She was only seven days old. ‘For three days, my baby has not passed stool,’ the mother said, anxiously. The infant squirmed in discomfort and strained to the point of turning red.
She had been on baby formula since birth. While in the hospital she had passed stool regularly every day, mostly after each feed, sometimes several times a day, until three days ago when suddenly she stopped moving her bowels and had been mostly crying and uncomfortable.
While the baby was on the examination table, and after I had watched and witnessed how uncomfortable she was, twisting from side to side, I knew I had to intervene to relieve her of the discomfort.
When to intervene
I don’t always choose to interfere with the natural process of bowel evacuation in newborns.
When to intervene or assist with bowel movement in the newborn depends on a clinician’s experience and the mother’s anxiety level. Where a mother or a caretaker is very anxious, I tend to intervene more readily.
Two available options
For very young newborns, say babies in their first four weeks of life, there are two main options available to assist with bowel movement. Rectal stimulation with a thermometer is one option. Inserting a glycerin suppository in the rectum is the second option. Both procedures are easy to learn.
A glycerin suppository is a medicine formulation that can be inserted into the rectum. When used it can temporarily relieve stool passage. Glycerin is inserted into the baby’s rectum the same way a Tylenol suppository may be inserted to reduce fever.
It is important to make sure the glycerin suppository goes inside the rectum. The suppository can be shaved down to a smaller size so that it can more easily be inserted. Usually once or twice a day for a couple of days is all that is required. If one suppository does the magic, there is no need to repeat.
Since I did not keep glycerin suppositories in my office I decided to do a rectal stimulation. What I actually was looking for was an immediate relief. Had I used a glycerin suppository on the baby, she may not have moved her bowel until she got home, and that would have been less desirable for the mother and the baby.
After explaining to the anxious mother my plan, and obtaining her approval, I put on my gloves, took out a rectal thermometer from the side cabinet, and lubricated the instrument with Lubriderm. Vaseline can serve in place of Lubriderm to lubricate the tip and distal part of the thermometer. Any person capable of taking a good rectal temperature can learn to do a rectal stimulation on babies.
As the baby lay on the exam table, butt over diaper, I said to the mother, ‘Hold the baby’s legs apart.’
Gently, I introduced the tip of the lubricated thermometer about one inch into the baby’s rectum, similar to what a practitioner would do when taking a rectal temperature. I held the thermometer in the baby’s rectum for a moment until she began to push against it and with it the stool in the rectum.
The baby continued to make concerted efforts to push, and moments later an avalanche of stool came rolling down. Thank goodness there was a diaper in place! More stools came down when I wiggled the thermometer a little while it was still in the rectum.
The first part of the stool that came down was dry, and hard enough to have clogged the toilet. Fortunately, together with the underlying dirty diaper, it was discarded into the garbage bin. Later, the stool became soft, but kept rolling down for a minute or two. Thereafter the baby sighed, then smiled and then fell asleep on the exam table. All the body twisting and crunching went away.‘My baby is okay now,’ the mother smiled.
Based on my clinical practice experience, I did not think there was anything wrong with the baby in discussion except that for some reason she was unable to pass stool. Temporary intervention was all that was needed.
When I saw them a week later, mother and baby were happy and baby had continued to pass stool regularly.
What else could constipation mean?
Many maladies that can afflict a baby — none of which was applicable in this particular case — fill a pediatrician’s mind when confronted with constipated infants. Could it be Hirschsprung, a congenital disorder in which parts of the colon and rectum lack the nerves necessary to propagate stool movement down and out of the rectum? Is it anal stenosis, in which the anal canal, the distal part of the rectum, is too narrow to allow a free passage of stool?
What other pediatricians think
Pediatricians differ widely in the way they treat otherwise healthy babies who are unable to pass stool. I spoke to a few pediatricians about this particular case. Some said they would have done nothing, others said that babies are never constipated, while a few said they would have waited for seven days before intervening.
The varied answers are not surprising, since clinicians act based on their experience, scope and length of practice.
Tips on preventing newborn constipation
Consider breastfeeding your newborn. Breast milk may possess laxative properties, and breastfed babies are less constipated than formula-fed babies. No matter whether you choose breast milk or formula, feed baby very frequently, on demand—when baby is crying due to hunger, and certainly every 2-3 hours. Follow instructions carefully while mixing powdered baby formula.
The older a baby gets, the more ways clinicians have of intervening during periods of constipation. In my next article I will discuss constipation in older babies and in children as a whole.
The above article is not intended to treat or diagnose any medical condition. Take your baby to a pediatrician if you are concerned that he or she is constipated.