Digestive Tract Birth Defects in Newborns

Grand Rapids, Michigan Guide for Parents

Digestive tract birth defects affect the way a baby’s mouth, esophagus, stomach, intestines, rectum, or anus form and function. In Grand Rapids and throughout Michigan, these conditions are rare but serious, and they usually require care at a neonatal intensive care unit (NICU) and pediatric surgery center such as:

  • Spectrum Health Helen DeVos Children’s Hospital
  • Trinity Health Grand Rapids
  • University of Michigan Health–West (Metro Health)
  • Other regional pediatric specialty centers serving West Michigan families

Kent County Health Department and Grand Rapids Public Health can also help connect families with local resources, early intervention, and follow‑up care.

How the Digestive Tract Normally Works

The digestive tract is the long tube that runs from the mouth to the anus. It includes:

  • Mouth and throat – where food is chewed and swallowed
  • Esophagus – the muscular tube that connects the throat to the stomach
  • Stomach and intestines – where food is digested and nutrients are absorbed
  • Rectum and anus – where waste (stool or feces) is stored and then leaves the body

In some babies, parts of this system do not form correctly during pregnancy, leading to digestive tract birth defects.

What Are Digestive Tract Birth Defects?

During fetal development, sections of the digestive tract may:

  • End in a closed pouch instead of connecting to the next part of the tract
  • Be abnormally narrow
  • Connect to other organs they should not connect to (for example, the windpipe or urinary tract)
  • Be missing or located in the wrong place

Two important types seen in newborns in Michigan, including the Grand Rapids area, are:

  • Esophageal atresia – a blockage or interruption of the esophagus
  • Imperforate anus / anorectal malformations – problems with the anus or rectum, such as a missing or blocked anal opening

These conditions are usually found soon after birth and require urgent evaluation by a pediatric surgeon.

Esophageal Atresia and Tracheoesophageal Fistula

These Defects Often Occur Together

Most babies born with esophageal atresia also have a tracheoesophageal fistula (TEF).

  • Esophageal atresia: the esophagus does not connect normally to the stomach. It may end in a blind pouch or connect incorrectly.
  • Tracheoesophageal fistula: an abnormal connection (fistula) between the trachea (windpipe) and the esophagus.

Because of this abnormal connection, swallowed milk or formula can enter the lungs, and air from the lungs can pass into the stomach or esophagus.

In Grand Rapids, newborns suspected of having these conditions are typically transferred to a NICU and pediatric surgery team at Spectrum Health Helen DeVos Children’s Hospital or another regional children’s hospital.

Causes and Risk Factors

The Causes Are Largely Unknown

For most families, the exact cause is unknown, and there is currently no known way to prevent these defects.

  • They usually occur sporadically, not because of anything the parents did or did not do.
  • Sometimes they are part of a broader pattern of birth defects (for example, VACTERL association, which involves multiple organ systems).

Possible Clues During Pregnancy

During pregnancy, too much amniotic fluid (a condition called polyhydramnios) can be a warning sign. Because a baby with esophageal atresia cannot swallow fluid normally, amniotic fluid may build up.

Prenatal ultrasounds done in Grand Rapids (for example, at Spectrum Health, Trinity Health Grand Rapids, or Metro Health) may detect:

  • Excess amniotic fluid
  • A small or poorly visible stomach bubble on ultrasound

However, not all cases are found before birth. Many are diagnosed soon after delivery.

Esophageal Atresia: Types and Associated Conditions

What Happens in Esophageal Atresia?

In esophageal atresia, the esophagus is blocked or interrupted:

  • It may end in a closed sac (blind pouch) instead of reaching the stomach.
  • It may connect to the trachea instead of the stomach.
  • It may be abnormally narrow (esophageal stenosis).

Around one-third of affected babies have other birth defects, which may include:

  • Congenital heart defects
  • Imperforate anus or other anorectal malformations
  • Other organ system abnormalities

These associated conditions are usually evaluated with heart ultrasound (echocardiogram), kidney ultrasound, and other imaging.

Symptoms of Esophageal Atresia in Newborns

Soon after birth, babies with esophageal atresia may show:

  • Excessive drooling or frothy saliva
  • Inability to feed properly – milk or formula may not go down
  • Vomiting or coughing during feeds
  • Choking or gagging when trying to swallow

Because the esophagus is blocked or misrouted, food and saliva cannot travel normally to the stomach.

In Michigan, including the Grand Rapids region, esophageal atresia or esophageal stenosis occurs in roughly 1 in every 1,800 births.

How Esophageal Atresia Is Diagnosed

In the hospital nursery or NICU, doctors may:

  1. Attempt to pass a thin feeding tube through the baby’s mouth or nose into the stomach.

    • If the tube stops and cannot reach the stomach, this suggests a blockage.

