What is the treatment for constipation in a 9-month-old infant?

Treatment of Constipation in a 9-Month-Old Infant

For a constipated 9-month-old infant, start with polyethylene glycol (PEG) as first-line pharmacologic treatment, combined with adequate fluid intake and small amounts of sorbitol-containing fruit juices (prune, pear, or apple juice). 1, 2

Initial Assessment

Before starting treatment, quickly assess for warning signs that would require further evaluation:

• Red flags requiring immediate investigation: delayed passage of meconium (>48 hours after birth), failure to thrive, abdominal distension, abnormal anal position, or absence of anal/cremasteric reflexes 1
• If none of these are present, proceed with functional constipation treatment 3

First-Line Treatment Approach

Non-Pharmacological Measures

• Ensure adequate fluid intake: Continue breastfeeding on demand if breastfed 1
• Add sorbitol-containing fruit juices: Small amounts of prune, pear, or apple juice increase stool frequency and water content, but avoid excessive intake to prevent bloating and abdominal pain 1
• Note that dietary fiber and mineral water are not effective treatments for established constipation in infants this age 2

Pharmacologic Treatment

Polyethylene glycol (PEG) is the preferred first-line medication for infants over 6 months of age 2, 3:

• PEG is effective, well-tolerated, and specifically authorized for infants over 6 months 2
• The treatment principle is sufficient dose for a long duration 2

Alternative option - Lactulose/Lactitol:

• These are authorized and effective for infants under 6 months and can be used in 9-month-olds 2
• Dosing for infants: 2.5-10 mL daily in divided doses 4
• Adjust dose to produce 2-3 soft stools daily 4
• If diarrhea occurs, reduce dose immediately; if it persists, discontinue 4

If Fecal Impaction is Present

First stage is disimpaction before maintenance therapy 2:

• Use high-dose PEG for the first few days, OR
• Use repeated phosphate enemas 2
• Glycerin suppositories are another option for impaction 5

Maintenance and Follow-Up

• Duration: Maintenance therapy may be required for months because relapse is common 3
• Goal: Achieve soft, painless bowel movements 1
• Regular reassessment: Monitor bowel habits continuously to ensure treatment effectiveness 1
• Education: Teach families about proper toileting habits and daily bowel movement routines to restore colonic motility and prevent relapse 2

Common Pitfalls to Avoid

• Don't rely on dietary fiber alone - it is not effective for established constipation in infants, though it may help in older children with adequate fluid intake 2, 5
• Don't use inadequate doses - underdosing is a common reason for treatment failure 2
• Don't stop treatment too early - maintenance therapy often needs to continue for months to prevent relapse 3
• Don't use cow's milk excessively - it may promote constipation in some children 3