Poop and Solid foods

 

Poop and Solid Foods

Infant poop is a fairly benign substance in the first couple months. Once your baby's food intake moves beyond simply milk, that is about to change. The ‘yuck factor’ when the poop gets on your hands, the walls...etc, moves into a new realm. I remember an email that I got one Sunday morning. The subject line was “undigested carrots, is this normal?” I should have known better than to open it when I was sitting down to eat breakfast. What was I thinking? The answer to the question was yes. It is normal to have little pieces of food show up in the poop, but there needed to be a much stronger warning for the attached photo. I will spare you a more detailed description. As your child's system adapts to digesting substances other than milk, the consistency of the stool will change. When I do my solid foods class, I tell the parents, "You are the Conductor of the Poop Orchestra." This simply means that you are in charge of how much milk, how much solid food, and how much extra fluid goes into your baby.  Your job is to pay attention to the outcome and make adjustments as needed. You don't want watery stools (I am talking about almost clear fluid with flecks) and you certainly don't want formed little pellets. The goal is for the stools to remain soft. At the risk of ruining your appetite or changing your dinner plans, (if I haven’t done so already), think hummus, soft cookie dough, or play-dough. Until your baby starts solids, it is unlikely that they need extra water in their diet (unless you are in a very hot climate). This changes once they start eating food. Now that they are eating, it is time to get in the habit of routinely offering water throughout the day. While it is perfectly fine to put water in a bottle, this is a great time for them to learn how to get some sips out of a cup.  I don’t generally have an exact amount. Even an ounce a couple of times a day is fine. If the urine is light colored and the poops are fine, then you are on the right track. If the stool is getting thicker, the first step is to bump up the amounts of fluid throughout the day beyond what you are already giving. You can offer plain water or very diluted juice. Prune juice is probably the best if they will take it, but otherwise, most any natural juice will do. Coconut water is another good option. The food choices are also important. Most foods are fairly neutral but some will help keep the stools soft. The majority of fruits and veggies fall into this category. Prunes, pears, and peas are some of my favorites. A little molasses can also get things moving. Foods that are higher in fiber are beneficial.  Good sources of fiber are: legumes, such as lentils, black beans, kidney beans, soybeans, and chickpeas fruits, such as berries, apples with the skin on, oranges, cut up grapes and pears vegetables, such as carrots, broccoli, green peas, and collard greens Nuts and seeds, such as chia seeds, almonds, peanuts, and pecans. You can always sprinkle chia or flax into an existing dish to up the fiber. Oatmeal and bran flake cereals are good. Other whole grain products can have some fiber, but you need to read the labels. Marketers have hijacked the term “whole grain” to sell you anything that they sprinkle a little fiber into, while the majority of the food item might still be constipating. Common culprits include whole wheat bread and pasta.  MyPlate.gov is a great resource for meal planning, and AI programs like https://www.parentgpt.io/ are excellent for designing a high-fiber meal plan for a weekly basis. Pay attention and see what is working for your particular child. Some foods tend to make the poops firmer. Most of you have probably heard of the BRAT diet. This is a diet with bland starchy foods such as bananas, rice, or applesauce and toast. This is a standard suggestion for kids and adults if they have diarrhea because these foods tend to be binding. Some of these are also among the first foods that many people offer when their kids are just starting solids, Bananas, rice cereal and applesauce are okay to be on the list for your beginning eater, but if the stool is getting thick, there are better choices for first foods. Beware, I have also found that some organic and/or toddler formulas can be a bit constipating With the addition of new foods, the poops can be quite fascinating.  When I get the frantic “there are little brown worms in my baby's poop” question, the first thing I ask is whether or not they had bananas recently. Dr. Ted gets this question about once a week. It turns out that bananas can cause little brown thread-like substances to be in there; imagine a piece of banana cake.  Different colored foods can give you a rainbow of different poop shades.  My daughter Alana once unbeknownst to me ate a pint of blueberries and had a bright blue load in her diaper that caught me by surprise to say the least. Anything with red color can stain it red. Beets are the obvious culprits, but watermelon can lead to an interesting shade and consistency. Some babies start the solid food journey with pureed food. As soon as they are able, I like to do a combination of feeding styles and introduce some “Baby led weaning”. With this method, babies can simply pick up soft pieces of food and feed themselves. Once they start eating little pieces be prepared to see some of those same pieces pass through without being digested (like the undigested carrots in the gross photo). This is normal. So when do you need to worry if they skip a day of pooping? If they seem happy, I am not terribly concerned, but if they are new to eating solids, I don’t want to let it go too long. Many nurse advise protocols will suggest intervening at 72 hours of no poops. There are some things you can try before 72 hours: 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. If your kid is old enough, get them up dancing and moving around.  If they are too young to be really mobile, you can 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 Vaseline or some kind of lubricant 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. (There are many brands now that all do the same thing.) A little warm pack on the lower belly can help relax the muscles 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 Dr. Den, my favorite local acupuncturist can do a lot for this (without needles), but if you are not in San Francisco, look about for someone who works with kids. If you little one is over two, consider Magnesium.      If it’s been 72 hours, or when you can’t stand it any longer: There is no intervention needed for infrequent stools as long as you have a happy baby, up to a certain point. It’s almost always a bit of an ordeal to pass a 3-day-old poop, so this is often the time to at least start thinking about options. If it has been many days in between poops and your baby seems quite uncomfortable and none of the actions above have helped (what’s going in the mouth has been optimized for fruit and fiber), 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 (some lube helps it slide right in). 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 either glycerin product will make your kid poop. (I am not kidding!) In any event, it is a useful to have this on hand.  If the stool is hard and firm, then it is good that you helped it pass. If you find that you need to use glycerin more than three times in a row, it is worth checking in with your pediatrician to see if there are any long-term adjustments you need to make. One of the most common interventions is something called Miralax. This is the brand name for polyethylene glycol, a substance that passes through the intestines completely unabsorbed, making it fairly safe to use long-term. It is widely used by gastroenterologists for chronic constipation. If needed for chronic use, Dr. Ted uses 1 teaspoon per year of life on a daily basis (starting at 1 teaspoon per day for infants), and goes up from there as tolerated. What about Probiotics? There is no good data on using probiotics for constipation. In fact, in Dr. Ted’s anecdotal experience, probiotics are more often constipating than they are loosening. ----------------------------------------------- P.S. As a gentle reminder here are the “red flag/when to get checked out” signs for poop: Black /tarry poop (not just “very dark,” it has to be fully black) Copious bright red blood Fully ghost white poop Watery diarrhea associated with a fever and pain. Generally if there is a real issue, your little one will have other symptoms along with the funky poops. Small flecks of blood can happen here and there, especially with large hard poops, so if that happens once in a while, it is just a signal to follow some of the advice in this post to work on getting softer poops. If you’re seeing a lot of it, let your pediatrician know. Constipated kids are really miserable. Please be proactive with diet, fluids and fiber, and try not to let it happen on your watch.