II. Precautions

  1. Most presentations for "Constipation" are not Constipation
    1. Decreased stool frequency is not Constipation (1 stool every 7-10 days)
    2. Crying or altered Skin Coloration while stooling in young infants is common and normal
  2. True Constipation is uncommon in newborns and requires evaluation
    1. See Constipation Causes in Infants

III. Etiology

  1. Functional Causes
    1. Constipation has functional cause in >95% of infants
    2. More common in formula fed than Breast fed infants
  2. Organic causes (most often present as newborns)
    1. Constipation Causes in Infants
    2. Evaluate for Hirschsprung Disease if first meconium >24 hours after delivery
      1. Hirschsprung Disease is an emergency in Infant with Vomiting or Abdominal Distention

V. Evaluation

  1. See Pediatric Constipation for History and Diagnostics
  2. See Pediatric Constipation for Red Flags

VI. Management: Constipation in under age 1 year

  1. See Pediatric Constipation Management
  2. Exclude serious organic cause
    1. See Constipation Causes in Infants
    2. See Pediatric Constipation for Red Flags
  3. Initial dietary trial
    1. Sorbitol Fruit juice as below (e.g. prune, pear or apple juice)
    2. Adequate fluid intake (Breast Milk or formula)
  4. Disimpaction: Medications
    1. Glycerin Suppository (preferred)
    2. Polyethylene Glycol (Miralax or Golytely)
    3. Enema with Normal Saline or Mineral Oil (refractory)
      1. Dose: 6 ml/kg up to 135 ml
      2. May repeat every 12-24 hours for 3 doses
  5. Maintenance: Medications
    1. Polyethylene Glycol (Miralax)
    2. Lactulose
    3. Sorbitol (e.g. prune juice)
  6. Maintenance: Dietary Management
    1. Baby under 6 months
      1. Maximize fluid intake (Breast Milk or formula)
      2. Apple, pear, or prune juice (Sorbitol juices)
        1. Give 1 to 3 ml/kg diluted with 1 to 2 ounces water once or twice daily
    2. Baby over 4 months: High fiber strained foods bid
      1. Cereals
      2. Fruits: Apricots, Prunes, Peaches, Pears, Plums
      3. Vegetables: Beans, Peas, Spinach
    3. Avoid constipating fruits
      1. Bananas
      2. Rice
      3. Apples

VII. References

  1. Claudius in Majoewsky (2013) EM:Rap 13(1): 8
  2. Nurko (2014) Am Fam Physician 90(2): 82-90 [PubMed]

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