Dear Doctor,
My sister gave birth a few days ago. Baby is fine, she was discharged and is feeding well. Our concern is that the baby has not passed any stool in three days. We called a doctor friend who advised us to be patient but now the baby is restless and crying nonstop. He is even refusing to feed. What could be the problem?
Jane
Dear Jane,
Timely passage of the first stool is a clear sign the baby is well and the little tummy is ready for breast milk. Usually, the first stool (also called meconium) is passed within 24 hours of birth in majority of cases of healthy full-term babies, and by day two in all healthy full-term infants.
In the event of failure of a full-term newborn to pass meconium within the first 24 hours, this should raise a suspicion of possible obstruction of the intestines. This condition is called Hirschsprung disease which simply means blockage or poorly developed anal canal.
A return to hospital in that case is advised, where the medics examine the child including the anal opening as well and possibly take an x-ray of the abdomen if need be. An important clue is the distension of the abdomen, vomiting and failure to breastfeed which are signs of an underlying serious problem.
It is important to note however that a child might be having a simple and mild condition called Meconium Plug Syndrome where the initial stool (meconium) is dry, hard and immobile, thus the baby finds it hard to push it out. In this case, a trained health worker may manipulate the rectum (putting a finger and unplugging) using enema to remove the plug.
There are cases where failure to pass stool as expected may be a sign of poor intake which can be corrected by ensuring a good latch so that baby sucks well, and gets enough breast milk. After the first four days, you expect a baby who is getting enough breastmilk to pass at least two stools per day till 4-6 weeks age.
Dr Ombeva Malande is a specialist pediatrician and can be reached at ombevaom@gmail.
