Constipation of the newborn

The first feces emitted by the newborn are characterized by a green - tarry color and a somewhat sticky consistency. This material, called meconium, is made up of amniotic fluid, cell residues, urine and anything else swallowed by the young organism during fetal life.

Typically, the first meconium discharge occurs within 12 to 24 hours of delivery. Failure to release these droppings should lead to suspicion of cystic fibrosis or Hirschsprung's disease (caused by abnormal development and maturation of the Enteric Nervous System).

After 3-4 days of life, the baby's feces take on a lighter color and become soft, creamy or semi-liquid, until it reaches a yellow-gold color with more or less intense green shades. During the first week of life, the newborn can evacuate very often - for example after each feeding - due to the presence of the so-called gastro-colic reflex, a biological mechanism whereby, when the food arrives in the stomach, peristaltic intestinal movements are automatically triggered to empty. the large intestine. This is why newborns eat and immediately, perhaps while they are still breastfeeding, emit feces.

The gastro-colic reflex gradually diminishes after the first days of life, so much so that the number of daily evacuations does not exceed 4-5 episodes. The fact that discharges are becoming less and less frequent should not lead parents to think that the infant is suffering from constipation; at times, in fact, several days can pass between one "evacuation" and the next. In this period, in addition to the natural dilation of the defecatory rhythms, the parent may notice a certain suffering of the newborn, who in reality is simply learning to use the right muscles to defecate; not knowing how to limit the work to only the "abdominal press", the little one pushes a little with the whole body, contracting the muscles of the hands and feet, until he becomes completely red and indulges in crying fits.

In pediatric age there are no absolute parameters to be able to speak of constipation in the newborn; it is not possible, for example, to take into consideration only the frequency of evacuations. Rather, other elements should also be evaluated, such as stool consistency and fecal continence. For what has been said, as long as the baby's feces remain soft and rich in water, we cannot speak of real constipation.

In the breast-fed infant, the number of evacuations can vary from one evacuation every suck to one every 4-5 days, while remaining within the normal range.

True constipation, understood as the rare and painful evacuation of hard and not very bulky stools, mainly affects bottle-fed babies, while it is rare among breast-fed babies. In the vast majority of cases, moreover, constipation is of food origin, for example due to insufficient dilution of infant formula or too early introduction of solid foods into the infant's diet. Furthermore, recent studies have highlighted a possible association between constipation and intolerance to cow's milk proteins.

In pediatric age, in 90-95% of cases, constipation is defined as idiopathic or functional, because it is separated from congenital diseases and malformations, anatomical alterations or side effects from drugs, which are responsible for the remaining 5% of cases.

In addition to food-borne causes, a child's functional constipation can be caused by psychological factors, such as stress or fear. In particular, one of the most frequent causes of constipation in the child is the experience of a painful "evacuation", for example due to the presence of small cracks in the anus called anal fissures. These rather painful cuts can result from passing hard, dry stools, often due to dietary changes (switching from breast milk to cow's milk) or an acute condition (fever). The pain can be such that the child decides to postpone the evacuation indefinitely, thus avoiding painful stimuli and contracting the pelvic floor muscles when the stimulus arrives. To suppress the defecatory impulse, the child implements a series behaviors that are easily identifiable by parents, such as standing up on toes or crossing the legs. This tendency to suppress the evacuation stimulus leads to the accumulation of voluminous fecal masses in the last section of the intestine (rectum), where they lose water becoming more and more consistent and difficult to evacuate (greater susceptibility to the formation of fissures). to create a vicious cycle constipation-pain-constipation, for which constipation gives pain and pain gives constipation. The presence of these fecal clusters in the rectum, moreover, is frequently accompanied by the involuntary loss of small quantities of stool; to describe this phenomenon doctors speak of "soiling" (soil in English means to dirty), while the term encopresis indicates the voluntary or involuntary passage of normal-formed stools in clothing in children over the age of 4. Finally, the perpetuated decision to withhold stool causes the contraction of the internal anal sphincter - at first conscious - then becomes paradoxical during the defecatory effort (in these cases we speak of i anism).

The onset of constipation in the child can also coincide with stresses of another nature, such as education in the use of normal toilets, the beginning of school, jealousy for the little brother or other social factors that make it necessary to contain or suppress the desire to evacuate. As for the use of the toilet, the position assumed by the child can favor the onset or worsening of constipation. The body attitude most suitable for evacuation is in fact that of squatting, which is typically assumed in Turkish baths. This "primordial" posture, in fact, favors the relaxation of the pelvic floor and the increase of intra-abdominal pressure.

Tips and remedies to prevent and treat constipation in infants and children "