What is the treatment for constipation in a 19-day-old newborn?

Treatment for Constipation in a 19-Day-Old Newborn

For a 19-day-old newborn with constipation, glycerin suppositories are the recommended first-line treatment for short-term relief, while ensuring adequate hydration if formula-fed. 1

Initial Assessment and Red Flags

Before initiating treatment, you must rule out serious organic causes that require immediate specialist referral:

• Failure to pass meconium within 48 hours of birth suggests Hirschsprung's disease 2
• Abdominal distension or tenderness warrants urgent evaluation 1
• Failure to thrive or poor weight gain requires further investigation 1
• Vomiting, especially bilious emesis may indicate intestinal obstruction 2

Treatment Algorithm for a 19-Day-Old

Step 1: Non-Pharmacological Interventions

• If formula-fed: Ensure adequate fluid intake to maintain proper hydration 1
• If formula-fed: Avoid excessive thickening of formula, which may worsen constipation 1
• If breastfed: Continue breastfeeding on demand, as breast milk rarely causes true constipation 3

Step 2: Pharmacological Treatment

For immediate relief:

• Glycerin suppositories are the safest option for short-term relief in newborns this age 1
• These provide mechanical stimulation and lubrication to facilitate stool passage 1

Important contraindications at this age:

• Do NOT use polyethylene glycol (PEG) - it is only approved for infants over 6 months of age 4, 5
• Avoid fruit juices (prune, pear, apple) - these are not recommended for young infants despite containing sorbitol 1
• Avoid chronic use of stimulant laxatives in infants 1
• Avoid phosphate enemas - these carry risk of electrolyte disturbances in young infants 4

Step 3: Alternative Options for Infants Under 6 Months

If glycerin suppositories are insufficient:

• Lactulose or lactitol-based medications are authorized and effective before 6 months of age 5
• These osmotic agents increase stool water content and frequency 5

Common Pitfalls to Avoid

• Do not assume infrequent stooling equals constipation - breastfed infants may normally stool once every several days without discomfort 1
• Do not use mineral oil retention enemas in newborns - aspiration risk is significant 1
• Do not delay evaluation if the infant has never passed normal stool - this may indicate Hirschsprung's disease 2
• Avoid overtreatment - constipation in this age group often resolves with hydration and time 1

When to Refer

Immediate referral to pediatric gastroenterology is indicated if:

• Constipation persists despite appropriate interventions 1
• Any red flag symptoms are present (failure to thrive, abdominal distension, delayed meconium passage) 1, 2
• Concern for organic causes such as Hirschsprung's disease, hypothyroidism, or anorectal malformation 2

Monitoring

• Reassess the infant's response to treatment regularly - within 24-48 hours initially 1
• Monitor weight gain, feeding tolerance, and stool frequency 1
• Educate parents that normal stool patterns vary widely in newborns, especially between breast-fed and formula-fed infants 1