From the Guidelines
To treat infant constipation, the most effective approach is to increase fluid intake and make dietary changes, such as offering high-fiber options like pureed prunes, pears, or peaches, as these methods can help soften stool and increase intestinal motility. Although the provided evidence primarily focuses on constipation in pregnant persons and dysfunctional voiding in children, the principles of increasing fluid intake and dietary fiber can be applied to infant constipation as well 1.
Key Considerations
- Increasing fluid intake, particularly water for babies over 6 months old, or more frequent breastfeeding for younger infants, can help soften stool and ease bowel movements.
- Dietary changes, such as offering high-fiber options like pureed prunes, pears, or peaches, can help increase intestinal motility and soften stool.
- A gentle belly massage in a clockwise motion or moving the baby's legs in a bicycling motion can stimulate bowel movements.
- For immediate relief, a glycerin suppository (following package instructions for infant dosing) or a small amount of apple or prune juice (1-2 ounces for babies over 4 months) can be tried.
- If the baby is formula-fed, consider switching formulas after consulting with a pediatrician, as some formulas may be more constaining than others.
- Warm baths can also relax the anal muscles and make passage easier.
Additional Recommendations
- The management of constipation is crucial, and treatment should be maintained for many months before the child regains bowel motility and rectal perception 1.
- Ensuring correct posture and teaching abdominal/pelvic floor muscle interaction may lead to the coordinated pattern necessary for relaxed voiding to completion 1.
- Biofeedback sessions, such as those using uroflow pattern, auditory stimulus, or noninvasive abdominal or perineal EMG, may be beneficial in some cases 1.
Important Notes
- Constipation in infants is often temporary and related to dietary transitions, but persistent constipation warrants medical attention, especially if accompanied by other symptoms like vomiting, abdominal distension, or blood in the stool.
- It is essential to consult with a pediatrician before making any significant changes to an infant's diet or treatment plan.
From the FDA Drug Label
Pediatric: Very little information on the use of lactulose in young children and adolescents has been recorded. As with adults, the subjective goal in proper treatment is to produce 2 or 3 soft stools daily. On the basis of information available, the recommended initial daily oral dose in infants is 2. 5 mL to 10 mL in divided doses. Infants receiving lactulose may develop hyponatremia and dehydration.
The treatment option for infant constipation (gastrointestinal motility disorder) is lactulose with a recommended initial daily oral dose of 2.5 mL to 10 mL in divided doses 2. It is essential to monitor for potential side effects, such as hyponatremia and dehydration 2.
From the Research
Treatment Options for Infant Constipation
The treatment options for infant constipation, a gastrointestinal motility disorder, vary depending on the age of the infant and the severity of the condition.
- For infants under 6 months, lactulose/lactitol-based medications are authorized and effective 3.
- For infants over 6 months, polyethylene-glycol (PEG) is recommended 3.
- Mineral oil is less commonly prescribed 3.
- In cases of fecal impaction, a high dose of PEG or repeated phosphate enemas may be used for fecal disimpaction 3.
- Dietary modifications, such as increased dietary fiber, may also be effective in treating childhood constipation 4.
- A clear management plan, including education on toileting habits and dietary modifications, is essential for treating childhood constipation 5.
- Laxatives may be required to re-establish regular, painless defecation 5.
Approach to Treatment
The approach to treating infant constipation involves:
- Evaluating the child's bowel habits and medical history 6.
- Ruling out organic causes of constipation 7, 6.
- Initiating a treatment plan that includes dietary modifications, laxatives, and education on toileting habits 3, 5, 6.
- Monitoring the child's progress and adjusting the treatment plan as needed 3, 5, 6.
- Considering psychological concerns and evaluating and treating them if necessary 3.