Treatment of Constipation in an 11-Month-Old Infant
For an 11-month-old with constipation, start with fruit juices containing sorbitol (prune, pear, or apple juice) as first-line therapy, and if this fails, use polyethylene glycol (PEG) as the primary pharmacological treatment. 1, 2, 3
Initial Assessment
Before starting treatment, perform a rectal examination to rule out fecal impaction, which would require disimpaction before maintenance therapy can begin 2. If impaction is present, use high-dose PEG for the first few days to achieve disimpaction 3.
Treatment Algorithm
First-Line: Dietary Interventions
Utilize fruit juices with high sorbitol content (prune, pear, and apple juices) to increase stool frequency and water content, as recommended by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition 1.
These juices work through osmotic effects—sorbitol is absorbed slowly via passive diffusion, and the nonabsorbed carbohydrate presents an osmotic load that softens stools 1.
Ensure adequate fluid intake overall, particularly if the infant is in the lowest quartile of daily fluid consumption 2.
Second-Line: Pharmacological Treatment
Polyethylene glycol (PEG) is the first-line pharmacological agent for infants over 6 months of age with constipation 2, 3.
The standard dose is 17 grams once daily mixed in 4-8 ounces of beverage (cold, hot, or room temperature) 2.
Critical caveat: The FDA label states "children 16 years of age or under: ask a doctor," but pediatric guidelines strongly support PEG use in infants over 6 months based on moderate-quality evidence 2, 4.
PEG effectively increases complete spontaneous bowel movements and has been shown to have durable response over 6 months 2.
Common side effects include abdominal distension, loose stool, flatulence, and nausea 2.
Alternative for Younger Infants
- For infants under 6 months of age, lactulose or lactitol-based medications are authorized and effective 3.
Treatment Goals
Aim for at least 3 bowel movements per week without straining, or ideally one non-forced bowel movement every 1-2 days without abdominal pain 2.
Monitor stool consistency, frequency, presence of abdominal pain or straining to adjust treatment 2.
Critical Pitfalls to Avoid
Never use stool softeners alone—they are ineffective for treating constipation in children 2.
Do not limit PEG to 7 days in chronic constipation despite FDA labeling; response has been shown to be durable over 6 months, and chronic constipation requires longer treatment 2, 4.
Do not add supplemental fiber without ensuring adequate fluid intake, as this can worsen constipation 2.
Ensure the PEG powder is fully dissolved before drinking and do not combine with starch-based thickeners 4.