עיכול א - GI A&P, Vomiting, Diarrhea, Constipation

Pediatric gastrointestinal anatomy and physiology, nursing assessment, vomiting mechanisms and causes, pyloric stenosis, and infectious diarrhea (Rotavirus, Salmonella, Shigella, C. difficile). Covers dehydration, oral rehydration therapy, delayed meconium passage, Hirschsprung disease, meconium ileus, meconium plug syndrome, congenital hypothyroidism, and functional constipation. Includes pathophysiology, clinical manifestations, diagnosis, complications, treatment, nursing interventions, and key exam points.

Pediatric GI Anatomy — Small Stomach Capacity and Rapid Emptying

𝗦𝗺𝗮𝗹𝗹 𝗦𝘁𝗼𝗺𝗮𝗰𝗵 𝗖𝗮𝗽𝗮𝗰𝗶𝘁𝘆: Newborns have a relatively small stomach capacity and rapid gastric emptying → require small frequent feedings. 𝗟𝗼𝘄𝗲𝗿 𝗘𝘀𝗼𝗽𝗵𝗮𝗴𝗲𝗮𝗹 𝗦𝗽𝗵𝗶𝗻𝗰𝘁𝗲𝗿 (𝗟𝗘𝗦): Relatively immature in infants → increased gastroesophageal reflux and regurgitation (spitting up).

Pediatric GI Anatomy — Immature Enzymatic Function

𝗜𝗺𝗺𝗮𝘁𝘂𝗿𝗲 𝗗𝗶𝗴𝗲𝘀𝘁𝗶𝗼𝗻: Newborns have immature digestive enzyme activity and gastrointestinal defenses. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Differences in gastric acidity and digestive enzymes and intestinal immunity → reduced pathogen protection → increased risk of GI infection.

Pediatric GI Anatomy — Developing Swallowing Coordination

𝗦𝘄𝗮𝗹𝗹𝗼𝘄𝗶𝗻𝗴: Requires coordination of the nervous and respiratory and GI systems. 𝗗𝗲𝘃𝗲𝗹𝗼𝗽𝗺𝗲𝗻𝘁: Mostly reflexive in newborns — voluntary control develops gradually. 𝗥𝗶𝘀𝗸: Poor coordination especially in premature infants → choking and aspiration. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Begin oral feeding in a premature infant when sucking and swallowing and breathing are normally coordinated.

Pediatric GI Anatomy — Greater Surface Area and Vulnerability

𝗣𝗵𝘆𝘀𝗶𝗼𝗹𝗼𝗴𝘆: Infants have a larger body surface area relative to body weight than adults. 𝗙𝗹𝘂𝗶𝗱 𝗕𝗮𝗹𝗮𝗻𝗰𝗲: Higher fluid requirements and less physiological reserve. 𝗖𝗼𝗻𝘀𝗲𝗾𝘂𝗲𝗻𝗰𝗲: Vomiting and diarrhea → rapid significant fluid and electrolyte loss → increased dehydration risk.

Nursing Assessment of GI Disorders — Clinical Observation and Growth

𝗦𝘁𝗼𝗼𝗹: Assess color and consistency and frequency and blood or mucus and unusual odor. 𝗩𝗼𝗺𝗶𝘁𝗶𝗻𝗴: Assess frequency and volume and color and relation to feeding — identify projectile or bilious vomiting. 𝗛𝘆𝗱𝗿𝗮𝘁𝗶𝗼𝗻: Assess dry mucosa and reduced urine output and absent tears and skin turgor and consciousness. 𝗙𝗲𝗲𝗱𝗶𝗻𝗴: Assess appetite and fluid intake and feeding tolerance and changes in habits. 𝗚𝗿𝗼𝘄𝘁𝗵: Weight reflects nutrition and fluid loss and growth. 𝗜𝗻𝘁𝗮𝗸𝗲 𝗮𝗻𝗱 𝗢𝘂𝘁𝗽𝘂𝘁 (𝗜&𝗢): Record oral and IV intake and urine and vomiting and diarrhea — weigh infant diapers to estimate urine output.