  2. Order x‑rays of the chest and abdomen.

    • X‑rays can show where the tube ends and whether there is air in the stomach or intestines (which may indicate a fistula between the trachea and esophagus).

Newborns in Grand Rapids are typically evaluated in hospitals with NICU capabilities, and pediatric surgeons are consulted urgently.

Treatment: Esophageal Atresia Requires Immediate Surgery

Surgical Repair

Esophageal atresia and any associated tracheoesophageal fistula require prompt surgery. Ideally, both problems are corrected in the same operation:

  • The surgeon disconnects any abnormal connection between the esophagus and trachea (repairing the TEF).
  • The two ends of the esophagus are sewn together to create a continuous tube from the throat to the stomach.

If the gap between the upper and lower esophageal segments is too large:

  • The baby may need tube feeding (for example, via a gastrostomy tube into the stomach) for a period of time.
  • Additional surgery may be planned once the baby grows and the gap is smaller.

In Grand Rapids, these surgeries are typically performed by pediatric surgeons at major centers such as Spectrum Health Helen DeVos Children’s Hospital, often within the first days of life.

Recovery and Hospital Stay

A prolonged hospital stay in the NICU is common after surgery. During this time, the care team will:

  • Monitor breathing and oxygen levels
  • Provide nutrition (IV fluids and/or tube feedings)
  • Watch for infection, leakage at the repair site, or narrowing (stricture) of the esophagus
  • Gradually introduce oral feedings when it is safe

Parents are supported by neonatologists, pediatric surgeons, lactation consultants, and social workers to help them prepare for going home.

Long-Term Feeding and Swallowing Difficulties

Even when surgery is successful, many children have ongoing feeding and swallowing challenges:

  • Poorly coordinated peristalsis – the muscular waves that push food down the esophagus may not work normally.
  • Food or liquid may move slowly or get briefly stuck in the esophagus.
  • Some children need feeding therapy with speech‑language pathologists or occupational therapists, available through local pediatric therapy programs in Grand Rapids.

Parents may notice:

  • Taking a long time to eat
  • Preference for softer foods
  • Occasional gagging or discomfort with certain textures

Your child’s care team will guide you on safe feeding strategies and when to seek urgent care.

Tracheoesophageal Fistula (TEF)

How TEF Affects Breathing and Feeding

In tracheoesophageal fistula, the esophagus is abnormally connected to the trachea. This allows:

  • Swallowed milk or formula to enter the lungs, causing coughing and choking
  • Air from the lungs to pass into the stomach or esophagus, which may cause a very distended abdomen

Common symptoms in the newborn period include:

  • Coughing and choking with feeds
  • Bluish color of the skin (cyanosis) from lack of oxygen
  • Difficulty breathing, especially during or after feeding

An x‑ray can reveal air in the esophagus or stomach that suggests a fistula.

Treatment for Tracheoesophageal Fistula

TEF requires immediate surgery. Usually, it is repaired during the same operation as esophageal atresia:

  • The surgeon closes the abnormal connection between the trachea and esophagus.
  • The goal is to protect the lungs from swallowed material and restore more normal breathing and swallowing.

Long-Term Respiratory Issues After TEF Repair

Some children experience long‑term breathing problems after TEF repair:

  • A characteristic, sometimes harsh or barking cough
  • Tracheomalacia – the trachea is softer and more flexible than normal, so it may partially collapse during hard breathing (crying, coughing, or respiratory infections)
  • Noisy breathing (stridor or wheezing)
  • Increased risk of respiratory infections, especially in cold and flu season, which is significant during Michigan’s long, cold winters

Pediatric pulmonologists in Grand Rapids can help manage these issues. Families are often advised to:

  • Avoid exposure to tobacco smoke
  • Stay up to date on vaccines, including flu and RSV prevention when recommended
  • Seek prompt care for breathing difficulties or frequent lung infections

Imperforate Anus and Anorectal Malformations

What Is Imperforate Anus?

In an imperforate anus or anorectal malformation, the lower end of the digestive tract (rectum and anus) does not form correctly. Instead of the rectum attaching to a normal anal opening, several problems can occur:

  • The rectum ends in a closed sac without connecting to the anus.
  • The rectum connects to other organs, such as the vagina in girls or the urethra (urine tube) in boys.
  • The anal opening is missing, very small, or in an abnormal location.
  • The rectum may be abnormally narrow (stenosis), limiting passage of stool.

In Michigan, including the Grand Rapids area, anorectal atresia (blockage) and stenosis (narrowing) occur in about 1 in every 1,800 births.

