Newborn and child health experts have warned parents that failure of a newborn to pass stool within the first 24 to 48 hours after birth is a medical red flag requiring prompt professional evaluation.

The experts explained that newborns normally pass their first stool, known as meconium, shortly after birth. Meconium is typically a thick, dark, tar-like substance made up largely of materials accumulated in the baby’s intestines during pregnancy.

Speaking with PUNCH Healthwise, a paediatric surgeon and Professor of Surgery at Bayero University, Kano, and Aminu Kano Teaching Hospital, Aminu Mohammad, said most healthy term newborns should have passed meconium within the first 48 hours of life.

Mohammad, who is also Chair of the Department of Surgery at Bayero University, Kano, described failure to pass stool within the expected period as highly abnormal and requiring immediate medical attention.

He explained that up to 90 per cent of healthy newborns pass meconium within the first 24 hours, while virtually all healthy term babies should have passed their first stool by 48 hours.

According to him, a newborn who has not passed meconium after 48 hours should be taken to a paediatrician or an emergency department for assessment.

He warned against waiting several days before seeking medical care, noting that delayed passage of stool could indicate a serious underlying condition.

“Delayed passage is officially considered when a baby does not stool within 48 hours. A delay beyond this point requires immediate medical evaluation,” he said.

Possible causes
Mohammad said failure to pass meconium could be caused by congenital abnormalities affecting the baby’s digestive system.

He identified imperforate anus, intestinal atresia or stenosis, intestinal obstruction and Hirschsprung’s disease among possible causes.

Imperforate anus occurs when the anus does not develop normally or is absent, making it impossible for the baby to pass stool through the normal route.

He explained that some babies could also have intestinal atresia or stenosis, in which parts of the intestine are either disconnected or abnormally narrowed.

“These are conditions that cannot be relieved by giving the newborn anything by mouth or from the anus. Such cases may require surgery,” he said.

The professor also identified Hirschsprung’s disease as another possible cause.

He explained that the condition involves the absence of specialised nerve cells in part of the intestine, affecting the normal movement of intestinal contents and making it difficult for the baby to pass stool.

Other possible causes, he said, include unusually thick and sticky meconium, systemic illnesses such as poor thyroid function and certain medications given to mothers during labour.

Experts warn against home remedies
The paediatric surgeon strongly cautioned parents against using home remedies, oils, concoctions or objects inserted into a newborn’s rectum to stimulate bowel movement.

He said such practices could cause serious complications while also masking an underlying condition that might require surgery.

“Parents should not attempt to treat this at home with remedies like rectal stimulation, as this can mask a serious diagnosis and delay proper treatment,” he warned.

Mohammad specifically cautioned against giving newborns oils such as castor oil or mineral oil orally.

According to him, oil could be accidentally inhaled into the lungs and cause a potentially fatal form of pneumonia.

He also warned that enemas and suppositories could injure the delicate tissues of a newborn’s rectum.

Another danger, he noted, was that home remedies might temporarily produce stool, creating a false impression that the underlying problem had been resolved.

He said this could allow conditions such as Hirschsprung’s disease or intestinal obstruction to continue undiagnosed and worsen.

Warning signs parents should watch
Mohammad advised parents to seek urgent medical attention if a newborn fails to pass stool within 24 to 48 hours, particularly when the condition is accompanied by other symptoms.

These include green-coloured vomiting, abdominal swelling, refusal to feed, weakness or blood in the stool.

He said affected babies would require physical examination and, where necessary, diagnostic investigations to determine the cause of the delayed stool passage.

Leaving an intestinal obstruction untreated, he warned, could eventually result in bowel perforation, severe infection and death.

Breastfeeding important after birth
Also speaking with PUNCH Healthwise, Professor of Paediatrics and Neonatology at Ahmadu Bello University, Zaria, Kaduna State, Isa Abdulkadir, said most healthy term newborns were expected to pass meconium within the first few days of life.

Abdulkadir, a Consultant Paediatrician and Neonatologist at Ahmadu Bello University Teaching Hospital, said failure to pass the first stool should prompt medical evaluation, particularly in term babies.

He noted that between 80 and 90 per cent of healthy term babies would normally pass meconium within the first two to three days.

“If that doesn’t occur, we need to worry,” he said.

The neonatologist advised parents of babies who failed to pass stool to seek immediate assessment from a paediatrician or neonatologist.

He said feeding practices after delivery could also support normal bowel function, although many causes of delayed meconium passage were congenital and unrelated to anything the mother did during pregnancy.

Abdulkadir encouraged mothers to initiate breastfeeding as early as possible after delivery, preferably within the first 30 minutes to one hour, and to give the newborn only breast milk unless a health professional advises otherwise.

He said breast milk was natural, easily digestible and appropriate for the newborn.

Antenatal and postnatal care
Abdulkadir further stressed the importance of quality antenatal care, skilled delivery and appropriate postnatal monitoring in reducing the risk of complications.

He urged expectant mothers to receive antenatal care from approved healthcare providers and deliver in certified health facilities under the supervision of trained professionals.

He also recommended that newborns receive appropriate postnatal assessment, including evaluation of feeding, general wellbeing and any abnormal signs.

The neonatologist stressed that babies required specialised care and should not be treated like adults.

“Every deviation from what we consider to be normal needs to be properly looked into and assessed,” he said.

He urged parents to report anything unusual about a newborn to a paediatrician or neonatologist rather than attempting self-treatment.

The experts emphasised that while many causes of delayed passage of meconium occur before birth and cannot be prevented through home interventions, early recognition and prompt medical treatment can prevent serious complications and save the baby’s life.