It may be the bane of my professional existence but it isn’t found in the major pediatric textbooks. It’s the source of stress and confusion for so many young parents. And too often it’s misunderstood if not mismanaged. It’s grunting baby syndrome.
The baby with grunting baby syndrome will push, squeeze, grunt, change color and carry on only to produce a soft bowel movement. Parents will report that their baby is constipated and seek help. Very often we’re lead down the down the primrose path searching for a solution. But there is no problem. The grunting baby’s problem is one of primitive incoordination. While we all take for granted our understanding of the need for simultaneous relaxation of the pelvic floor and abdominal pressure to poop, not all babies have this figured out. And it’s this lack of coordination that makes us believe that our babies are in trouble.
A common trap for parents and even pediatricians is to stimulate the GBS baby with a thermometer or a cotton swab. When the anus is stimulated, babies exhibit what’s referred to as an “anal wink.” When this happens the bottom relaxes ever so briefly but just enough to allow rectal contents to be eliminated.
The reason this is a trap is that it actually works. And because it works so well we do it again and again. But as the baby becomes accustomed to pooping with stimulation it comes to be that the baby can only poop when stimulated (thus the trap).
The baby with grunting baby syndrome is best left to work out her issues on her own. The simple timing of elimination is something that we all sort out early on and we shouldn’t interfere. As difficult as it may be to watch, the short-term relief of rectal stimulation is never a good long-term solution. Parents of babies with GBS will often look for help after weeks of continuous bottom tweaking and failure of a baby to poop on her own. After a thorough history, physical, and exclusion of other causes I educate the family on GBS and suggest a slow withdrawal of stimulation with the understanding that baby will figure it out.
As far as I can tell, the first formal description of GBS as a clinical entity was made by Dr. Carlo Dilorenzo, Professor of Pediatrics at Ohio State University in the textbook, Pediatric Gastrointestinal Motility Disorders.