What are the treatment options for constipation in a newborn?

Treatment Options for Constipation in Newborns

For newborn constipation, dietary modifications should be the first-line approach, including increased fluid intake and consideration of formula changes, before progressing to glycerin suppositories or osmotic laxatives like lactulose for persistent cases. 1, 2

Understanding Newborn Constipation

• Constipation in newborns is a common concern that may present as infrequent bowel movements (≤2 per week), hard stools, or painful defecation 3
• Normal stool patterns in newborns vary widely, especially between breast-fed and formula-fed infants 1
• It's important to distinguish true constipation from infant dyschezia (straining and crying before successful passage of soft stools) 4

First-Line Interventions

Dietary Modifications

• For breastfed infants:

  • Continue breastfeeding as the preferred feeding method 5
  • Consider a 2-4 week trial of maternal exclusion diet that restricts at least milk and egg if constipation persists 1

• For formula-fed infants:

  • Consider changing to a formula with partially hydrolyzed protein, prebiotics, and β-palmitate, which may help soften stools 2
  • Ensure adequate fluid intake to maintain proper hydration 1
  • Avoid excessive thickening of formula, which may worsen constipation 1

Second-Line Interventions

Osmotic Laxatives

• Lactulose can be safely used in infants younger than 6 months with constipation 2

  • Initial daily oral dose for infants: 2.5 mL to 10 mL in divided doses 6
  • If initial dose causes diarrhea, reduce immediately; if diarrhea persists, discontinue lactulose 6

• Polyethylene glycol (PEG):

  • Not approved for infants under 6 months of age 2
  • Preferred over lactulose in infants older than 6 months 2

Mechanical Interventions

• Glycerin suppositories may be considered for short-term relief 1
• For impaction, consider:
  • Glycerin suppository with or without mineral oil retention enema 1
  • Manual disimpaction (only following pre-medication with analgesic and/or anxiolytic) 1

Special Considerations

• Fruit juices containing sorbitol (prune, pear, and apple juices) may help increase stool frequency and water content in older infants, but are not recommended for young infants 1
• Avoid chronic use of stimulant laxatives in infants 1
• Rule out underlying medical conditions that may cause constipation, such as Hirschsprung disease, hypothyroidism, or anatomical abnormalities 3

Warning Signs Requiring Further Evaluation

• Delayed passage of meconium (beyond 48 hours of life) 3
• Associated symptoms of intestinal obstruction 3
• Failure to thrive or poor weight gain 1
• Abdominal distension or tenderness 1
• Ribbon-like stools or blood in stool 4

Monitoring and Follow-up

• Use the Bristol stool chart to monitor stool consistency 3
• Reassess the infant's response to treatment regularly 1
• If constipation persists despite appropriate interventions, consider referral to a pediatric gastroenterologist 1