What should I do if a newborn hasn't had a bowel movement for 24 hours?

Newborn Not Pooping for 24 Hours

A newborn who hasn't had a bowel movement for 24 hours is generally not concerning if the infant is otherwise well-appearing, feeding adequately, and showing normal voiding patterns, particularly if exclusively breastfed. 1

Normal Stool Patterns in Newborns

• Exclusively breastfed infants commonly experience infrequent stools, with 37% experiencing at least one episode of intervals >24 hours between bowel movements, often beginning before 1 month of age 1
• Episodes of infrequent stools can last a median of 10 weeks with maximal intervals up to 28 days in healthy breastfed infants 1
• The pattern of voiding and stooling should be assessed as part of routine newborn follow-up to evaluate adequacy of intake 2

When to Observe vs. Intervene

Safe to Observe (No Intervention Needed):

• Infant is well-appearing and feeding normally 2
• Normal voiding pattern is present (indicates adequate hydration) 2
• Abdomen is soft and non-distended 3
• No vomiting or signs of distress 3
• Parents who are aware that infrequent stools are normal in breastfed infants intervene significantly less (17%) than those unaware (79%) 1

Red Flags Requiring Immediate Evaluation:

• Delayed passage of meconium >48 hours after birth (suggests Hirschsprung disease or other anatomical abnormalities) 4
• Abdominal distension with a tense abdomen (may indicate obstruction or necrotizing enterocolitis) 4, 3
• Bloody stools or hematochezia 4, 5
• Vomiting, particularly bilious emesis 4, 3
• Failure to thrive or poor weight gain 4
• Signs of shock (tachycardia, hypotension, poor perfusion) 5, 3
• Abnormal neurological findings 4

Initial Management Approach

For Well-Appearing Infants:

• Continue breastfeeding on demand (8-12 times daily) if breastfed 2, 6
• Reassure parents and adopt a wait-and-see attitude for exclusively breastfed infants with infrequent stools 1
• Abdominal massage is the most common benign intervention (79% of parents use this) 1

First-Line Dietary Interventions (if intervention desired):

• For breastfed infants: Continue breastfeeding; consider maternal exclusion diet (restricting milk and eggs) for 2-4 weeks if constipation persists 4
• For formula-fed infants: Consider switching to lactose-free or lactose-reduced formulas if symptoms persist 4
• For infants on solid foods: Add fruits and vegetables while avoiding foods high in simple sugars and fats 4
• Fruit juices containing sorbitol (prune, pear, apple) at 10 mL/kg body weight can help increase stool frequency 4

Common Pitfalls to Avoid

• Do not routinely supplement breastfed infants with water or dextrose water, as this will not prevent constipation and may interfere with breastfeeding 6
• Avoid premature use of laxatives in infants <6 months unless medically indicated; lactulose/lactitol are authorized before 6 months, polyethylene glycol only after 6 months 7
• Do not dismiss parental concerns without proper assessment of feeding adequacy, weight gain, and voiding patterns 2
• Maternal anxiety correlates with perceived infant discomfort (p=0.0001), so education about normal stool patterns is crucial 1

Follow-Up Recommendations

• All newborns should be examined by a qualified healthcare professional within the first few days after discharge to assess feeding adequacy, voiding/stooling patterns, and overall well-being 2
• For infants discharged before 48 hours, follow-up should occur by 96 hours of age 2
• If constipation persists beyond simple observation or if any red flags develop, immediate medical evaluation is warranted 4, 3