From the Guidelines
For a 16-month-old experiencing constipation for 4 days, I recommend starting with dietary changes, specifically offering 100% fruit juice, such as prune, pear, or apple juice, to help increase the frequency and water content of stools, as suggested by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition constipation guideline 1.
Dietary Changes
To manage constipation in a 16-month-old child, it is essential to make dietary changes. Increase fluid intake by offering more water throughout the day and reduce constipating foods like bananas, rice, and dairy products. Add more fiber-rich foods such as pureed prunes, pears, or peaches, and include whole grains when possible.
- Offer 100% fruit juice, such as prune, pear, or apple juice, in appropriate amounts (10 mL/kg body weight) to help increase the frequency and water content of stools, as the sorbitol and other carbohydrates in these juices can help with constipation 1.
- Encourage physical activity to help stimulate bowel movements.
Medication and Other Interventions
If dietary changes don't help within 1-2 days, you can try a small dose of over-the-counter pediatric osmotic laxative like Miralax (polyethylene glycol 3350) - typically 1/2 to 1 teaspoon dissolved in 4 ounces of liquid once daily for 2-3 days.
- Warm baths and gentle belly massage in a clockwise direction can also help relax the abdominal muscles.
- Contact your pediatrician if you notice blood in the stool, severe abdominal pain, vomiting, or if constipation persists beyond a week despite these measures.
Monitoring and Follow-up
Constipation in toddlers often occurs during dietary transitions or when children begin holding stool due to discomfort or being too busy playing, and these interventions help soften the stool and restore regular bowel habits. It is crucial to monitor the child's condition and follow up with the pediatrician if the constipation persists or worsens.
From the FDA Drug Label
children 16 years of age or under: ask a doctor The FDA drug label does not answer the question.
From the Research
Management Plan for Constipation in a 16-Month-Old Child
The management plan for constipation in a 16-month-old child that has persisted for 4 days involves several steps:
- Disimpaction using oral or rectal medication, with polyethylene glycol being effective and well tolerated 2, 3
- Maintenance program for months to years to prevent relapse of functional constipation, which may include mineral oil, lactulose, milk of magnesia, polyethylene glycol powder, and sorbitol 2
- Education of the family and, when possible, the child on improving functional constipation, including dietary counseling and toilet training 2, 4
- Consideration of withholding cow's milk and adding fiber to the diet to improve constipation 2
Treatment Options
Treatment options for constipation in children include:
- Osmotic laxatives, such as polyethylene glycol 3350 (PEG 3350) and lactulose, which are effective and safe for both long and short term treatment of pediatric functional constipation 5
- Stimulant laxatives, like Senna and Bisacodyl, probiotics, fiber preparations, enemas, and suppositories, which can be used as adjunct therapies in specific clinical scenarios 5
- Hyperosmotic mineral water, diet, and endoanal medications are not recommended as treatments for established constipation 3
Red Flags and Organic Causes
It is essential to rule out red flags and organic causes of constipation, such as Hirschsprung's disease, pseudo-obstruction, spinal cord abnormality, hypothyroidism, diabetes insipidus, cystic fibrosis, gluten enteropathy, or congenital anorectal malformation 2, 4