What should I do if my 6-month-old baby hasn't had a bowel movement for 3 days?

Management of a 6-Month-Old Infant Without Bowel Movement for 3 Days

For a 6-month-old infant who hasn't had a bowel movement for 3 days, start with fruit juices containing sorbitol (prune, pear, or apple juice) at 10 mL/kg body weight as first-line treatment, followed by lactulose if juices are ineffective. 1

Understanding Normal Bowel Patterns at This Age

Before intervening, it's important to recognize that bowel patterns vary significantly in infants:

• Breastfed infants can have normal bowel movements ranging from several times per day to once every 7-10 days, as long as stools are soft when passed 1
• Formula-fed infants typically have more frequent bowel movements, and 3 days without stooling may indicate true constipation 2
• By 6 months, feeding patterns have evolved from the newborn period, which naturally affects stool frequency 1

Initial Assessment: What to Look For

Evaluate these key factors immediately:

• Type of feeding: Determine if the infant is breastfed, formula-fed, or receiving both 1
• Recent dietary changes: Any new formula introduction or changes in maternal diet if breastfeeding 1
• Signs of distress: Look for abdominal distension, vomiting (especially bilious vomiting), irritability, or poor feeding 1, 3
• Stool characteristics when passed: Hard, pellet-like stools versus soft stools suggest different problems 4
• Weight gain pattern: Poor growth may indicate an underlying organic cause requiring further evaluation 1

Red Flags Requiring Immediate Medical Attention

Seek urgent evaluation if any of these are present:

• Bilious vomiting, which may indicate intestinal obstruction 1
• Abdominal distension with no passage of gas 3
• Delayed passage of meconium beyond 48 hours after birth (historical red flag for Hirschsprung's disease) 4
• Signs of dehydration: decreased urine output, lethargy, or irritability 5
• Blood in stool or perianal fissures with significant bleeding 1

First-Line Treatment Approach

Step 1: Dietary Interventions

• Administer fruit juices containing sorbitol such as prune, pear, or apple juice at 10 mL/kg body weight 1
• These juices work by creating an osmotic load in the gastrointestinal tract due to their poorly absorbed sorbitol and carbohydrate content 1
• Caution: Avoid excessive juice consumption as it may cause diarrhea, flatulence, abdominal pain, and poor weight gain 1

Step 2: Continue Appropriate Feeding

• For breastfed infants: Continue nursing on demand as the primary nutritional source 1
• For formula-fed infants: Ensure adequate hydration and maintain full-strength formula 1
• Consider whether the infant is developmentally ready for solid foods (appropriate at 6 months), as introducing solids may help 1

Step 3: Consider Milk Protein Allergy

If constipation persists or is accompanied by other symptoms:

• For breastfeeding mothers: Consider a 2-4 week trial of maternal exclusion diet restricting milk and egg 1
• For formula-fed infants: Consider switching to an extensively hydrolyzed or amino acid-based formula if milk protein allergy is suspected 1

Pharmacological Treatment if Dietary Measures Fail

At 6 months of age, you have two main options:

• Lactulose or lactitol: Authorized and effective for infants under 6 months 6
• Polyethylene glycol (PEG): Authorized for infants over 6 months, making your 6-month-old eligible 6
• PEG is effective and well-tolerated for both disimpaction and maintenance therapy 3

Important treatment principle: Use sufficient doses for adequate duration—constipation treatment often requires months of therapy 6, 3

Common Pitfalls to Avoid

• Don't assume all infrequent stooling is constipation: Breastfed infants may normally go several days without stooling 1
• Don't use hyperosmotic mineral water, endoanal medications, or dietary fiber alone: These are not effective treatments for established constipation in infants this age 6
• Don't perform digital rectal examination routinely: This is typically unnecessary for functional constipation and should be reserved for cases with red flags 1
• Don't discontinue treatment too early: Relapse is common, and maintenance therapy may be required for months to years 3

When to Escalate Care

Contact a pediatrician or seek evaluation if:

• The infant develops vomiting, especially if bilious 1
• No improvement after 24-48 hours of juice therapy 1
• The infant appears uncomfortable, refuses feeds, or shows signs of dehydration 5
• There are concerns about growth or development 1
• Constipation becomes chronic or recurrent, requiring long-term management strategies 4