For most newborns, one of the first few activities after birth is the passage of poop.
When parents and caregivers notice that a newborn is not passing stools, they become alarmed. In this article, we will examine the causes of delayed passage of stools by your newborn and how it is managed.
Newborns and Poop
Before a baby is born, he/she utilizes energy from the mother’s blood supply for energy uses and growth while still in the womb. They also get rid of their waste products in the same way – through the mother’s blood.
After birth, one of the first few transitions from being totally dependent on their mother to needing to live independently is breathing, as well as, getting nourishment from food.
After feeding, waste products are discarded, this time by themselves. It is very important to start feeding newborns as soon as possible after childbirth (after you have been given clearance by your healthcare professional).
In the first few hours after birth, newborns pass meconium – a greenish, sticky, tar-like poop which contains materials ingested during their time in the womb. It is one of the indications that all is indeed well. Afterward, they often pass dark-greenish to yellow stools which may be seedy or contain mucus. This goes on for the first few days of life.
If your baby does not pass stools after birth, passes hard stools or stops passing stools for a few days, your baby may be constipated. The frequency of poop, the texture of poop, the color of poop and ease of passage of stool matters in assessing constipation.
Passage of firm or hard stools less than once a day or less than once a week in older babies, eating less, grunting sounds when trying to pass stools, passing bloody or dark stools or associated tummy ache are particularly distressing signs of constipation.
In newborns, constipation may be due to a number of reasons, some of which may be mild while others are severe enough to warrant immediate specialist assessment and care. Please note that the frequency of pooping varies from baby to baby. Some babies may pass stools once a week and be perfectly fine, however, they have to be thoroughly assessed first to rule out any medical condition.
Causes Of Newborn Not Pooping
1. Normal Development
After the initiation of feeding, the digestive system absorbs nutrients and energy from the food and then removes the remnant waste products from the body. The digestive system of newborns is not proficient enough in the extraction of nutrients at optimum levels compared to that of an adult because it is learning and undergoing maturation.
Therefore, it is not uncommon for newborns to pass stools almost after every feed, especially if they are being breastfed. Over time, this gets better and virtually all ingested meals are absorbed around the 4th week of life. Some babies may drastically reduce the frequency of pooping during this time until their digestive system matures some more.
Breastfed babies are expected to pass less number of poops compared to formula fed babies because breast milk contains everything a baby needs and has little or no waste products.
2. Underdeveloped Abdominal Muscles
For one to pass stools, you need to have some degree of strength in your abdominal muscles. This strength is required to initiate and aid pooping. Newborns are often seen straining before being able to pass stools. This is quite normal and gets increasingly better as they grow.
While this may cause your baby to be constipated for a few hours to days after birth, it is often short-lived and stops before the worry sets in. However, if your baby seems distressed, is in pain or uncomfortable after feeding, this may be a sign of an underlying condition and you should see your pediatrician. The process may be longer in formula fed babies who often have larger and firmer stools.
3. Formula Food
There is a higher tendency for constipation to develop in formula-fed babies due to the difficulty with digesting formula compared to breast milk. This is increased when babies are fed improperly mixed formula (wrong ratio of water to powder).
Your formula-fed baby is also expected to pass more frequent and firmer stools. If your formula-fed newborn has passed normal poop earlier and suddenly stopped, this may be the cause.
4. Medical Conditions
One of the causes of constipation in newborns is a problem with the gut. There are several diseases that may cause constipation in newborns. One of them is Hirschsprung’s disease. It affects a section of the large intestine which develops without some nerve cells, causing unusual growth in one part (causing dilation) and growth restriction in another part (causing constriction).
This causes delayed movement of poop though these sections, causing constipation. It is first noticed within the first 48 hours of birth when meconium is expected to be passed, if not picked up before delivery. In some people, the affected sections are still able to function near normal levels and so the delays in the passage of poop are missed during early life but are soon picked up months later. Your pediatrician will perform a rectal examination to screen for Hirschsprung’s disease during clinic visitation after constipation.
Other medical conditions that may cause constipation in a newborn include Down’s syndrome, Hypothyroidism, Botulism. Your newborn may also have a developmental disorder of the gut causing problems with the position of the individual parts of the digestive system (gut malrotation and volvulus).
For first time mothers, the concern is often to act at the right time, rather than causing unnecessary panic by presenting too early or waiting too late. If your newborn has some aforementioned symptoms and you think that he or she may be constipated, you are likely to be right.
Below are some tips to help you deal with constipation in your newborn at home:
- Help your child squat: this is particularly useful if you notice that your newborn strains infrequently while passing poop. You should help make the process easier by holding up his or her knees against his or chest. This will help ease the process of pooping and eliminate straining.
- Change your baby formula: if your baby is being formula-fed, a change in the formula type after consulting with your pediatrician may solve your constipation problems. This is because some baby formulas have higher tendencies to cause constipation based on their constituents.
- Feed your baby in smaller but frequent fractions: this allows the gut to process smaller portions more efficiently. It is particularly important in a formula-fed baby who has been deemed totally fine by the pediatrician but is still constipated. For breastfed babies, the reverse is the case. More breast milk will help increase bowel content and improve bowel movement because breast milk has a laxative effect.
- Bicycle motion: this is the placement of your child on his or her back followed by the movement of the legs in a circular cycling motion, like in riding a bicycle. This helps to relieve the abdominal pressure and stimulates a bowel movement.
- Stimulate the rectal muscles: You could do this by inserting a lubricated rectal thermometer into the anus gently. This may cause an immediate outflow of poop or show results much later. You may also gently massage their abdominal muscles to help stimulate bowel movements.
You should avoid using laxatives for newborns unless cleared by a health professional. You should NOT use adult laxatives for newborns as this may be harmful to them. If you have tried the steps above and your baby is still constipated, you may need to see your pediatrician. If your baby has any of the following, it is imperative to visit your pediatrician as soon as possible:
- Passage of very little or no meconium in the first 36 hours.
- Bloody or dark stool.
- Presence of a distended stomach.
- The baby looks dehydrated.
- Greenish or dark vomit.
- Distress while passing stools.
- Continuous constipation.
- Progressively increasing days between the passage of poop.
Your healthcare professional will examine your newborn while taking a history of feeding and pooping. In some cases, it is quite obvious to the professional what the problem is from taking a history and examining your child. In other cases, investigations such as blood tests, imaging scans and so on are carried out to confirm a suspicion or reveal the underlying problem.
Typically, your newborn is helped to evacuate their bowel contents via suppositories, enemas or laxatives at the hospital. He or she may also be given fluids to help sustain her daily energy and nutrient requirement.
In the event of a medical problem, surgery may be required. This is often offered immediately or at a later date if the problem is mild, or till when the child is deemed strong enough to withstand the hassles of surgery.
Babies normally pass meconium in the first 36 hours of life. Thereafter, pooping follows a varied pattern which changes as your newborn matures. Some babies poop several times a day while others take it slower with poops coming once every few days.
It may be less frequent in breastfed babies compared to formula-fed babies. Constipation may be due to a normal process or be a pointer to an underlying pathology. If your newborn is not passing stools, it may be time to pay attention to that.
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