Symptoms of Imperforate Anus in Newborns

Signs that may be noticed soon after birth include:

  • No visible anal opening, or an anus that looks unusually small or misplaced
  • No stool passed within the first 24–48 hours of life
  • Stool passing from an abnormal opening, such as:
    • The vagina
    • The urethra (with urine)

Other conditions sometimes seen with imperforate anus include:

  • Exomphalos (omphalocele) – intestines or other abdominal organs herniating through a hole in the abdominal wall
  • Esophageal atresia and tracheoesophageal fistula
  • Other congenital abnormalities involving the spine, kidneys, or heart

Diagnosis is made by careful physical examination and x‑rays or other imaging to see where the rectum ends and how it connects.

Treatment for Imperforate Anus

Initial Surgical Management

Treatment depends on the specific type and severity of the malformation. Common initial steps may include:

  • Creating a stoma – the surgeon brings the end of the intestine to a small opening in the abdominal wall.
  • Attaching a colostomy bag to collect stool so it can leave the body safely.
  • Closing any abnormal connections between the rectum and the vagina or urethra.

This first surgery helps protect the baby from serious infection and allows time to plan the final repair.

Definitive Anal Repair

At a later stage, when the baby is stable and has grown:

  • The rectum is brought down and attached to a new anal opening in the correct location.
  • The surgeon may need to create or enlarge the anal opening.
  • The stoma may be closed in a separate surgery once the new anal passage is working well.

These procedures are typically performed by pediatric colorectal surgeons at specialized centers. Families in Grand Rapids may receive care locally or be referred to larger pediatric colorectal programs in Michigan, depending on the complexity.

Long-Term Bowel Function and Continence

Long‑term outcomes depend on:

  • How well the nerves and muscles around the rectum and anus developed
  • The type of anorectal malformation
  • The success of surgery and any complications

Some children may experience:

  • Difficulty controlling bowel movements (incontinence)
  • Constipation or trouble fully emptying the rectum
  • Need for a special diet, stool softeners, or bowel management programs for several years

To help maintain soft, easy‑to‑pass stools, doctors may recommend:

  • Adequate fluid intake
  • A high‑fiber diet, when age‑appropriate
  • Stool softeners or laxatives as prescribed

In Grand Rapids, pediatric gastroenterologists and colorectal specialists can provide bowel management programs, including scheduled toileting, enemas, and individualized nutrition plans.

Living in Michigan: Seasonal Considerations

For families in Grand Rapids and across West Michigan:

  • Cold winters and frequent respiratory infections can be especially challenging for children with a history of TEF or lung problems.
  • Indoor heating can dry the air, which may worsen cough and breathing issues. A humidifier, good hand hygiene, and avoiding sick contacts can help.
  • Regular follow‑up with pediatric specialists is important, particularly before and during winter respiratory virus season.

When to Seek Medical Help

Call your baby’s doctor or seek emergency care at a Grand Rapids hospital if you notice:

  • Coughing, choking, or turning blue during feeds
  • Difficulty breathing, noisy breathing, or frequent chest infections
  • No stool in the first 48 hours after birth or stool coming from an unusual location
  • Severe constipation, vomiting, or abdominal swelling in a child with a known anorectal or esophageal condition
  • Poor weight gain or feeding refusal

Your primary care provider (pediatrician or family doctor) can coordinate care with:

  • Pediatric surgeons
  • Pediatric gastroenterologists
  • Pediatric pulmonologists
  • Nutrition and feeding specialists

Local Resources in Grand Rapids, MI

Families dealing with digestive tract birth defects can seek help from:

  • Spectrum Health Helen DeVos Children’s Hospital – NICU, pediatric surgery, gastroenterology, pulmonology
  • Trinity Health Grand Rapids – maternity and newborn care, surgical services
  • University of Michigan Health–West (Metro Health) – pediatric and surgical services
  • Kent County Health Department – public health programs, early intervention referrals
  • Grand Rapids Public Health and local clinics – support for follow‑up care, immunizations, and nutrition counseling

Key Points to Remember

  • Causes of these malformations are largely unknown, and there is currently no proven way to prevent them.
  • Esophageal atresia symptoms include:
    • Excessive drooling
    • Inability to feed properly
    • Vomiting or choking during feeds
  • Tracheoesophageal fistula symptoms include:
    • Coughing and choking when feeding
    • A blue tinge to the skin (cyanosis) from lack of oxygen
  • Imperforate anus may present with:
    • No visible anal opening or an anus in an abnormal position
    • No stool in the first 1–2 days of life
    • Stool passing through the vagina or urethra
  • All of these conditions require prompt evaluation and surgical care, usually at a hospital with pediatric surgery and NICU services, such as those in Grand Rapids.

Early diagnosis, expert surgical treatment, and ongoing follow‑up with local pediatric specialists give children the best chance for healthy growth and development.