Hard Pooping In Newborns: What Causes It?

Newborns may have trouble pooping due to a condition called infant dyschezia, which is when a baby struggles with the muscle coordination necessary to pass stool. This is a common problem that usually resolves on its own within a few weeks as the baby figures out how to coordinate their muscles. Infant dyschezia is different from constipation, which is characterised by hard, dry stools that are difficult to pass. While constipation is typically not a concern for newborns, it can occur due to dietary changes, lack of fluids, or, in rare cases, medical conditions affecting the intestine or bowel.

Infant dyschezia, or the struggle to coordinate muscles to poop

This condition can be frustrating for both babies and parents. However, it is important to note that infants with dyschezia are not in pain and are not sick or suffering. They are simply struggling with the muscle coordination necessary for passing stool. This is a learned reflex, and most babies will figure it out within a week or two without any interference.

While it can be distressing to witness your baby's struggles, it is recommended that parents do not attempt to stimulate their baby's rectum to aid in passing stool. Such interventions can delay the baby's natural learning process and may even lead to a dependence on stimulation for future bowel movements. Instead, infant massage may be beneficial in stimulating the baby's nervous system and physical development, aiding in the coordination required for pooping.

Infant dyschezia usually resolves on its own within a few days to a few weeks, and most babies outgrow it by the time they are 2 to 3 months old. If you are concerned about your baby's pooping habits or suspect constipation, it is always best to consult your paediatrician for advice and guidance.

Constipation, caused by a change in diet or lack of fibre

Constipation is a common issue for newborns, and it can be worrying for parents. However, it is important to remember that constipation is typically caused by a change in diet or a lack of fibre and is easy to treat.

Constipation occurs when a baby's stool is hard and dry, making it challenging for them to pass. One of the primary causes of constipation in newborns is a change in diet, such as switching from breast milk to formula or introducing solid foods. Additionally, a lack of fibre in their diet can also lead to constipation, especially if they are older babies. Breastfed babies are less likely to experience constipation than formula-fed babies, as breast milk is a natural laxative.

If your newborn is constipated, there are several things you can do to help relieve their discomfort:

• If your baby is old enough, offer them extra drinks of water (boiled and cooled).
• Gently rub their stomach to stimulate the bowel and provide a gentle massage to help manage any pain.
• A warm bath can calm and soothe your baby while also providing relief from discomfort.
• For babies over six months, introduce more fruits and vegetables into their diet to increase their fibre intake.
• For babies over nine months, adding stewed prunes or apricots to their meals can be beneficial.
• Older babies can try prune juice diluted with water, starting with small amounts and gradually increasing until they can pass a soft stool.

It is important to remember that every baby is unique, and there is a wide range of what is considered "normal" when it comes to bowel movements. If you are concerned about your baby's constipation or they seem to be in pain, it is always best to consult your doctor or child health nurse for advice.

The baby's diet—breastfed babies tend to poop more frequently

The frequency of a newborn's bowel movements can vary. It is common for newborns to have several bowel movements a day, but it is also normal for them to go a few days or even a week without one. Breastfed babies tend to have more frequent bowel movements than formula-fed babies. Breastfed infants may go anywhere from several times a day to once a week with a big blowout. Formula-fed babies can have bowel movements several times a day or once every three to four days.

The texture of a newborn's stool also varies. Breastfed babies' stools tend to be soft and somewhat runny, while formula-fed babies' stools are often pasty.

It is important to monitor the consistency of your baby's stool. If it becomes too loose or watery for three or more diapers, it could lead to dehydration. On the other hand, hard, pellet-like stools can be a sign of constipation.

If your baby is having difficulty pooping, it is important to first assess whether they are truly constipated. Constipation in babies is characterised by hard, dry stools that are difficult to pass. It is often accompanied by pain or discomfort during bowel movements. However, it is important to note that some babies may strain and cry before passing soft stools, which is known as dyschezia. Dyschezia is not constipation and will usually resolve on its own without intervention.

If your baby is truly constipated, there are several things you can do to help relieve their discomfort. Offering extra water or juice during the day can be beneficial, as it helps to bring water to the colon. Fruit juices such as grape, pear, apple, cherry, or prune juice are recommended. Additionally, if your baby is over four months old and has started solid foods, introducing high-fibre foods such as peas, beans, apricots, prunes, peaches, pears, plums, and spinach may help. It is important to ensure your baby stays adequately hydrated by consuming plenty of fluids.

If dietary changes do not provide relief, you may need to consider other options. For babies who are not yet eating solid foods, giving 1 to 2 ounces of 100% fruit juice once a day can help stimulate bowel movements. If your baby is older and consuming solid foods, pureed pears, peaches, or prunes are recommended instead of juice. Oatmeal, wheat, or barley cereal may also be helpful, as rice cereal can sometimes contribute to constipation. Warm baths and leg exercises, such as riding a bicycle, can also help stimulate the bowels.

If your baby's constipation persists despite these measures, it is important to consult your healthcare provider. They may recommend glycerin suppositories or saline enemas for occasional use. In some cases, medication, laxatives, or enemas may be prescribed, but these should only be used under the guidance of a healthcare professional.

Signs of constipation—fussy, unsettled, less hungry, blood in stool

Signs of Constipation in Newborns

Fussy

Newborns with constipation may show signs of fussiness or irritation. They may also be unsettled, cry, or scream while trying to pass a stool. This is known as dyschezia, and it is often mistaken for constipation. However, dyschezia is not constipation, as the stool is usually soft and not hard or dry.

Unsettled

Constipation can cause babies to be unsettled and irritable. They may also experience stomach pain, pulling their legs up to their stomach and crying when in pain.

Less Hungry

Babies with constipation may eat less or feed less well than usual. They may also lose their appetite or have a decreased interest in feeding.

Blood in Stool

Constipation can sometimes lead to the presence of blood in the stool. This can be a result of hard stools causing tears or cracks in the skin around the anus, which may bleed. In rare cases, blood in the stool can also indicate a more severe medical problem, such as problems with nerve endings in the bowel or issues with the spinal cord.

Treatment for constipation—lifestyle changes, laxatives, suppositories, enemas

Treatment for Constipation in Newborns

Lifestyle Changes

If your newborn is having a hard time pooping, it could be due to infant dyschezia, a condition where the baby struggles with the muscle coordination necessary to poop. This condition usually resolves on its own within a few days to weeks as the baby figures out the required coordination. No treatment is necessary, but parents can find it distressing to watch their babies struggle.

Laxatives

In some cases, constipation in newborns may be treated with laxatives. The amount of laxative needed will depend on the baby's colon and how much is required to empty it daily.

Suppositories and Enemas

In more severe cases of constipation, suppositories or enemas may be recommended. Enemas can be administered at home, with the guidance of a medical professional, to clear impacted stool from the bowel.

• Prepare a normal saline enema solution by dissolving 1 teaspoon of table salt in 1 liter of water.
• Place your child on their side or stomach with their knees pulled up under their chest and their bottom in the air.
• Insert a soft silicon tube (Foley catheter), approximately 4 inches long, into the child's rectum.
• Inflate the balloon at the end of the catheter with 20-25 ml of water to form a "plug" and prevent leakage.
• Keep the child in this position for 5-10 minutes to allow the fluid to interact with the stool.
• After the retention time, have the child sit on the toilet for about 45 minutes to allow the bowel to empty. If the child is in diapers, simply wait for the recommended time.

It is important to ensure your child is well-hydrated before administering an enema, and to be cautious not to infuse the solution too quickly, as this may cause dizziness. If there is no bowel movement after an hour, the catheter can be reinserted to drain the fluid.

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