Thursday, April 25, 2013

The Poop series: Chapter #1 Baby poop

updated April 2017

The poop series.

I joke about it, but it is quite true that part of my job seems to involve talking about poop several times a day.  I don't just get to talk about it, many of my email poop questions now come with photos...

Today's post is the first of a four part "poop series"  

Today's topic is 
*Basic baby poop/ the first couple of months

Watch out for future topics which will be: 
*the changing stools once kids start eating,
*Toilet training tips
*General constipation for older kids

Most folks don't realize when they sign up for this "parenthood" gig that poop is going to be the frequent subject of many conversations. I am not kidding when I tell you that I have poop related phone calls every single day. It helps to know what is normal so that you don't worry.
I remember as if it were yesterday, my husband Sandy's first real experience changing a poop laden diaper. He soon became an expert, but that first one was a disaster. Lauren's little feet managed to get covered in poop, and before he knew it there was poop all over the place, including most of the baby and part of the walls. 
When babies are first born the stools are very dark and tarry. This is called meconium.
The meconium is very sticky and can be a bit challenging to clean. Vaseline, Aquaphor or Cerave ointment can help you gently remove the meconium from your child’s gentle skin.
Once babies start to successfully feed, the stools will gradually transition to a lighter color.
Normal colors range from yellow, orange, green or brown. I rarely pay much attention to color unless it is accompanied by a fussy baby or other symptoms that are telling us that something is off.
Those first bowel movements help signal us that the system is working and that the baby is actually getting milk. We certainly want to encourage breast feeding, but I understand that it is not an option for everyone. If you can make nursing work, there are a lot of benefits. If it feels overwhelming, try to give it at least 2 weeks before you give up. Take advantage of the excellent lactation assistance that is out there.
One of the real challenges for a nursing mom, is that It is harder to track the milk intake for the breast fed babies. It can be hard for new parents to be certain that the baby is successfully nursing. The baby might be hanging out on the breast for hours, but not reliably transferring adequate milk. The not-being-able-to-know-for-sure how much the baby was getting drove me nuts with my firstborn. Listening for swallowing and watching mom's breasts to see that the milk is coming in will give important clues, but when we see those first yellow stools I always want to give mom a big congratulatory hug. Yellow stools are proof that the baby is getting milk. If a baby is fed from a bottle, then of course we can track how much they are eating fairly easily.
Normal breast milk stools are very squirty and yellowish. Some may have little seeds. Think Mustard. (You may want to change your plans for having lunch at the deli today)
It seems that almost every new parent gives me a call to make sure it is okay for the stools to be so runny. Yes it is. Diarrhea would be clear watery stools with only flecks. Baby poop is routinely very liquidy. Remember, they are not eating any solid food, liquid in/liquid out!  Some babies seem to have loud squirty poops every time they eat (or as soon as you have put a fresh diaper on them). As long as it has a color, it is likely fine.
There are many factors that can impact the color. Stools from a formula fed baby tend to be a bit greener than the yellow ones we get from breast milk. Grippe water can also make stools greenish, as can the lack of hind milk. (see the colic post)
If blood is noted in the stool, we certainly want to be notified, but most of the time it is not something I am alarmed about as long as the baby looks good...(Is their color fine? The belly nice and soft? Are they eating well?)
Red blood is usually fresh and comes from near the anus. It can be caused by the gentle skin down there getting irritated.
Darker blood is not as fresh and comes from higher up in the digestive tract. My first question will be about mom's nipples. If they are very sore, it is likely that there was some bleeding and the blood we are seeing in the stool is mom's blood. (I know, yuck.)
If stools are mucousy with some fresh blood it can also be connected to mom’s diet. Often removing dairy completely will alleviate the issue.
Once we see that the baby is gaining weight and having a regular pooping pattern we are no longer concerned about monitoring the frequency.
It is quite common for babies who used to have frequent poops, to suddenly shift to way less frequent stools.
As long as the stools remain soft it is not something that concerns us. Some babies go as infrequently as once a week.
It is also quite normal for babies to grunt, groan and turn bright red as they work on a bowel movement.
It is considered constipation when the actual stool is hard, formed and pellet-like. If that is the case, check in with your doctor's office. This is very unusual for a breastfed baby. I have found some organic formulas to be the culprit.

A pooping baby tends to be a happy baby. If you have one of those infrequent poopers it is hard to watch them struggle.
Massage their tummy. Go on youtube and search out some Infant Massage techniques. A good belly massage can help stimulate peristalsis (which is the movement within the intestines that moves the poop along.)
The tummy may be the most important area, but doing an entire body massage will help them relax. 
Don't forget their little hands! Take your thumb and make firm little circles on their palms. This is a reflexology technique that grandmas have been practicing for generations.
You can also bicycle their legs. Let gravity help them out. Hold them in an upright position and pull their little legs up to a squat position. Nobody poops as easily in a reclining position.
Sometimes a little rectal massage will also help. To do this you can put a dab of KY jelly or Vaseline on a Q-Tip and stick it a tiny bit of the way (just the cotton tip worth) into the butt. In the office when we take a rectal temp, more than half of the time this will make the baby poop right on the thermometer.
The Windi is another gentle way to stimulate pooping and help relieve gas at the same time.
There is no intervention needed for infrequent stools as long as you have a happy baby.
If it has been many days in between poops, your baby seems quite uncomfortable and massage has not helped, our next step will be glycerin. With the glycerin you have 2 options.
Glycerin suppositories are little sticks of glycerin (over the counter in most drugstores.) You break off a piece and stick it into the butt (KY jelly helps.) This stimulates the babies to poop fairly soon.
The other option is a product called Pedialax. These are little bulbs full of liquid glycerin. You pull off the cap and insert the pre-lubricated tip into your baby's butt and squeeze the liquid in. These works really well. The box says that these are for babies 2 and over, but I have found them safe and quite effective for younger folks.
Often just going out and buying glycerin will make your kid poop. It is a useful product to have on hand. Someday within the next couple of years it will come in handy.
Baby poop is a fairly benign substance. This will change.....
Next week’s post will address the changing stools as solids are introduced. )


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