All About Poop
The Scoop on Poop
When I was pregnant, my husband and I swore to each other that we would not be the kind of parents who talked about poop. Like so many good intentions, that one, pardon the pun, quickly went down the toilet. Three years and two children later, I can honestly say we talk more about our daughters' BMs than about movies, books, or politics.
To my relief, we're not weirdly obsessive, say the experts. After all, most of us grew up with the notion, presumably from our mothers, that a regular poop schedule is a sign of a healthy body that's receiving the proper fuel. Turns out, Mom was right. "For breastfeeding moms who can't measure what their baby is eating, poop is one of the only clues. What goes in is what comes out," says Ari Brown, MD, a pediatrician and coauthor of Baby 411: Clear Answers & Smart Advice for Your Baby's First Year (Windsor Peak).
But there's an even better reason for being obsessed with baby poop: If you're a newborn novice, the colors and textures, not to mention the frequency, can really throw you for a loop (who knew poop could be bright orange?). You're going to spend many a waking hour looking at it and cleaning it up, so you might as well get the facts on what's normal and what isn't.
Dissecting Diaper Contents
The surprises start with your baby's first diaper change. When you peel off that cute little newborn-size diaper, you will be confronted with something that looks like sticky, greenish-black tar. This is your baby's first bowel movement, which is known as meconium, a mixture of amniotic fluid, bile, and secretions from the intestinal glands.
It will pass in the first 24 hours, and a few days later, the real stuff will arrive. "Don't expect infant poop to look anything like yours," Dr. Brown warns. "If you breastfeed, it will probably look seedy and mustard-like, and if you bottlefeed, expect something more greenish with the consistency of toothpaste," she explains.
Any variation on the colors yellow, green, or brown is normal. "The only colors that warrant a call to the doctor are red and black, which could indicate gastrointestinal bleeding, and white, which could represent liver disease and/or nutrient malabsorption," says Nanci Pittman, MD, a pediatric gastroenterologist and assistant professor of pediatrics at Mount Sinai School of Medicine in New York City. And since your infant is on an all-liquid diet, soft, squishy poops will be the norm for a while.
For most new parents, BM frequency is another fixation. I remember trying to calm down a friend who was alarmed that her baby hadn't made a diaper deposit in four days. Meanwhile, my own daughter seemed to go every hour on the hour for the first few months. Both extremes are perfectly fine. "For a breastfed baby, it can be normal to have only one bowel movement a week," says Dr. Pittman. "It can also be normal to have as many as one bowel movement with each feeding."
Bottlefed babies tend to average between one and four a day. Doctors point out that the most important thing to watch for is the consistency of the stool, not necessarily the frequency. If your baby seems uncomfortable and is filling her diaper with something that is thicker than toothpaste or that looks like logs or marbles, then she's probably constipated.
This problem occurs for several reasons. In babies under 4 months of age, it's usually because your child isn't getting enough fluids, so remedy the situation by encouraging her to drink more breast milk or formula. Some doctors recommend giving baby a little sugar water, as sugary substances can help to soften up stool.
In toddlers, the constipation culprit may be a fluctuating interest in food. Your doctor may recommend giving her a few teaspoons of prune juice or water. If she is straining with no results, Dr. Brown recommends inserting a rectal thermometer for a minute, which will stimulate the bowel to get moving. Pediatricians may also recommend a suppository to move things along.
On the other end of the scale, if baby's poop becomes thin, watery, or streaked with mucus and she's pooping a lot more often than usual, she probably has diarrhea. This can be caused by antibiotics; too much fruit juice; milk allergies (which are pretty rare); or gastroenteritis, a viral illness that results in vomiting and diarrhea.
If your baby has loose stools, "it's important to keep him hydrated with breast milk, formula, or pediatric electrolyte solutions," Dr. Pittman explains. But if you notice any signs of dehydration, such as dry lips, sunken eyes, or sunken fontanels (the soft spots on baby's head), call your doctor immediately.
