Is your preemie not pooping, or maybe he or she seems to be in pain when pooping?
Let’s take a look at why pooping is commonly difficult for preemies, and find out what you can do about it.
Is it common or normal for premature babies not to poop or that it is difficult for them to poop? I have a 3-month-old baby premature at 28 weeks. Technically 2 weeks, she is having problems pushing her poop out, she is not constipated because her stool is very loose. I’ve been helping her with a Q-tip and it seems to help. When she pushes, she gets very tense.
What else can I do so she can start going on her own again? She is on formula lactose intolerance.
Thanks in advance,
Pooping Issues In Preemies and Newborns
When Pooping is Difficult for Preemies – Can it be Normal?
I’m actually wondering if your baby really does have problems pushing out her poop – or if what you’re seeing is just normal infant behavior.
Newborn babies (preemie or not) tend to make a lot of noise when they poop, with all sorts of grunts and straining sounds. They may even go quite red in the face. This is quite normal – and the fact that your baby’s stools are loose when she passes them makes it less likely that she’s experiencing anything unusual. Just make sure that their stools aren’t completely watery or very hard.
Constipation in Premature Babies
That said, it is true that preemies are more prone to constipation than full-term babies. Their intestines are still immature, to the point that movement of digested foodstuff is still uncoordinated – it takes some time before poop comes out, compared to babies who were born term.
Some types of iron supplements that may also be found in preterm formulas could cause constipation in premature babies, although more research is needed to confirm this.
It is possible that your daughter’s gastrointestinal system isn’t fully mature yet, so she needs to work harder to push the poop out.
Some signs of constipation are hard, pebble-like stools, or even a small amount of blood on the surface of the stools. You can find more signs of constipation in babies in this article. Since your daughter’s poop is loose, she in unlikely to be constipated.
Medical Reasons to Consider when Premature Babies are Not Pooping
In addition to constipation itself, there are other medical reasons that can cause pooping difficulties. We’ll briefly discuss some of the most common conditions, but it’s important to remember that this cannot replace your doctor’s advice. If at any point you are uncomfortable or worried, it’s best to have your child seen by a doctor.
Hirschsprung’s disease is a congenital condition wherein nerve cells that control the movement of the colon walls are missing or not enough. The walls of the colon are unable to move properly, so stools can get stuck and build up in that area of the intestines.
Most babies with Hirschsprung’s disease are unable to pass stools within the first 24 hours of life, but for some infants, they are able to pass poop at first but then start to develop other symptoms. Some signs and symptoms include difficulty feeding, irregular or infrequent bowel movements that may be explosive, and a bulging tummy.
Small bowel obstruction
It’s possible that other parts of the intestines did not form properly (or did not form at all), causing stools to be blocked and making it difficult to pass them out. However, this is more commonly seen in babies who have not pooped at all yet. Affected babies may have a slowly enlarging abdomen, along with vomiting episodes and difficulty in feeding.
There are different conditions that cause small bowel obstruction. In duodenal atresia, a segment of the duodenum (a part of the small intestine) does not fully develop. In jejunoileal atresia, a segment of either the jejunum or the ileum (also parts of the small intestine) do not fully develop. In these cases, the poop cannot pass through and will simply build up in that area until it blocks the intestinal passageway.
The gastrointestinal tract undergoes multiple stages of development before a baby is born. In one of these stages, the developing intestinal tract slowly changes its position in the abdomen. In malrotation, this change in position does not happen, or happens in the wrong direction. This makes it prone to twist on itself, blocking the passageway of stools throughout the intestinal tract. Babies who have these conditions usually have episodes of vomiting bile and bloody stools.
Anorectal malformations are another type of congenital condition. The rectum and the anus are two structures at the end of the intestinal tract. Babies may be born with unusual structures or malformations in these areas, making it difficult for stools to pass through properly.
In anal stenosis, the anal opening is too narrow. A baby’s poop will usually look like soft, thin ribbons in this condition.
In anal atresia, the anus does not form at all. A baby might not be able to poop at all, but in some cases, the poop comes out instead through another anatomical malformation, called a fistula. This usually forms between the intestinal wall and a genital organ (the urethra for boys, and the vagina for girls).
