Baby Poop 101

 

Baby Poop 101

The Poop Series/ Chapter one/ Baby Poop 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 I have poop related conversations in the Oath chats every single day. And if someone told you that you would be sending poop photos, you might not have believed them. But it makes sense…baby poop is like an alien substance when compared to adult poop. Parents don’t have a baseline for what’s normal. At some point, if you are like most parents, you also will get poop on your hands, your clothes, the carpets and just shrug it off as no big deal.   The first poops  When babies are first born the stools are greenish-black and thick. This is called meconium. The meconium can be a bit challenging to clean because it is so sticky. Nurse Judy Tip: Vaseline, Aquaphor, Cerave ointment or anything nice and goopy can help you gently remove the meconium from your child’s delicate skin better than regular baby wipes. Within about 48 hours, the baby will have some transitional stools that are not quite as dark and tarry (the color ranges from greenish to brownish). Those first bowel movements help signal that the system is working and some milk is moving through.   If the baby is taking a bottle, there is no mystery about the amount the baby is taking in. It can be more challenging for a breastfeeding mom to be certain that the baby is successfully nursing. Some babies might be hanging out on the breast for hours without 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 the changes in mom's breasts are important clues that the milk is coming in. The ultimate proof that milk has made its way into the system comes when we see the first yellow stools. I always want to give mom a big congratulatory hug.  Dr. Ted’s Poop Science: Meconium stools are thick and black because they are concentrated digested molecules, including bile, baby hair, mucous, and cells from intestinal lining. The change to yellow poop signifies that fresh milk has passed by the gallbladder and picked up more bilirubin, the yellow pigment that makes jaundice, and helped it to excrete the bilirubin into the poop, without the concentrated stuff from the meconium.   Color Once babies start to successfully feed, the stools will gradually transition to a lighter color. Normal colors can be a veritable rainbow and range from yellow, orange, green or brown. I rarely pay much attention to this color palette unless it is accompanied by a fussy baby or other symptoms that are telling us that something is off. Normal breast milk stools are very squirty and yellowish. Some may have little seeds.    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 from breast milk.    If blood is noted in the stool, you want to report that to your pediatrician, but most of the time it is not something I am alarmed about as long as the baby looks fine. Here are some key questions. How is the baby’s color and general appearance?  Are they calm or fussy? Is 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.  The first thing I will ask you to check is mom's nipples. If they are very sore, it is likely that there was some bleeding and the blood you are seeing in the stool is actually maternal 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. If stools are greenish and mucousy along with a fussy baby, it could be the lack of hind-milk   Gripe water, a popular colic remedy, can also make stools greenish If you are interested in a comprehensive list for colic relief click here  Very pale white stools are worth checking with your pediatrician.   Consistency It seems that almost every new parent checks in 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 liquid. Remember, they are not eating any solid food - liquid in/liquid out!  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 can cause the poops to be a little firm.   Frequency Once the baby is gaining weight and having a regular pooping pattern, it is no longer necessary to closely monitor the frequency. 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. A baby with actual diarrhea does need to be monitored because they could be at risk for dehydration.   Some probiotics, such as Evivo, will cause the stools to be dramatically less frequent, but many babies naturally make this switch on their own. You can bet the parents reach out when they are used to poopy diapers several times a day and suddenly there is nothing but pee for almost a week. As long as the stools remain soft, less frequent poops are not a concern   They seem to be uncomfortable A pooping baby tends to be a happy baby. If you have one of those infrequent poopers it is hard to watch them struggle. It is quite normal for babies to grunt, groan and turn bright red as they work on a bowel movement. There is a term for this. It is called Infant dyschezia (you can promptly forget that term, you will likely never hear it again, and there won’t be a test).   There are some things you can try. 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. 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 if they are flat with their legs straight. You can also bicycle those legs. Push the thighs all the way up to touch the belly. If you are doing anything that is uncomfortable, trust me, they will let you know. Swirl their little hips around, like a little hula as you move the thighs up and if you do it correctly it will make them fart. (very satisfying)   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. When I would take a rectal temp, back when I was working in the pediatric office, more than half of the time the baby would poop right on the thermometer. The Windi is another gentle way to stimulate pooping and help relieve gas at the same time.   Epsom salts in the bath can sometimes stimulate poop My chiropractor, Sandra Roddy Adams, tells me that her gentle treatments often get the little ones to to have a bowel movement     When you can’t stand it any longer 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 none of the actions above have helped, my next step is using 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. This product works really well. The box says that these are for babies two and over, but I have found them safe and quite effective for younger folks. As soon as they poop you can assess the quality of the bowel movement. If it was soft and mushy, you probably could have let it ride for another day or so, but don’t stress. Occasional use is quite safe. Often just going out and buying glycerin will make your kid poop. In any event, it is a useful product to have on hand.  If the stool is hard and firm, then it is good that you helped it pass. At that point it is worth checking in with your pediatrician to see if there are any adjustments you need to make.   Dr. Ted’s Science Tidbit: It’s not typical that children will become long-term dependent on help for pooping from agents like glycerin suppositories. All of our bowel movements, young and old, depend a little bit on mucous produced by the lining of the intestines. This mucous is the lubrication through which our poop is able to slide out of our anus. Shortly after a suppository is used, the mucous can be wiped away, and the next poop can be temporarily slowed. But after some time, mucous is produced again and the next poop is passed.