Treatment of Constipation in a 3-Month-Old Infant
For a 3-month-old infant with constipation, fruit juices containing sorbitol (prune, pear, or apple juice) are the recommended first-line treatment, along with ensuring adequate hydration through continued breast-feeding on demand or full-strength formula. 1, 2
Initial Assessment Considerations
Before initiating treatment, ensure this is true constipation and not infant dyschezia (normal grunting and straining in infants under 6 months who have not yet learned to coordinate abdominal pressure with pelvic floor relaxation). 3 True constipation at this age warrants careful evaluation, as delayed passage of meconium beyond 48 hours of life or constipation since birth are red flags that may suggest Hirschsprung disease and require referral. 3, 4
Recommended Treatment Approach
First-Line Non-Pharmacological Management
Continue breast-feeding on demand or use full-strength formula to maintain proper hydration, as recommended by the CDC. 1
Offer sorbitol-containing fruit juices (prune, pear, or apple juice) which help increase stool frequency and water content in infants with constipation. 1, 2 This is the most appropriate dietary intervention for a 3-month-old.
Pharmacological Options for Infants Under 6 Months
Lactulose or lactitol-based medications are authorized and effective for infants before 6 months of age. 5 These osmotic laxatives are preferred when dietary measures alone are insufficient.
Glycerin suppositories may be used if rectal examination identifies a full rectum or if immediate relief is needed, as they act as a rectal stimulant through mild irritant action and are safe for this age group. 1
Medications to AVOID in This Age Group
Polyethylene glycol (PEG) should NOT be used in infants under 6 months of age; it is only recommended for infants 6 months and older. 1, 5
Bisacodyl has no safety or efficacy data for use in infants under 6 months and should be avoided. 1
Bulk laxatives (such as psyllium) are not recommended for infant constipation. 6
Critical Pitfalls to Avoid
Do not delay referral if constipation has been present since birth or if meconium passage was delayed beyond 48 hours, as these suggest possible Hirschsprung disease. 3, 4
Do not use stimulant laxatives as first-line therapy in this age group; osmotic agents or dietary modifications are preferred. 6, 1
Avoid relying solely on dietary changes if there is evidence of fecal impaction; suppositories may be needed first. 1
Do not use enemas in infants with neutropenia, thrombocytopenia, recent surgery, or anal trauma. 6, 1
When to Refer
Refer immediately to pediatric gastroenterology if there are red flags including: delayed meconium passage, constipation since birth, failure to thrive, developmental delays, or lack of response to initial conservative management. 3, 4 At 3 months of age, organic causes must be ruled out more carefully than in older children, as functional constipation typically develops later during weaning or toilet training. 4