What are the treatment options for constipation in an infant?

Treatment of Constipation in Infants

For infants with constipation, start with ensuring adequate fluid intake through continued breastfeeding or full-strength formula, add small amounts of sorbitol-containing fruit juices (prune, pear, or apple), and use glycerin suppositories for disimpaction if fecal impaction is present. 1

Initial Non-Pharmacological Management

Fluid and Feeding Approach

• Continue breastfeeding on demand or maintain full-strength formula feeding to ensure adequate caloric intake 1, 2
• Avoid switching from breastfeeding to formula, as functional gastrointestinal disorders like constipation are normal and typically don't require formula changes 3
• Small amounts of fruit juices containing sorbitol (prune, pear, or apple juice) can increase stool frequency and water content 1, 2
• Caution: Excessive juice intake should be avoided as it may cause bloating, flatulence, and abdominal pain 1

Dietary Considerations

• Dietary fiber alone is NOT effective for established constipation in infants, though it may benefit older children 1
• For formula-fed infants with persistent constipation, formulas enriched with high β-palmitate and increased magnesium content may be considered to soften stool 3

Pharmacological Treatment

For Disimpaction

• Glycerin suppositories are the recommended option for fecal impaction in infants 1, 2
• Manual disimpaction may be performed if necessary 2

For Maintenance Treatment (Infants >6 months)

• Polyethylene glycol (PEG) is the first-line laxative for infants over 6 months of age 4, 5
• Lactulose or lactitol-based medications are authorized and effective for infants under 6 months 5
• The key principle is using a sufficient dose for a prolonged duration 5

Warning Signs Requiring Further Evaluation

Red flags that indicate potential organic causes requiring immediate investigation include: 1

• Delayed passage of meconium (>48 hours after birth)
• Failure to thrive
• Abdominal distension
• Abnormal position of anus
• Absence of anal or cremasteric reflex

Treatment Monitoring

• Regular reassessment of bowel habits is essential, with the goal of achieving soft, painless bowel movements 1
• Treatment duration often needs to continue for many months before normal bowel motility and rectal perception are restored 2
• Common pitfall: Parents frequently discontinue treatment prematurely before the infant regains normal bowel function 2

Treatment Algorithm Summary

1. First: Ensure adequate fluid intake through continued breastfeeding/formula 1
2. Second: Add small amounts of sorbitol-containing juices 1
3. Third: If impaction present, use glycerin suppositories 1
4. Fourth: For infants >6 months with persistent symptoms, initiate PEG 5
5. Fifth: Continue maintenance treatment for extended period (months) 2, 5