Failure to Thrive (FTT)

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Inadequate weight gain or growth compared with the expected growth pattern. 𝗠𝗼𝘀𝘁 𝗖𝗼𝗺𝗺𝗼𝗻 𝗖𝗮𝘂𝘀𝗲: Inadequate caloric intake. 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗦𝗶𝗴𝗻: Apathy → reduced activity or interest or responsiveness. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁𝘀: Inadequate caloric intake is the commonest cause — apathy may be a presenting feature.

Nursing Assessment of GI Disorders — Laboratory Tests and Imaging

𝗘𝗹𝗲𝗰𝘁𝗿𝗼𝗹𝘆𝘁𝗲𝘀: Check sodium (Na⁺) and potassium (K⁺) and chloride (Cl⁻) and bicarbonate (HCO₃⁻) for vomiting or diarrhea-related losses. 𝗥𝗲𝗻𝗮𝗹 𝗧𝗲𝘀𝘁𝘀: BUN and creatinine assess kidney function and dehydration effects. 𝗜𝗻𝗳𝗲𝗰𝘁𝗶𝗼𝗻 𝗧𝗲𝘀𝘁𝘀: CBC and inflammatory markers assess infection or inflammation — stool testing identifies bacterial or viral or parasitic pathogens. 𝗨𝗹𝘁𝗿𝗮𝘀𝗼𝘂𝗻𝗱: Useful for pyloric stenosis and intussusception. 𝗔𝗯𝗱𝗼𝗺𝗶𝗻𝗮𝗹 𝗫-𝗿𝗮𝘆: Can show bowel dilation or obstruction or abnormal gas patterns. 𝗢𝘁𝗵𝗲𝗿 𝗧𝗲𝘀𝘁𝘀: Endoscopy or GI motility testing when indicated.

Vomiting (Emesis) — Neurological Mechanism

𝗩𝗼𝗺𝗶𝘁𝗶𝗻𝗴 𝗖𝗲𝗻𝘁𝗲𝗿: The medulla oblongata in the brainstem coordinates an active muscular reflex. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Diaphragm and abdominal muscles contract → abdominal pressure rises → stomach contents are expelled. 𝗖𝗵𝗲𝗺𝗼𝗿𝗲𝗰𝗲𝗽𝘁𝗼𝗿 𝗧𝗿𝗶𝗴𝗴𝗲𝗿 𝗭𝗼𝗻𝗲 (𝗖𝗧𝗭): In the area postrema near the fourth ventricle — senses drugs and toxins and metabolic changes. 𝗢𝘁𝗵𝗲𝗿 𝗧𝗿𝗶𝗴𝗴𝗲𝗿𝘀: Signals from the GI tract and vestibular system and higher brain centers — pain and stress and neurological illness. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Vomiting associated with a brain tumor may worsen when getting up in the morning.

Vomiting (Emesis) vs. Regurgitation

𝗩𝗼𝗺𝗶𝘁𝗶𝗻𝗴: Active forceful muscular process that may include nausea or retching — can indicate infection or obstruction or other illness. 𝗥𝗲𝗴𝘂𝗿𝗴𝗶𝘁𝗮𝘁𝗶𝗼𝗻: Passive non-forceful return of gastric contents without strong contractions — common after feeds in healthy infants with immature LES. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗦𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝗰𝗲: Non-forceful spitting up in a thriving infant differs from progressive projectile vomiting with poor weight gain.

Bilious (Green) Vomiting — Intestinal Obstruction

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Green vomit contains bile. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Bile enters the intestine in the duodenum — an obstruction beyond this entry may cause bile-containing vomit. 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗦𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝗰𝗲: Possible intestinal obstruction in a newborn or young infant → urgent assessment for a surgical emergency.

