Treatment of Constipation in Babies
For infants with normal or frequent bowel movements, clear liquids for 24 hours plus a normal saline enema (10 mL/kg) is usually sufficient, while infants over 6 months with established constipation should receive polyethylene glycol (PEG) 3350 as first-line therapy at 0.8-1 g/kg/day. 1, 2, 3
Age-Specific Treatment Approach
Infants Under 6 Months
- Fruit juices containing sorbitol (prune, pear, apple) can increase stool frequency and water content effectively 2
- Lactulose/lactitol-based medications are authorized and effective for this age group, with initial dosing of 2.5-10 mL daily in divided doses 4, 5
- Breastfed infants should continue nursing on demand 1, 2
- Formula-fed infants should receive full-strength, lactose-free or lactose-reduced formulas immediately 1
Infants 6 Months and Older
- PEG 3350 is the laxative of first choice at 0.8-1 g/kg/day, aiming for 2-3 soft, painless stools daily 2, 3
- Lactulose remains an alternative option at 2.5-10 mL daily in divided doses for younger infants, increasing to 40-90 mL daily for older children 4
- Mineral oil is less commonly prescribed but remains an option 5
Critical First Step: Rule Out Impaction
Before starting maintenance therapy, you must assess for fecal impaction 3:
- If impaction is present, use glycerin suppositories as first-line suppository therapy 2, 3
- Manual disimpaction may be performed if needed 2
- Avoid suppositories/enemas in infants with neutropenia, thrombocytopenia, recent colorectal surgery, anal trauma, or severe colitis 2
Maintenance Phase Requirements
This is where most treatment failures occur - premature discontinuation leads to 40-50% relapse rates within 5 years 2, 3:
- Continue maintenance therapy for many months until the infant regains normal bowel motility and rectal perception 2, 3
- Goal is one non-forced bowel movement every 1-2 days 2, 3
- Adjust dosing based on response, not arbitrary timelines 3
Non-Pharmacological Adjuncts
- Maintain adequate hydration - this is especially critical in infants 1
- Continue breast milk or full-strength formula - do not dilute or restrict 1, 2
- Increase age-appropriate dietary fiber as solids are introduced (fruits, vegetables, whole grains) 2
- Avoid foods high in simple sugars and fats 1, 2
Common Pitfalls to Avoid
- Do NOT use bisacodyl in infants under 6 months - there is no safety or efficacy data for this age group, and safer alternatives exist 2
- Do NOT rely solely on dietary changes if impaction is present - this will worsen the problem 2
- Do NOT use stimulant laxatives as first-line therapy - osmotic agents like PEG are preferred 2
- Do NOT stop treatment prematurely - parents often cease treatment before the infant regains bowel function, leading to high relapse rates 2, 3
Special Considerations
- Hyperosmotic mineral water, diet alone, and endoanal medications are NOT treatments for established constipation at any age 5
- If constipation persists despite optimal treatment, consider underlying organic causes (Hirschsprung's disease, hypothyroidism, cystic fibrosis) 6
- Aggressive constipation management can decrease urinary tract infections in infants with vesicoureteral reflux 1, 3