What is the treatment for constipation in a 6-month-old infant?

Treatment of Constipation in a 6-Month-Old Infant

For a 6-month-old infant with constipation, the first-line treatment is increasing fluid intake, considering fruit juices containing sorbitol (like prune, pear, or apple juice), and using lactulose as a medication if needed. 1, 2, 3

Initial Assessment and Non-Pharmacological Management

• Ensure adequate fluid intake, particularly in breastfed infants who should continue nursing on demand 1
• For formula-fed infants, consider a partially hydrolyzed formula with prebiotics and β-palmitate, which may help improve constipation 3
• Small amounts of fruit juices containing sorbitol (prune, pear, or apple juice) can help increase stool frequency and water content in infants with constipation 1
• Avoid excessive intake of juice as it may cause other gastrointestinal issues like bloating, flatulence, and abdominal pain 1

Pharmacological Management

• Lactulose is safe and effective for infants younger than 6 months with constipation 3

  • Initial daily oral dose for infants is 2.5 mL to 10 mL in divided doses 2
  • If the initial dose causes diarrhea, reduce the dose immediately 2
  • If diarrhea persists despite dose reduction, discontinue lactulose 2

• For infants older than 6 months:

  • Polyethylene glycol (PEG) is preferred over lactulose for infants older than 6 months 3
  • Mineral oil is less commonly prescribed but remains an option 4

Management of Severe Constipation

• In cases of fecal impaction:
  • For infants over 6 months, high-dose PEG for the first few days may be necessary 4
  • Glycerin suppositories may be considered for immediate relief 1

Duration of Treatment

• Treatment should be maintained at a sufficient dose for an adequate duration 4
• Long-term maintenance therapy may be required for months as relapse of functional constipation is common 5
• Gradual tapering of medication is recommended once regular bowel patterns are established 4

When to Seek Further Evaluation

• Be alert for warning signs that may indicate an organic cause of constipation, such as:
  • Delayed passage of meconium (>48 hours after birth)
  • Failure to thrive
  • Abdominal distension
  • Abnormal position of anus
  • Absence of anal or cremasteric reflex
  • Decreased lower extremity tone or strength 5, 6

Follow-up

• Regular reassessment of the infant's bowel habits is essential to monitor treatment effectiveness 1
• Adjust treatment based on response, with the goal of achieving soft, painless bowel movements 4
• Despite appropriate treatment, 40-50% of children with constipation experience at least one relapse within 5 years 6

Remember that constipation in infants is usually functional and responds well to appropriate interventions, but consistent application of the treatment plan is necessary for long-term success.