What is the treatment for constipation in a 7-month-old infant?

Treatment for Constipation in a 7-Month-Old

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, 2

First-Line Dietary Interventions

• Fruit juices with sorbitol are the recommended initial treatment for infants under 1 year, specifically prune, pear, and apple juices, which create an osmotic load in the gastrointestinal tract that increases stool water content and frequency 1, 2
• Administer 10 mL/kg body weight of these juices as the appropriate starting dose 1
• Avoid excessive juice consumption as it can cause diarrhea, flatulence, abdominal pain, and poor weight gain 2

Feeding-Specific Modifications

For breastfed infants:

• Continue breastfeeding on demand without interruption 2, 3
• Consider a maternal exclusion diet restricting milk and eggs for 2-4 weeks if milk protein allergy is suspected 1, 2

For formula-fed infants:

• Switch to lactose-free or lactose-reduced formulas if symptoms persist 1
• Use full-strength formula immediately 1, 3
• Consider extensively hydrolyzed or amino acid-based formula if milk protein allergy is suspected 2

Solid Food Considerations

At 7 months, most infants have started solids:

• Add fruits and vegetables to the diet 1
• Avoid foods high in simple sugars and fats 1

Second-Line Pharmacological Treatment

• If fruit juices fail, lactulose is the next appropriate medication for infants under 1 year 2
• Polyethylene glycol (PEG) is recommended for infants over 6 months and can be considered at this age 4, 5, 6

Critical Safety Warnings

Absolutely contraindicated medications at this age:

• Never use antidiarrheal agents (including loperamide) in infants—risk of respiratory depression, cardiac arrest, and death 3
• Avoid stimulant laxatives (bisacodyl, senna) in infants this young 3
• Avoid magnesium-based laxatives at this age 3

Red Flags Requiring Immediate Evaluation

Refer urgently if any of the following are present:

• Failure to thrive or poor weight gain 1, 2
• Abdominal distension 1
• Bloody stools 1
• Bilious vomiting 1, 2
• Abnormal neurological findings 1
• Delayed passage of meconium (>48 hours after birth in history) 1
• Irritability, lethargy, or decreased urine output 3

Initial Assessment Requirements

Before treatment, evaluate:

• Weight to establish baseline and assess for failure to thrive 3
• Signs of dehydration: skin turgor, mucous membranes, mental status, pulse, and capillary refill 3
• Visual inspection of perianal area for fissures, skin tags, or redness 2
• Feeding history including type of feeding and recent changes 2

Hydration Management

• Ensure adequate fluid intake throughout treatment 3
• If mild dehydration is present, administer 50 mL/kg oral rehydration solution over 2-4 hours 3