From the FDA Drug Label
Pediatric: ...the recommended initial daily oral dose in infants is 2. 5 mL to 10 mL in divided doses. The treatment for constipation in a 2-week-old neonate with lactulose is an initial daily oral dose of 2.5 mL to 10 mL in divided doses 1.
- The dose may be adjusted to produce 2 or 3 soft stools daily.
- If the initial dose causes diarrhea, the dose should be reduced immediately.
- If diarrhea persists, lactulose should be discontinued.
From the Research
For constipation in a 2-week-old neonate, initial management should focus on glycerin suppositories and ensuring adequate hydration, with consideration of dark corn syrup or prune juice as mild osmotic laxatives, as recommended by recent guidelines and evidence-based reviews 2, 3. The most recent and highest quality study, a 2021 review on the evidence for over-the-counter laxatives to treat childhood constipation, suggests that osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, are effective and safe for both long and short-term treatment of pediatric functional constipation 3. However, for a 2-week-old neonate, a more gentle approach is necessary.
Initial Management
- Rule out more serious conditions like Hirschsprung's disease or intestinal obstruction
- Glycerin suppositories (1/4 to 1/2 of an infant suppository) for gentle stimulation and lubrication, used once daily for 1-2 days
- Ensure adequate hydration, especially for formula-fed infants who may need additional water between feedings (1-2 oz)
Ongoing Management
- Consider 1-2 mL of dark corn syrup mixed with formula or expressed breast milk once or twice daily as a mild osmotic laxative
- Alternatively, 1-2 mL/kg of prune juice diluted with water can be effective
- Gentle abdominal massage in a clockwise direction and bicycle leg movements can stimulate bowel activity It is essential to note that constipation in neonates is often related to immature digestive systems, formula intolerance, or inadequate fluid intake. If symptoms persist beyond 2-3 days despite these interventions, or if the infant shows signs of distress, vomiting, or abdominal distension, prompt medical evaluation is necessary, as suggested by a 2020 review on pediatric constipation for general pediatricians 2.