Hypertrophic Pyloric Stenosis — Pathophysiology

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Hypertrophy of the pyloric muscle narrows the canal between stomach and duodenum. 𝗡𝗼𝗿𝗺𝗮𝗹 𝗥𝗼𝗹𝗲: The pyloric sphincter controls gastric emptying into the small intestine. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Muscle thickening → narrowed gastric outlet → food cannot empty → gastric pressure increases → forceful projectile vomiting after feeds. 𝗡𝗼𝗻-𝗕𝗶𝗹𝗶𝗼𝘂𝘀 𝗩𝗼𝗺𝗶𝘁𝗶𝗻𝗴: Obstruction is before the duodenal entry of bile so classic vomit contains no bile.

Pyloric Stenosis — Clinical Signs and Complications and Treatment

𝗢𝗻𝘀𝗲𝘁: Usually 3–6 weeks of age — exam examples include a 3-week-old. 𝗦𝗶𝗴𝗻𝘀: Progressive projectile NON-bilious vomiting after feeding sometimes within about 60 minutes — infant remains hungry — poor weight gain or weight loss — dehydration — possible olive-shaped upper abdominal or epigastric mass. 𝗖𝗼𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀: Dehydration and hypochloremia (low Cl⁻) and hypokalemia (low K⁺) and metabolic alkalosis from loss of gastric hydrochloric acid (HCl). 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀: Clinical findings confirmed primarily by abdominal ultrasound. 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁: NPO/fasting → IV fluid and electrolyte and acid–base correction → surgical pyloromyotomy. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗣𝗿𝗶𝗼𝗿𝗶𝘁𝘆: Stabilize before surgery. 𝗘𝘅𝗮𝗺 𝗗𝗶𝘀𝗰𝗿𝗲𝗽𝗮𝗻𝗰𝘆: A 2026 question describes greenish vomit but answers pyloric stenosis — TRUE green bilious vomiting is not typical and requires urgent assessment for other obstruction.

Vomiting — Partially Digested Food or Sour-Smelling Vomit

𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗖𝗹𝘂𝗲: May suggest delayed gastric emptying or upper GI dysmotility. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Poor gastric motility → food remains in stomach longer → partially digested food is vomited. 𝗘𝘅𝗮𝗺𝗽𝗹𝗲: Gastroparesis is impaired gastric emptying. 𝗦𝗼𝘂𝗿 𝗦𝗺𝗲𝗹𝗹: May reflect gastric acid exposure — not diagnostic alone.

Vomiting with Fever and Diarrhea — Gastroenteritis

𝗟𝗶𝗸𝗲𝗹𝘆 𝗖𝗮𝘂𝘀𝗲: Acute infectious gastroenteritis due to viruses or bacteria or parasites. 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀: Vomiting and diarrhea and fever — abdominal discomfort may occur. 𝗖𝗼𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻: Fluid and electrolyte losses → dehydration and electrolyte imbalance. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗣𝗿𝗶𝗼𝗿𝗶𝘁𝘆: Assess urine output and mucosa and tears and perfusion and hydration status.

Vomiting Patterns — Important Clinical Clues

𝗚𝗿𝗲𝗲𝗻/𝗕𝗶𝗹𝗶𝗼𝘂𝘀: Possible intestinal obstruction → urgent neonatal assessment. 𝗣𝗿𝗼𝗷𝗲𝗰𝘁𝗶𝗹𝗲/𝗡𝗼𝗻-𝗕𝗶𝗹𝗶𝗼𝘂𝘀: Consider pyloric stenosis in early infancy. 𝗣𝗮𝗿𝘁𝗶𝗮𝗹𝗹𝘆 𝗗𝗶𝗴𝗲𝘀𝘁𝗲𝗱/𝗦𝗼𝘂𝗿: Consider delayed gastric emptying or motility disorder. 𝗩𝗼𝗺𝗶𝘁𝗶𝗻𝗴 𝘄𝗶𝘁𝗵 𝗙𝗲𝘃𝗲𝗿 𝗮𝗻𝗱 𝗗𝗶𝗮𝗿𝗿𝗵𝗲𝗮: Consider acute gastroenteritis → monitor hydration.

