One of the most common concerns I address from parents is regarding bowel movements. From the newborn period through early childhood and on, they are constantly changing in content, texture, and frequency. Parents often don’t know what’s normal and what is concerning. Here is a basic guide to help you troubleshoot whether or not your child’s stool is normal or if there’s something you should address with your child’s doctor.
The first type of stool that you see after the baby is born is called meconium. It is a black, tarry substance and only lasts for a few days as the baby starts to eat. The stool then transition from black to dark green to light green to a seedy, yellow substance that looks suspiciously like deli mustard (sorry, we pediatricians love to compare gross things to food!). This will continue for quite awhile, until the introduction of solid foods between 4 and 6 months.
The frequency of newborn stooling is quite variable and will change for no apparent reason. Anywhere from 8-10 stools per day to once every 5-7 days is considered normal. As long as the frequent stoolers are not having watery stool and the infrequent stoolers are not having hard, formed stools, it’s normal. If you think you are in one of the abnormal categories, please speak with your primary care physician (PCP). Your baby might start as a 10 time a day pooper and then change to once a day. This is not concerning, enjoy changing fewer diapers!
Parents often are concerned about their baby’s comfort if they have not stooled in a few days. Backed up stool can make a baby quite gassy. Rest assured that if the stool comes out in a squishy explosion even after not stooling for 5-7 days, it is not concerning. Having said that, if your baby is miserable and refusing to eat, it is fine to use 1/2 of a pediatric glycerin suppository to relieve the discomfort. If you find you have done this more than once, please mention this to your PCP.
There should never been red or black in the stool, those are signs of blood. Stool should never look completely white. These colors warrant a call to your PCP. As the intestinal environment matures in your child, you may notice days of green or brown in addition to yellow. I would consider all of these colors normal and unconcerning.
Parents often tell me that they think their newborn is in pain during stooling. Most likely, this is not true “pain.” Babies certainly do not like to stool or pass gas. My favorite analogy is this: try to picture defecating on your back without any abdominal tone. Doesn’t sound pleasant, right? Babies also tend to be extra gassy in the first few months of life as their intestinal environment matures. Please know that while gas pain is unpleasant, it is not dangerous or damaging and babies grow out of this issue generally after the first few months. It is fine to try gas drops like simethicone or gripe water, but keep in mind that while safe, these are not miracle medications. There are infant probiotics available as well, and there is some soft evidence that this may help. You can try abdominal massage or bicycle kicks to help things pass. Probably the most important thing you can do is shower your baby with smiles and love.
As you start to introduce solid foods, your minimally smelly yellow seedy stools will slowly become the stinky poop that we all know. Keep in mind, what goes in is what comes out. If your baby is chowing down on peas and carrots, will you likely see all of those peas and carrots in the stool. Don’t worry that it looks undigested, this is normal. Your child’s stool will probably look different on a daily basis.
Certain foods are more constipating than others. Very common foods, like apples, bananas, and carrots are all constipating. If your child’s stools are starting to appear more formed, it might be time for some additional water in a sippy cup.
As you advance your child’s diet, you will see the frequency of stooling change. If stools are getting firmer, in additional to extra water, you might try what I call the “poop fruits”: prune, peach, pear. They all help with stool loosening. It will take some trial and error, but with a little experimentation, you will find a good mix of foods to help keep your child regular.
Bowel movements should generally be smooth and soft, formed but not too bulky. They should come out easily, without pain or too much effort. They are generally daily, but some people go multiple times per day and others every 2-3 days with the above description of their stool.
Stool in older children is generally brown, but the “what goes in comes out” rule still applies. If your child is sick and only eating crackers, the stool may look lighter or more green. Strong colors like food coloring and beets will come out the same. Yes, you may see that blue cupcake icing again in the toilet! Some foods, like tomato and corn, may still come out looking whole and undigested.
Constipation is one of the most common reasons for abdominal pain in childhood. As soon as your child is out of diapers and going to the bathroom independently, it becomes more difficult to track the frequency of stooling.
Constipated poop looks like little balls or very bulky and rocky. Even if your child poops daily, if the stool looks like this and there is an associated abdominal discomfort, your child is most likely constipated. Adjusting the mix of “poop fruit” (see above), fiber, and fluids is the right first step. This is the one circumstance in which pediatricians will recommend juice. Prune juice or apple juice can be helpful. We live in a dry environment, making sure your child is drinking enough water may be all it takes.
If you have tried these dietary interventions and they are not helping or they have helped soften the stool, but abdominal pains continue, this would be a good reason to see your PCP. For all significant abdominal pain complaints, don’t wait, just see your PCP.
I hope that this small primer on what to expect with pooping has helped you to feel more confident in managing this part of your child’s health and well being.
— By Lauren Brave, MD
Boulder Medical Center