It's a dirty job, but someone's gotta tell you all about what's in your child's diapers.
As a mother of two young boys and a pediatrician who gets pooped on in the office, I've seen and smelled it all. Diapers and their contents are a part of my everyday dialogue. Nearly all new parents ask me about their infant's bowel movements. "Is this diarrhea?" I've been asked, as a full diaper is pushed toward me. I regularly explain the normal variations of color, consistency, and content.
There have been moments where I sincerely worried about my own kids' poop. But it's a rare baby who doesn't have "normal" BMs. In order to know what normal is, though, it'll help you to have specifics. (Warning: Do not read if you're eating -- or maybe even if you're about to eat.)
Stool is made up of broken-down food, bacteria, cells that shed from the intestines, and bile. Bile is a waste product that is excreted from your liver; it dumps into your intestines and accounts for the majority of poop's color. At birth, babies' intestines are sterile, but in a matter of weeks their intestines (and poop) are full of a huge variety of healthy, diverse bacteria. Exclusively breastfed infants ingest different proteins every day, depending on what Mom eats, which causes color variations. And while formula-fed infants will get the same food daily, their variations in bacteria can also alter the color of BMs. So poop on Monday may look really different from poop on Tuesday.
Baby and toddler poop can be as thick as peanut butter or mushier, like cottage cheese or yogurt. Breast-milk poop usually looks like fancy mustard: yellow, seedy, or curdy. Formula poop tends to resemble beat-up flan or pudding. If your child, regardless of her age, passes anything that looks like cat poop (loglike) or rabbit poop (a pebble), she's probably constipated. Rule of, um, thumb: If the poop can roll, it's too hard.
How often your baby or toddler poops isn't all that important, but it seems to be a big deal to new parents. After about 6 months of age, more than four BMs a day are too many, and less than one a week for a breastfed infant or less than one a day for children over age 2 is too few. That's because we want poop to move through gradually and steadily. If it moves too quickly, the body absorbs less food and nutrition. If it moves too slowly, it can cause constipation. Yet what the poop looks like matters more than how often you see it.
The scent is most often a reflection of how long the poop was in the intestines -- the longer it sits in bacteria, the more it'll smell. However, some babies with very sour- or foul-smelling poop may have an intolerance or allergy. In general, breastfed baby poop doesn't stink at all, while that from formula-fed infants is just lightly odorous. Those early poopy diapers really shouldn't clear the room. However, once you add baby food, and then various protein sources, it's another story. If you think your baby's BMs are exceptionally smelly, talk with your pediatrician.
When to Worry: Constipation
BMs: A Timeline
Poop will evolve dramatically as your baby ages and expands his diet.
In utero Bet you didn't know that stool was forming in your baby's intestines far before birth. It's full of meconium, a sterile, sticky, brownish-green substance made up of swallowed amniotic fluid, hair, bile, and body cells. Most babies wait until birth to pass meconium.
1 to 4 months When your baby is 3 or 4 days old, his stool changes from tarry meconium to a watery consistency. Babies usually make up to ten dirty diapers a day for the first one or two months and then go two to four times a day until around 4 months. This is thanks to the gastrocolic reflex, which occurs as the stomach stretches with food and the colon is automatically signaled to empty and make room for more. In babies, the gastrocolic reflex is immature, so each time they feed they usually squirt out a little poop. Over time, some babies' intestines absorb so much breast milk that they create extremely small amounts of waste and their colon doesn't empty more than once daily, or even once weekly in some cases. Formula-fed babies typically poop less frequently than breast-milk eaters because their stool moves through the intestines more slowly. They go about once or twice a day, every one or two days, after the first one or two months -- but some poop up to three or four times daily at first. Meanwhile, babies on both formula and breast milk go somewhere between multiple times a day and once a week.
5 to 12 months Once a baby starts eating pureed foods and cereals, between 4 and 6 months, her stool will change. A breastfed baby's poop often thickens with the addition of solids, whereas a formula-fed baby's usually softens. If your breastfed baby used to go only every five days or so, you'll see it becomes more of a daily event.
1 to 3 years As you transition from breast milk or formula to whole milk and a more solid diet, the stool will continue to change. For most babies, it gets thicker and harder. Between 12 and 18 months, you'll probably also notice what I call the "salad diaper," filled with larger pieces of veggies that are more difficult to digest. This can make your effort to offer a diverse range of foods feel like a huge waste of time! But it's not, insists Evelyn Hsu, M.D., a gastroenterologist at Children's Hospital of Seattle. "Your toddler's colon is just learning how to process whole veggies," Dr. Hsu explains. (Not to mention that kids aren't necessarily chewing well at this stage.) Over time you'll see the food get more digested.
Research shows that the perfect time to begin potty training is between 27 and 32 months of age. When we talk about potty training, though, we usually mean learning to pee. Pooping in the potty often comes later; most kids are able to do it by 3 or 4 years of age.
3 to 5 years By now, kids ideally poop once a day. And when they do, it should be soft and pain-free. However, constipation is common around this age. I often ask older children if their stool looks like a bowl of chunky soup, a snake, a log, or a bunch of pebbles. The answer I'm looking for: a long snake.
Kids who are constipated often have trouble toilet training because they'll avoid pooping if they're afraid it will hurt. To treat constipation, I suggest that 50 percent of a child's calories come from fresh fruit and veggies and that she should have no more than 2 or 3 cups of milk per day. Parents should also have their child try to sit on the potty after every meal. If those methods don't work, we prescribe stool softeners such as Miralax. Have patience and stay positive! With that, I wish you well in the diaper years. We all want an end to the potty patrol, but the exact timing is ultimately up to your child. Do your best to provide support for your child. And then know this: Although pooping on the potty may seem like the finish line, many of us can be found wiping bottoms for a few more years to come.
Poop Problems: When to Call the Doctor
- If it's white (a sign your baby isn't producing enough bile), black (which signals blood digested from the stomach or small intestine), or contains streaks of red (it could mean blood from the colon or rectum)
- If your child screams out in pain or bleeds while pooping
- If you see mucus, which can be a sign of an infection or intolerance
- If your child's stool changes dramatically after you introduce a new food; this may signal an allergy
- If your child's poop is still a very runny consistency by age 1 (if your child has diarrhea -- watery stools more than five times a day -- mention this to your doc too)
3 Things That Can Alter Your Child's BMs
If your child takes them, he may experience diarrhea, gassiness, stomach upset, or more frequent poops. So use antibiotics for your child only when you have to. Have your child eat yogurt with active cultures every day while on an antibiotic (it'll have a seal that says "Live & Active Cultures"). Or ask your pediatrician about giving your child probiotics daily while taking an antibiotic. Research shows that probiotics can shorten bouts of diarrhea in children who are taking antibiotics.
Children with a stomach virus often vomit for about 24 hours, but they may need up to two weeks for their stools to get back to normal. When a virus sets up camp in the intestines, it takes time for the good bacteria to re-populate and allow your child's stools to get back to the way they were.
Being on the road can make it tricky to stay hydrated, leading to harder BMs. When you're drinking water from new places, the normal bacteria living in the gut can change and may also lead to runnier stools. Try to eat culture-rich yogurt daily and use probiotics the week before you travel.
Originally published in the March 2012 issue of Parents magazine.
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