Vomiting — Fluid and Electrolyte Replacement

𝗠𝗶𝗹𝗱–𝗠𝗼𝗱𝗲𝗿𝗮𝘁𝗲 𝗗𝗲𝗵𝘆𝗱𝗿𝗮𝘁𝗶𝗼𝗻: Give small frequent oral rehydration solution (ORS) amounts to replace fluid and electrolytes without triggering more vomiting. 𝗦𝗲𝘃𝗲𝗿𝗲 𝗗𝗲𝗵𝘆𝗱𝗿𝗮𝘁𝗶𝗼𝗻 𝗼𝗿 𝗣𝗼𝗼𝗿 𝗢𝗿𝗮𝗹 𝗧𝗼𝗹𝗲𝗿𝗮𝗻𝗰𝗲: IV fluids may be necessary. 𝗜𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁: Suspected bowel obstruction requires urgent evaluation rather than routine ORS.

Vomiting — Aspiration Prevention

𝗥𝗶𝘀𝗸: Aspiration means vomit enters the respiratory tract. 𝗗𝘂𝗿𝗶𝗻𝗴 𝗔𝗰𝘁𝗶𝘃𝗲 𝗩𝗼𝗺𝗶𝘁𝗶𝗻𝗴: Position the child to allow drainage and protect the airway — keep the airway clear. 𝗦𝗹𝗲𝗲𝗽: Always place infants on their backs according to safe-sleep guidance.

Vomiting — Oral Hygiene

𝗥𝗶𝘀𝗸: Gastric acid from vomiting damages tooth enamel. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗖𝗮𝗿𝗲: Rinse or gently clean the mouth after vomiting. 𝗔𝘃𝗼𝗶𝗱: Immediate toothbrushing because acid temporarily softens enamel and brushing may increase erosion.

Vomiting — Antiemetic Treatment and Nutrition

𝗢𝗻𝗱𝗮𝗻𝘀𝗲𝘁𝗿𝗼𝗻 (𝗭𝗼𝗳𝗿𝗮𝗻): Antiemetic that blocks serotonin 5-HT₃ receptors in the vomiting reflex. 𝗨𝘀𝗲: In selected children with acute gastroenteritis → less vomiting → improved ORS tolerance and possibly fewer IV fluids. 𝗡𝘂𝘁𝗿𝗶𝘁𝗶𝗼𝗻: Avoid very sugary or greasy foods that worsen symptoms — continue an age-appropriate diet as tolerated. 𝗖𝗵𝗶𝗰𝗸𝗲𝗻 𝗦𝗼𝘂𝗽: Does not have the correct glucose-electrolyte balance to replace ORS.

Acute Diarrhea — Rotavirus

𝗧𝘆𝗽𝗲: Virus causing acute gastroenteritis in infants and young children. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Damages intestinal epithelial cells → reduced absorption → watery diarrhea. 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀: Watery diarrhea and possible vomiting and fever — main complication is dehydration. 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁: ORS and supportive fluid and electrolyte replacement — NO antibiotics because this is a viral infection. 𝗣𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗼𝗻: Rotavirus vaccination lowers severe disease and hospitalization — infection can still occur despite vaccination.

Acute Diarrhea — Salmonella

𝗧𝘆𝗽𝗲 𝗮𝗻𝗱 𝗧𝗿𝗮𝗻𝘀𝗺𝗶𝘀𝘀𝗶𝗼𝗻: Bacterium acquired from contaminated food especially poultry and eggs or contact with infected animals. 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀: Diarrhea and fever and abdominal cramps and vomiting. 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁: Most uncomplicated cases resolve with supportive hydration. 𝗔𝗻𝘁𝗶𝗯𝗶𝗼𝘁𝗶𝗰𝘀: Usually NOT given in uncomplicated disease because benefit is limited and carriage may be prolonged — consider for severe disease or high-risk patients including some infants or immunocompromised children. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Uncomplicated Salmonella → prefer supportive care over routine antibiotics.

Acute Diarrhea — Shigella

𝗧𝘆𝗽𝗲 𝗮𝗻𝗱 𝗧𝗿𝗮𝗻𝘀𝗺𝗶𝘀𝘀𝗶𝗼𝗻: Highly contagious bacterium spread by the fecal–oral route including person-to-person contact. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Inflames intestinal mucosa → may cause bloody diarrhea. 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀: Fever and abdominal cramps and bloody diarrhea (dysentery). 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁: Hydration — antibiotics when indicated especially in severe illness and chosen according to local resistance. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Shigella is associated with bloody diarrhea or dysentery.

