Hi there, my name is Fifi; one of the paediatricians at Paedicare. I am writing for Paedicare’s new blog; sharing helpful information for new parents. As a doctor, I frequently receive out of the blue text messages from acquaintances worried about their children’s health but don’t know what to do about it. I have lost count how many pictures of funny looking rashes, odd lumps and dirty nappies forwarded to me over the years. Luckily I am getting more diligent at deleting these pictures immediately to avoid them being randomly displayed as my screensaver! As the number of conversations grow, I feel that it is time to turn these questions into a series of medical blogs to assist other parents with similar concerns. I hope you find them helpful. My first post is on constipation in babies.
Friendly text #1: My seven month old daughter has not pooped for six days!
My interstate friend texted me, worried, as her seven month old daughter, Tee, had not opened her bowel for six days. Tee was born healthy at full term. Tee was developmentally ready at six months, so my friend started introducing pureed vegetables once a day on top of Tee’s usual breastfeeding regime. My friend noted that since starting solids, Tee’s stool frequency has changed from daily to every three to four days.
Since it was the weekend, should I say to my friend, observe and see the GP on Monday?
Should I ask my friend to go to the emergency department straight away?
I need more info!!! So, our text conversation went something like this:
“Did Tee pass meconium poop within 48 hours of life? Yes.”
Most infants pass thick and sticky dark tar like stool called meconium within their first 48 hours of life. History of delayed passage of meconium indicates potential for large gut obstructions from various conditions. Knowing that Tee normally passed her newborn stool meconium at one day of life is reassuring.
“Frequency? Currently has not pooped for six days!”
Some infants have strong gastrocolic reflex and can open their bowel immediately after each feed. Some infants can open their bowel three to six times a day, some every three days. Breastfed infants can even go without passing stool for up to 10 days!
“Stool consistency? Soft, always soft. Colour? Brownish.”
Infant’s stool range widely in colour, consistency, smell and frequency depending on the type of feed. Once meconium has cleared and a newborn starts to feed, their stool will change into darkish green colour – the so-called ‘transitional stool’ – and then into soft, curd like mustard yellow-greenish coloured stool if they are breastfed, or darker yellow or brownish stool if they are formula fed. Breastfed infants tend to have softer stool compared to formula fed infants.
Stool that is pale or clay white in colour is concerning as it indicates problem with the liver, especially if the infant is also jaundiced, this warrants urgent review.
“Any blood or mucus? Nope.”
Blood and/or mucus mixed in with stool indicate inflammation of the intestines (colitis). Colitis can also present with diarrhoea. It is caused by either infection (viral or bacterial) or allergy to food protein. It is important to ensure that your infant is adequately hydrated and to seek medical review if you see blood and mucus mixed in stool.
My friend was never concerned with the colour or consistency of Tee’s stool, so that’s a good sign. Since I’ve not kept any pictures of dirty nappies on my phone, please visit Baby Center’s website for photos of baby poo. For more information on normal poos and wees for a baby, please visit Raising Children’s website.
“Any vomiting? Nope.”
We take green colour (bilious) vomiting in infants under 12 months old seriously as it suggests an obstructed gut. Green colour vomiting needs an urgent review.
“Is her tummy distended and hard? Nope.”
A tummy that looks more distended than usual and hard on palpation, especially in a sick looking infant, could signal gut obstruction. This too needs urgent review.
“Any discomfort or pain or bouts of screaming? Nope, she looks happy and well.”
Younger infants under six months can cry, turn red on the face, squirm and crunch up their legs when they open their bowel. Many new parents often think that their babies are in pain or constipated when they see this. This is not always the case. It is actually very normal for young babies to do this. Their abdominal muscle is still rather weak and these manoeuvres help to generate force to push the poop out.
Saying that, in the case of infants that are unsettled more than usual with bouts of screaming and drawing up legs, pale face, lethargy, distended tummy, and other bowel habit changes, please seek medical advice urgently to exclude intussusception. Intussusception is when part of the intestine telescopes on itself causing gut obstruction. It can occur at any age with peak incidence at five to nine months.
“Any fever? Nope. Wet nappies? Same as usual. Feeding well? Yes.”
So far, Tee is ticking all the right boxes of being a healthy infant. What could possibly be the cause of her not pooping for six days? Is it simply because her gut is slowly adjusting to digesting solid materials? Or, could it be constipation?
Constipation?
Constipated infant’s poop looks like little pebbles, hard, dry, making them difficult to push out. Occasionally, the shearing of the hard stool against the inside skin of the anus might cause a tiny tear called an anal fissure. This tear might cause pain during bowel motion and might cause little streaks of bright red blood to be visible around the stool. Infants might show signs of real discomfort when they have an anal fissure.
Constipation in babies is common during the introduction of solids, so Tee’s not pooping for six days could be the early sign for constipation.
How to treat constipation in babies?
In the absence of any red flags, mild cases of constipation in infants who have just started solids can be managed initially by ensuring that the infant is well hydrated, checking that the infant still passes the same amount of wet nappies. If the constipated infant is formula fed, it is always good practice to check that the formula feed has been made with the correct amount of water before switching brands. Increasing the amount of pureed high fibre vegetable/fruits e.g. pear, apple, prunes, apricot or a couple of spoonfuls of half diluted prune/apricot/pear juice (natural laxative) every second day are worth trialling.
If these simple remedies fail, review, laxative medication and close follow up by a health professional is warranted to ensure that all other rarer cases of constipation are excluded. For more information please visit the Raising Children webpage on constipation.
So, what happened to Tee in the end?
One hour after our conversation, my friend sent a large smiley face and dancing woman emoji to mark the joyful occasion of Tee passing her biggest poop to date. No picture attached!
Keep an eye out for more ‘friendly text advice’ coming soon.
Fifi
If you feel you require paediatric advice for your child please contact us.
For more qualified, easy-to-understand specialist paediatric information visit Paedicare’s blog.
Disclaimer
I emphasise to my friends and relatives that my text advice is not meant to replace a timely face-to-face review with their own local health professional, especially in the presence of sinister symptoms. Similarly, if you have any concern that your child might have red flag symptoms, please see your health professional urgently or phone Paedicare on 07 3358 8890.