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The Scoop on Poop

It's easy to obsess over your baby's bowel movements. With more than 2,000 diaper changes during the first year alone, you've got plenty of opportunities to study the color, texture, odor, and frequency of your child's stools. His poop profile depends a lot on age and diet, and getting to know what's normal for your baby is key to spotting problems such as diarrhea or an allergy.

Your newborn's first few dirty diapers will contain sticky, tar-like, green-black stool called meconium. Once this passes out of his system, his BMs will take on the telltale features of breast-milk- or formula-derived poop.

Breastfed Infants
If you're nursing, your baby will likely have seedy, runny, mustard-yellow stools that don't have much of an odor. In the first weeks, she'll have at least four bowel movements a day; breastfed newborns commonly poop after every feeding-up to a dozen times a day.

Formula-fed Infants
Babies on formula tend to poop less often -- about three or four times a day. Their stools are usually greenish or dark yellow, more solid, and smellier.

Regardless of whether he's on breast milk, formula, or both, your child's bowel movements will become less frequent as he gets older. By 4 months, most infants average about two poops a day, says Houston pediatric gastroenterologist Bryan Vartabedian, M.D., author of First Foods (St. Martin's, 2001). "But the frequency is less important than the consistency and effort it takes your child to pass his stools," he notes. "It's fine if your baby goes just once every three days as long as his stool remains soft, he's gaining weight, and he has no abdominal pain or bloating."

Babies on Solid Foods
Diaper changes get more unpleasant at 4 to 6 months, when your baby starts solid foods. The sugars in fruit and vegetables change the amount and types of bacteria in your child's colon. This usually doesn't affect the frequency of bowel movements, but stools may become browner, firmer, and downright stinky. They can sometimes take on the colors of your baby's last meal, so don't be surprised if you open her diaper and find bright-orange poop (the likely remains of the strained carrots she consumed). Once your child starts eating chunkier foods, it's normal to see undigested bits -- peas or pasta, for instance -- in her stools.

If your baby's stools become loose, watery, and more frequent than usual, a stomach virus is the probable culprit, Dr. Vartabedian says. A rotavirus infection, particularly common during winter months, is the most common cause of severe diarrhea (lasting about 10 to 12 days) in kids under 2 and is easily spread via dirty hands or toys. A milk or food allergy, changes in a nursing mom's diet, excessive juice intake (particularly apple or pear), and certain antibiotics can also trigger diarrhea.

What To Do:

Call your doctor if your baby has watery stools for more than three days (immediately if he's young-er than 3 months), if diarrhea is accompanied by vomiting, or if you see blood in his stool. Replace lost fluids with an oral electrolyte solution, giving your baby a little at a time. Your doctor may also suggest half-strength formula and other easy-to-digest foods (bananas, applesauce, or rice) for a few days.

When to Worry

Mild cases disappear in two to five days. But if your baby is also having trouble keeping fluids down, he could be at risk for dehydration. Call your doctor if your child shows signs of being parched: a sunken soft spot on his skull, few tears, a dry mouth, infrequent urination, lethargy, and a refusal to eat.

It's common for babies to get constipated every now and then, though it's rarer among breastfed infants. Consumption of soy formula, changes in diet (such as the introduction of infant cereals), and excessive milk intake can lead to hard, infrequent, difficult-to-pass stools.

What To Do:

If your infant hasn't pooped in two to three days, her stools are hard and dry, and you notice her straining excessively to pass a bowel movement, offer her extra water between feedings. If your child is older than 6 months, you can offer prune or apple juice (dilute 2 ounces with water -- the sugars it contains help retain fluid inside the intestines and soften her stools. Don't use laxatives, stool softeners, or other medications without your doctor's okay.

When To Worry:

Call your pediatrician if your baby's bowel movements draw blood or if she has a forceful or explosive stool.

Most of the time, you won't bat an eyelash (or hold your nose) at your baby's diaper contents. But see your doctor if your child develops any of these red flags.

Problem: Blood in the stool

Poop Protocol:
Your pediatrician may suggest a change in your baby's diet to soften the stool or advise switching to a hypoallergenic infant formula.

What It Could Be:
Most likely anal fissures, or cuts, from passing a hard stool. Could also indicate a milk allergy or a bacterial infection in the intestines.

Problem: Light-colored, almost-white stools

What It Could Be:
No bile flow; possible liver disfunction.

Poop Protocol:
This needs immediate evaluation by your doctor, who may perform blood tests, an ultrasound, and other liver tests.

Problem: Mucus in the stool

What It Could Be:
A milk allergy or an intestinal infection (though in some babies, mucus is normal).

Poop Protocol:
Your baby may need a formula change; some doctors will order a stool culture to check for bacteria.

Problem: Recurring hard, pellet-like stools

What It Could Be:
Constipation; inadequate fluid intake.

Poop Protocol:
Your pediatrician may suggest switching infant formulas or recommend a medication to help soften the stools.

Problem: Excessively watery stools

What It Could Be:
Infectious diarrhea; formula intolerance.

Poop Protocol:
Your doctor may perform stool tests for viruses or bacteria and recommend changes in your baby's diet.

Problem: Explosive stools

What It Could Be:
Excess gas from formula intolerance or swallowed air (while crying or feeding, for instance); narrowing or blockage of the anus.

Poop Protocol: Your doctor may refer you to a pediatric surgeon if he's concerned that your infant might have a bowel obstruction.

Problem: Grease or oil in the stool

What It Could Be:
Poor absorption or excessive intake of fat.

Poop Protocol:
This requires a thorough exam; your pediatrician may perform a stool analysis for fat, as well as screenings for cystic fibrosis.

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