Acute Diarrhea — Clostridioides difficile (C. diff)

𝗧𝘆𝗽𝗲 𝗮𝗻𝗱 𝗥𝗶𝘀𝗸: Bacterium often associated with prior antibiotic exposure. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Antibiotics reduce normal microbiota → C. difficile overgrows → toxins damage colonic mucosa. 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀: Watery diarrhea and abdominal pain and fever — severe cases may cause colitis. 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁: Clinically significant infection requires specific antibiotics such as oral vancomycin or fidaxomicin depending on age and severity. Metronidazole (Flagyl) has been used in selected non-severe pediatric cases but is less favored in newer protocols. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗖𝗮𝘂𝘁𝗶𝗼𝗻: Infants are commonly colonized without illness so a positive test alone does not establish infection. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Antibiotic exposure → flora disruption → C. diff toxin-mediated diarrhea.

Acute Diarrhea — Treatment and Nursing Management

𝟭. 𝗢𝗿𝗮𝗹 𝗥𝗲𝗵𝘆𝗱𝗿𝗮𝘁𝗶𝗼𝗻: ORS is preferred for mild–moderate dehydration if the child can drink. Its water and sodium and glucose and electrolytes use sodium-glucose absorption → water follows even during diarrhea. Give small frequent amounts despite occasional vomiting. 𝟮. 𝗙𝗲𝗲𝗱𝗶𝗻𝗴: Continue breastfeeding or age-appropriate formula and resume a balanced age-appropriate diet as tolerated to support nutrition and recovery. 𝟯. 𝗕𝗥𝗔𝗧: Bananas and rice and applesauce and toast alone are nutritionally inadequate → do not restrict the child to a BRAT-only diet. 𝟰. 𝗙𝗹𝘂𝗶𝗱𝘀 𝘁𝗼 𝗔𝘃𝗼𝗶𝗱: Sugary drinks and fresh-squeezed juices and soda can increase intestinal osmotic load → worsen diarrhea — avoid caffeine. Chicken or meat broth alone cannot replace balanced ORS. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗣𝗿𝗶𝗼𝗿𝗶𝘁𝘆: Restore fluids and electrolytes and maintain nutrition and monitor hydration. Severe dehydration or shock → urgent IV/IO resuscitation.

Constipation in Newborns — Normal Passage of Meconium

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Meconium is the newborn’s first stool — dark green or black and thick and sticky — made of materials accumulated before birth. 𝗧𝗶𝗺𝗶𝗻𝗴: Most healthy term newborns pass meconium within 24 hours. 𝗟𝗲𝗰𝘁𝘂𝗿𝗲 𝗪𝗮𝗿𝗻𝗶𝗻𝗴: No meconium by 36 hours merits assessment under the 2026 lecture guidance. 𝗖𝗼𝗻𝗰𝗲𝗿𝗻𝗶𝗻𝗴: No passage by 48 hours raises concern for obstruction or impaired bowel motility. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Older exams used 24 hours or 24–48 hours — lecturer now emphasizes 36 hours as a warning.

Constipation in Newborns — Hirschsprung Disease

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Congenital absence of enteric ganglion cells in a segment of bowel. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: No ganglion cells → impaired peristalsis and failure of relaxation → functional obstruction and possible megacolon. 𝗦𝗶𝗴𝗻𝘀: Delayed meconium and abdominal distension and constipation and sometimes bilious vomiting — increased internal anal sphincter tone. 𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀: Rectal biopsy confirming absent ganglion cells. 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁: Surgical removal of the aganglionic segment with restoration of bowel continuity. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁𝘀: Distended abdomen and increased sphincter tone — diagnostic hallmark is absence of ganglion cells on rectal biopsy.

