Male1: A very common question to pediatricians is why babies are not making a lot of stools when a baby is a week old. Is that a problem?
Male2: Well, it depends what we call a lot of stool. When a patient comes to our practice, we try to define the approximate number of stools that the baby maybe be passing. Certainly, at this age, the baby may pass a volume of number of stools, but between one, two, six or within eight stools a day, an important thing to consider is what is the quality of the stools and especially the consistency of the stools. Certainly, we are going to be very concerned about a baby passing watery stools or the presence of mucus or blood.
Male1: But if the baby did not make a stool for a day or two, is that a problem?
Male2: That is certainly not a problem, except if this absence of passage of stool is complicated by the presence of any other symptom such as abdominal distention, vomiting, persistent irritability of the child that could mean that there is something else, but otherwise, if the baby is doing very well and he is eating appropriately and interact very well with the family, there is no reason for concern.
Male1: Because if a kid had passed a stool before and if the kid makes stools and it may come out as soft, not hard, it is usually not a problem is that true?
Male2: That is right.
Male1: If for some reason, the stools come out extremely hard, is that a problem?
Male2: Well, it can be a problem for the babies, certainly. When the stools become very hard and they may be difficult to pass.
Male1: But if it is, is there anything that we could or could not do or should we not do anything?
Male2: Well, it depends. If the problem is persistent and certainly the child may be seen by the pediatrician to begin with who can examine the illness of the baby, sometimes, there is a little bit of a narrowing of the anal canal, particularly in the first week of life and after passing the pinky—very carefully, and doing the dilatation of the anus, the problem may be solved.
Certainly, at some point also, the problem may be due to the fact that the stools are very hard and they are very difficult to pass. In that circumstance, sometimes, we recommend a little bit of a stool softener for the baby.
Male1: If a baby is a year old and sort of like, maybe even train the kid and the kid just refuses to go, how do get along with that?
Male2: Well, again, it is important to analyze what is the type of the diet that the patient is having and sometimes, there is a group of patients who may have problems with calcium and milk intolerance, may become constipated. Any condition of presenting with fever for example, giving the patient medication may produce some transitory constipation. But if the problem is persistent and in a vast majority of cases, we do not know what is the cause of the constipation. We call that functional constipation. The patient may have the benefit of having an increase in the amount of fiber provided in the diet or again, give a mild stool softener.
Male1: There is term we use in pediatrician called Hirschsprung’s disease. What is Hirschsprung’s disease?
Male2: Well, in the intestines, along with cells that absorb the food and water, we have also cells like in the muscles because that is why the intestine moves and the food is propelled from the mouth to the anus and then in order to have this muscle cells moving, we need also some cells neurons—they are the same cells that we have in the brain. So in Hirschsprung’s disease, there is an absence of these cells that very similar to the cells that we have in our brain in a segment of the intestine. Most commonly in a segment of the colon or even the totality of the colon. In such a case, then that part of that intestine lacking those cells is not going to move properly and then the patient may be seriously constipated.
Male1: How do these kids usually present to a pediatrician?
Male2: Well, most commonly, the patient may present really very early in life. The first day of life, they can have problems passing the stools of the babies called meconium—this thick, very dark green material that are the first stools of the baby, and then the patient may have problems with that and if the baby has problems passing that stool, certainly, the patient may present with abdominal distention, vomiting or any other complications.
Subsequently also, the patient may present with chronic constipation and certainly, I am always concerned about the baby that presents with constipation from the very beginning and HIrschsprung’s disease is a condition to be ruled out.
Male1: How do you diagnose Hirschsprung’s disease?
Male2: Well, first of all, as we say, commonly particularly when we are teaching resident students, it is very important is their medical history. So in that particular case, the parents are going to be extremely helpful trying to give the maximum amount of information. So if the baby has had problems with constipations very early in life, certainly, again, this is a diagnosis to be considered.
A physical examination may also suggest Hirschsprung’s disease if there is persistent abdominal distention and particularly, if at the end of the pediatrician or the pediatric consult, you perform a rectal exam, we find an increased and enhanced tone of the anal sphincter. That may suggest that condition.