In general, these conditions definitely make it more difficult for babies to poop. Depending on which condition is involved and how severe it is, there are different possible treatments, including surgery.
Necrotizing enterocolitis, or NEC
Another, quite severe possible reason when a preemie has difficulties pooping is a disease called Necrotizing enterocolitis, or NEC. It is the most common in babies born before week 32 and occurs when tissue in the small or large intestine is inflamed or injured. The intestines will not hold the waste, which can pass into the baby’s abdomen and make the child very sick.
Some symptoms can be constipation or diarrhea, a swollen, red, or tender belly, green vomit, and a lethargic baby to mention some.
However, your baby is NOT likely to have NEC, because it seems like your preemie has already been on infant formula for some time and is already at home. NEC usually happens when a preemie is being transitioned to oral feeding while at the NICU. It’s very rare for a preemie to be sent home if there are still issues with feeding. It takes a few weeks of good feeding outcomes and constant weight gain before a premature baby is usually sent home. The reason I mention NEC is because this article is found by many parents searching about information on why their premature baby is not pooping, and in some cases NEC could be a reason.
Learn more about NEC in this video:
What to do When Preemies Have Difficulties Pooping
For Normal Newborn Straining, It is Best to Not Intervene
If your preemie can poop, but strains and have difficulties, I would personally not intervene with a Q-tip at least not on a regular basis. If she cries or seems overly distressed, then, of course, you can help her once in a while.
It takes a while for babies’ intestines to mature and for their bodies to figure out how to poop; for some babies, it takes longer than for others. A preemie obviously may take longer than a full-term baby. “Helping them”, which seems very natural to do as a parent, may very well delay the learning process.
Give Your Baby a Massage
Instead of intervening, you can try a clockwise tummy massage, starting from your baby’s right side towards the left side of the tummy.
Try Different Movements
An efficient “exercise” for your baby to help her poop is to lay her down on her back, then bend her knees towards her tummy in a cycling motion. This really helps for releasing gas and poop.
You can also try placing your baby in a squatting position during warm baths.
Take the opportunity to make eye contact, and talk or sing to your daughter!
Carry in an Upright Position
Being carried either belly down on your arm or in an upright position in a baby carrier or baby sling can also help.
For Formulafed, Constipated Preemies, Assess the Formula
For formula-fed babies, it is a good idea to talk to your baby’s health care provider to see if the formula should be changed in any way to improve the situation.
As I have written above, premature babies often drink special high-calorie, iron rich formula, which some studies say could contribute to constipation. In such a case, there may be alternatives available.
For those who breastfeed and supplement with formula, increasing the share of breastmilk may help.
Babies that Appear to be Ill or Weak Need Immediate Assessment
Finally, if your baby appears to be ill – he or she is weak-looking, appears to be in pain, has a swollen belly, is feeding poorly, or has other symptoms you are uncomfortable with, no home remedies should be tried. You should contact a doctor immediately.
To conclude; while it is certainly possible that your baby is experiencing normal newborn straining, I do believe you should bring up the matter with your baby’s health care provider. You do not write anything about your baby appearing to be ill, but it is much better to bring up one “unneccesary” issue, than to miss something that may need treatment.
I hope this helps,
Helpful Books on Baby Poop and Premature Babies
If you want more in-depth information and tips on baby poop issues, here are a few books to check out. (Links to Amazon)
- Baby Poop: What Your Pediatrician May Not Tell You … about Colic, Reflux, Constipation, Green Stools, Food Allergies, and Your Child’s Immune Health.
- The Ins and Outs of Poop: A Guide to Treating Childhood Constipation.
- Preemies: The Essential Guide for Parents of Premature Babies
More Babies With Pooping Difficulties
- Baby Won’t Poop By Herself
- 1 Month Baby Not Pooping Since Days
- Baby Not Pooping? Important Reasons, Remedies, When to Worry
- Baby Cries In Pain When Pooping Even When Loose Stools
- Volvulus and intestinal malrotation in the newborn
- Necrotizing Enterocolitis
- Human milk for the premature infant
- Iron supplementation in preterm infants: a study comparing the effect and tolerance of a Fe2+ and a nonionic FeIII compound
- Failure to Pass Meconium: Diagnosing Neonatal Intestinal Obstruction