Once your baby starts eating solid food (usually between 4 and 6 months), her poop and her poop schedule will start to change. She'll go less frequently, and the stools themselves will become thicker in consistency.
Because baby's first food is usually rice cereal fortified with iron, you may notice some constipation: Rice and iron are notorious for backing things up, so to speak. If that's the case, you can switch to iron-fortified baby oatmeal or limit rice cereal intake to once a day and mix in some pureed prunes.
But consistency and frequency aren't the only diaper surprises. Dorre Kleinman, of Brooklyn, New York, opened her 8-month-old's diaper one morning and had quite a shock. "Sasha's poop was striped in orange, green, and blue, almost like a scarf," she says.
"I would have panicked, but then I remembered she had eaten sweet potatoes, peas, and quite a few mushed-up blueberries for dinner the night before." When babies start solids, Technicolor poop is very common and nothing to fret over; if your baby has a penchant for Blue's Clues yogurt, expect even stranger hues ahead.
An even bigger shock is when the corn you fed baby for dinner arrives several hours later -- whole and intact -- in her diaper. "Certain foods will pass through undigested. This is normal, as babies don't chew their food well and tend to process food quickly through the digestive tract," Dr. Pittman explains.
By your baby's first birthday, when he is eating a wider range of solid foods, poop starts to change its style again. You might notice that the smell, color, and texture of the stool varies throughout the day, depending on what the child has eaten, says Dr. Brown. In general, it will start getting browner and thicker and will look more like grown-up poop.
A word of warning: Now that your toddler isn't pooping as often as when he was a newborn, you are probably changing diapers less frequently. That's great for your sanity, but not so great for your kid's tush. Prolonged exposure to a wet diaper filled with bacteria-ridden poop can cause diaper rash. "It's a good idea to change diapers after meals and before naptime or bedtime to prevent the diaper area from being chronically moist," says Dr. Brown.
Bathroom or Battlefield?
Hold on -- toddlerhood is packed with a few more poop surprises, some of them positive. As children become more aware of their body, they will become more attuned to the fact that they have to go.
A kid who used to dump in his diaper in the middle of playing blocks without missing a beat may start hiding in the corner when he needs to go; another may let you know she's pooped and ask for a quick change. This desire for privacy and a fresh diaper are the first signs that he or she is ready for potty training, so the two of you might want to head for the store and pick out a potty together.
But when it comes to potty training, your child may approach poop differently than pee. Many children master controlling number one faster than number two. You can help your child tackle this part of pottying by looking for BM cues, such as grunting or becoming red-faced, and leading her to the potty so she can do her business there. Eventually, she'll get the idea.
Another big change is when pooping goes from a bodily function to an emotional battlefield. When my older daughter, Bellamy, was 2 1/2, we noticed that she would go days without pooping and then walk around grimacing in pain.
A pediatric gastrointestinal specialist explained that it is very common for toddlers to withhold their poop. "It can be part of a battle for control," says Deirdre Donaldson, PhD, director of pediatric psychiatric services at the May Institute in Norwood, Massachusetts. "Some kids pick their battles with eating, and some with toileting," Donaldson says.
The problem is, once your child holds it in for a while, he sets off a snowball effect. "The colon absorbs water from the stool, so the longer your child refrains from going, the bigger and harder the stool becomes," Dr. Pittman explains. Then your child may be afraid to go for fear it will be painful.
Put a stop to this cycle by adding fiber to your child's diet. "A regular bathroom schedule also helps," Donaldson says. "Have your child sit on the potty at the same time every day. Eventually, she'll understand what's supposed to happen next. And thanks to some good advice and lots of fiber, the poop wars are finally coming to an end in my family. There's just one downside: What on earth will my husband and I talk about now?
Marisa Cohen, a mother of two, is a writer in New York City.
Originally published in American Baby magazine, January 2005.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.