Newborn feeding, elimination, and overall well-being are top concerns for parents. Constipation is particularly common among newborns, especially preterm infants. Witnessing a baby's discomfort from a swollen belly due to strained bowel movements, or seeing their little face turn bright red during the effort, leaves parents helplessly anxious.So, what causes persistent constipation in newborns?
Persistent constipation in newborns may be related to the following causes:
1. Failure to pass meconium within 72 hours: Be alert for congenital digestive tract malformations
Typically, newborns pass meconium shortly after birth. This stool is green to black in color, smooth, and sticky,which gradually changes to yellow stool. If meconium is not passed within 24 hours, it may indicate congenital digestive tract abnormalities such as imperforate anus, anal stenosis, intestinal atresia, intestinal stricture, or congenital megacolon. These conditions often present with additional symptoms like vomiting or diarrhea.Seek prompt medical attention if any of these conditions are suspected.
2. Feeding-Related Factors
Most cases of infant bloating and constipation are linked to feeding practices. Key feeding factors include: First, intake volume—reduced feeding leads to reduced output. If a newborn's stool or urine volume decreases, assess whether feeding is inadequate.Second, food allergies. Milk protein allergy is relatively common in infants. Allergic reactions during infancy can manifest in the skin, digestive, and respiratory systems. Digestive symptoms may include vomiting, gastroesophageal reflux, bloating, constipation, and diarrhea. For breastfed infants exhibiting these allergic symptoms,mothers should avoid or minimize consumption of potential allergens or gas-producing foods like milk, eggs, soy, wheat, ginger, alcohol, and potatoes. Formula-fed infants should switch to a partially hydrolyzed formula, or even a extensively hydrolyzed formula or amino acid-based formula if necessary.Additionally, due to higher levels of casein and calcium in cow's milk compared to breast milk, infant formula stools often contain insoluble calcium soaps. Consequently, formula-fed babies typically have firmer stools than breastfed infants and are more prone to constipation. Furthermore, preparing formula at a concentration higher than recommended can also lead to constipation in babies.Therefore, whenever possible, mothers should prioritize breastfeeding. 3. Metabolic and Endocrine Factors Congenital hypothyroidism, abbreviated as CHT, results from abnormal thyroid tissue development, absence, or ectopic placement during embryonic growth, or enzyme defects in thyroid hormone synthesis. This leads to insufficient thyroid hormone secretion and subsequent metabolic disorders.Clinically, infants with hypothyroidism may exhibit characteristic facial features, delayed motor and cognitive development, growth retardation, abdominal distension, constipation, feeding difficulties, and prolonged jaundice. Diagnosis is confirmed through newborn screening or thyroid function tests. Once diagnosed, treatment must be administered as prescribed by a physician.
4.Perianal Abscesses and Anal Fissures
When infants develop perianal abscesses or anal fissures, defecation exacerbates pain, causing reluctance to pass stool. Over time, this leads to constipation. Perianal abscesses in children are often detected during diaper changes when swelling around the anus is noticed.The exact cause of perianal abscesses in infants and young children remains unclear. It may be related to deep anal crypts or inflammation caused by loose stools irritating the anal mucosa, leading to blocked anal crypt glands and abscess formation. However, perianal abscesses are often unrelated to infection, so antibiotics should not be used indiscriminately.Dr. Nie Chuan, Chief Physician, Neonatal Department, Guangdong Maternal and Child Health Hospital