Constipation in Newborns — Meconium Ileus

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Intestinal obstruction caused by abnormally thick sticky meconium typically in the terminal ileum. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Thick intestinal contents cannot progress → blockage and delayed stool passage. 𝗔𝘀𝘀𝗼𝗰𝗶𝗮𝘁𝗶𝗼𝗻: Strongly associated with cystic fibrosis (CF) and its thick secretions. 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗦𝗶𝗴𝗻𝗶𝗳𝗶𝗰𝗮𝗻𝗰𝗲: Evaluate for CF in newborns with meconium ileus. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Failure to pass meconium by 48 hours may raise suspicion of CF especially with meconium ileus.

Constipation in Newborns — Meconium Plug Syndrome

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Temporary blockage from thickened meconium forming a plug in the colon. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Plug prevents normal passage of stool. 𝗦𝗶𝗴𝗻𝘀: Delayed meconium and possible abdominal distension. 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁: May resolve after appropriate medical assessment and treatment. 𝗜𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁: Persistent symptoms require evaluation for Hirschsprung disease or other disorders.

Constipation in Newborns — Congenital Hypothyroidism

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Insufficient thyroid hormone from birth. 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺: Low thyroid hormone → reduced intestinal peristalsis → constipation and delayed meconium. 𝗦𝗰𝗿𝗲𝗲𝗻: Part of the newborn screening program (heel-prick dried blood spot test) with tests for PKU and other congenital conditions. 𝗧𝗶𝗺𝗶𝗻𝗴: Past exam states 48 hours — current Israeli guidance indicates sampling from at least 36 hours after birth and usually before discharge. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Congenital hypothyroidism can be detected by routine newborn screening before symptoms become apparent.

Functional Constipation — Pathophysiology and Pain–Withholding Cycle

𝗗𝗲𝗳𝗶𝗻𝗶𝘁𝗶𝗼𝗻: Constipation without an identified major structural or organic cause — often maintained by fear-based stool withholding. 𝗖𝘆𝗰𝗹𝗲 𝟭: Hard dry stool → painful defecation and sometimes anal fissure. 𝗖𝘆𝗰𝗹𝗲 𝟮: Fear of pain → child deliberately withholds stool. 𝗖𝘆𝗰𝗹𝗲 𝟯: Stool accumulates → rectal distension → reduced sensation and urge to defecate. 𝗖𝘆𝗰𝗹𝗲 𝟰: More water absorbed → stool becomes larger and harder → more pain → cycle repeats. 𝗖𝗼𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀: Rectal enlargement and reduced sensitivity and fecal impaction and overflow soiling. 𝗡𝘂𝗿𝘀𝗶𝗻𝗴 𝗣𝗼𝗶𝗻𝘁: Treat both stool hardness and withholding behavior. 𝗘𝘅𝗮𝗺 𝗣𝗼𝗶𝗻𝘁: Constipation is common in children with autism.

Functional Constipation — Breaking the Cycle

𝗦𝘂𝗽𝗽𝗼𝗿𝘁𝗶𝘃𝗲 𝗧𝗼𝗶𝗹𝗲𝘁𝗶𝗻𝗴: Calm consistent routine — toilet sitting after meals uses gastrocolic reflex — reassure and reward — never punish or shame. 𝗔𝘃𝗼𝗶𝗱 𝗥𝗲𝗰𝘁𝗮𝗹 𝗦𝘁𝗶𝗺𝘂𝗹𝗮𝘁𝗶𝗼𝗻: No routine thermometers or objects or rectally inserted olive oil or parsley — risks include mucosal injury and irritation and infection. 𝗦𝘁𝗼𝗼𝗹 𝗦𝗼𝗳𝘁𝗲𝗻𝗲𝗿𝘀: Polyethylene glycol (PEG) is an osmotic laxative → retains water in bowel → softer stool → less pain and withholding — treatment may continue for an extended period. 𝗡𝘂𝘁𝗿𝗶𝘁𝗶𝗼𝗻: Age-appropriate fiber and fluid intake — fruits and vegetables and whole grains. Prunes and pears contain sorbitol that can soften stool. 𝗜𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁: Extra water beyond normal fluid needs alone does not reliably resolve functional constipation