For infants on solids: Add fruits and vegetables, avoid simple sugars 1
   • Try fruit juices with sorbitol (prune, pear, apple) in appropriate amounts (10 mL/kg body weight) 1

2. If dietary changes are insufficient: Add medication

   • Under 6 months: Lactulose 2.5-10 mL/day in divided doses 3, 2
   • Over 6 months: Polyethylene glycol or other laxatives as prescribed 2

3. For severe cases with fecal impaction:

   • Disimpaction using oral cathartics, enemas, or suppositories followed by daily laxative therapy 4
   • High-dose PEG for the first few days or repeated phosphate enemas may be necessary 2

Important Considerations

• Aggressive treatment that includes colonic evacuation followed by daily laxative therapy is more effective than less aggressive approaches 4
• Primary care physicians tend to undertreat childhood constipation, with nearly 40% of children remaining symptomatic after 2 months of treatment 4
• Dose adjustment is critical - physicians should instruct parents to adjust laxative doses up or down to achieve the desired effect 4
• Long-term maintenance therapy may be required for months to years as relapse of functional constipation is common 5
• Despite appropriate treatment, only 50-70% of children with functional constipation demonstrate long-term improvement 5

Red Flags Requiring Further Investigation

• Delayed passage of meconium (>48 hours after birth)
• Failure to thrive
• Abdominal distension
• Bloody stools
• Vomiting
• Abnormal neurological findings
• These may indicate serious organic causes requiring specialist evaluation 5