Constipation of the newborn

The first faeces emitted by the newborn are characterized by a green-tarry complexion and a somewhat sticky consistency. This material, called meconium, consists of amniotic fluid, cellular debris, urine and anything else swallowed by the young organism during fetal life.

Typically, the first discharge of meconium is recorded within 12/24 hours of delivery. Failure to release these dejections should lead to suspicion of cystic fibrosis or Hirschsprung's disease (caused by developmental and maturation abnormalities of the Enteric Nervous System).

After 3-4 days of life, the faeces of the baby take on a lighter color and become soft, creamy or semi-liquid, until they reach a golden-yellow color with more or less intense green shades. During the first week of life the newborn can evacuate very often - for example after every feeding - due to the presence of the so-called gastro-colic reflex, a biological mechanism whereby, when food arrives in the stomach, peristaltic intestinal movements are automatically triggered to empty the large intestine. That's why babies eat and immediately, maybe while they're still nursing, they make faeces.

The gastro-colic reflex fades gradually after the first days of life, so that the number of daily evacuations does not exceed 4-5 episodes. The fact that the discharges become less and less frequent should not lead parents to think that the infant is suffering from constipation ; sometimes, they can spend several days between one evacuation and another. In this period, in addition to the natural dilation of defecatory rhythms, the parent may notice a certain suffering of the newborn, who is actually simply learning to use the right muscles to defecate; not knowing how to limit work to just the "abdominal press", the child pushes a little with his whole body, contracting the muscles of the hands and feet, until it becomes all red and abandon himself to crying.

In pediatric age there are no absolute parameters to talk about constipation; it is not possible, for example, to consider only the frequency of evacuations. Rather, other elements must also be evaluated, such as stool consistency and fecal continence. For what has been said, as long as the faeces of the newborn remain soft and rich in water we cannot speak of real constipation.

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

The actual constipation, understood as a rare and painful evacuation of hard and little bulky stools, affects mainly artificially fed babies, while it is rare among breastfed babies. In the vast majority of cases, moreover, constipation is of food origin, for example due to the insufficient dilution of artificial milk or to the premature introduction of solid foods in the diet of the infant. Moreover, 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, responsible overall for the remaining 5% of cases.

In addition to food-related causes, the 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 children is the experimentation of a painful evacuation, for example due to the presence of small fissures in the anus called anal fissures. These rather painful cuts can originate from the passage of hard and dry stools, often due to dietary changes (transition from breast milk to cow's milk) or to an acute condition (fever). The pain can be such that the child decides to postpone evacuation indefinitely, thus avoiding painful stimuli and contracting the pelvic floor muscles when the stimulus arrives. To suppress the defecatory impulse, the child carries out a series of behaviors that are easily identifiable by the parents, such as rising on the tips or crossing the legs. This tendency to suppress the evacuative stimulus, leads to the accumulation of voluminous faecal masses in the last section of intestine (rectum), where they lose water becoming increasingly more consistent and difficult to evacuate (greater susceptibility to the formation of fissures). A vicious constipation-pain-constipation circle is thus created, so constipation gives pain and pain gives constipation. Moreover, the presence of these fecal clusters in the rectum is frequently accompanied by the involuntary loss of small quantities of faeces; to describe this phenomenon the doctors speak of "soiling" (soil in English means dirtying), while the term encopresis indicates the voluntary or involuntary passage of normal-shaped feces in clothing, in children over 4 years of age. Finally, the perpetuated decision to retain the faeces means that the contraction of the internal anal sphincter - at first conscious - then becomes paradoxical during the defecatory effort (in these cases we speak of anism).

The beginning of constipation in the child can also coincide with other kinds of stress, such as the education in the use of normal toilet facilities, the beginning of school, jealousy for the little brother or other social factors that impose to contain or suppress the desire to evacuate. As far as the use of the toilet is concerned, the position assumed by the child can favor the onset or the aggravation of constipation. The body attitude most suitable for evacuation is in fact that of crouching, which is typically assumed in Turkish baths. In fact, this "primordial" posture favors the relaxation of the pelvic floor and the increase in intra-abdominal pressure.

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