From the Research
Constipation in a 2-3 week old neonate is most commonly caused by Hirschsprung's disease, a congenital absence of nerve cells in part of the colon, particularly if constipation has been present since birth, as suggested by 1. The most frequent causes of constipation in neonates include:
- Formula intolerance (particularly cow's milk protein)
- Inadequate fluid intake
- Improper formula preparation (too concentrated)
- Anatomical issues like anal stenosis
- Hirschsprung's disease
- Hypothyroidism For breastfed babies, maternal diet containing allergenic proteins may contribute to constipation. Initial management includes ensuring proper feeding technique, adequate hydration, and gentle abdominal massage. For formula-fed infants, changing to a different formula may help. Small amounts of apple or pear juice (1-2 oz) diluted with water can be considered for babies over 2 weeks, as seen in general pediatric practice, although not directly mentioned in 1, 2, 3, 4, 5. Glycerin suppositories may provide temporary relief but should not be used regularly. If constipation persists despite these measures, medical evaluation is necessary to rule out more serious conditions, such as Hirschsprung's disease, which can be diagnosed with a rectal biopsy, as discussed in 4. Constipation in neonates occurs because their digestive systems are immature and still developing the muscle coordination needed for regular bowel movements, making them particularly susceptible to changes in diet and hydration. It is essential to consider Hirschsprung's disease in the differential diagnosis of constipation in neonates, as highlighted in 2 and 5, to ensure prompt and appropriate management.