I have often asked
parents not to bring poop samples into my office. While there
is a lot of information to be gleaned from studying full diapers,
I think I can do most stool analysis on the phone or online unless
an emergency situation occurs.
There is a wide
variety of color and consistency of bowel movements. In
my glamorous job as a pediatrician, I discuss this hot topic every
day.
A change of pattern
can throw the most confident mom for a loop and can even confuse
an experienced pediatrician. Babies have blood in their
stool fairly often and it virtually never is the sign of serious
illness, but I pay a lot of attention to this because it alarms
parents and requires that a reason be found.
We shouldn't be
any more surprised to see a variety of bowel movements in our
babies than we would in anyone of any other age. In breastfed
babies, the mom's diet can affect the color or consistency of
a baby's stools, particularly if the baby is showing an allergic
reaction to a certain food or food group.
Sticky, tar-like
and green or black
This is meconium. The first stools of a newborn will
be this consistency and color. It is what is present inside the
bowels of a newborn upon birth and will clear itself out within
the first couple of days and represents the "byproducts"
of building an entire human being for nine months.
Greenish
or Yellow/Brown, grainy or seedy
This is the transition between meconium and a regular breastfed
stool and begins as mom's milk is coming in on the second, third
or fourth day of life. There may be three stools each day,
ten, or even twenty. Occasionally, even a baby in the first
week of life will skip a day and have no bowel movements at all.
Call your doctor to discuss this even though it is normal.
This does not require a dietary change or supplementation of a
breastfed baby.
Light yellow
to bright green, loose/runny, curdy, lumpy, seedy, creamy, mustard-like
These are normal breastfed stools. The consistency,
frequency and color vary from day to day. My wife described
the smell as "curried yogurt". Opinions on this
odor description differ widely.
Frequent
Watery Stool often "Greener" than usual
How can you spot diarrhea in a baby who has loose frequent
stools every day? This type of poop is "diarrhea"
in a breastfed baby. It can be due to a virus, a bowel infection,
stress, anxiety or a food intolerance.
Hard, pellet
- like, presence of blood or mucous
This is constipation in a breastfed baby and is so very rare
that I cannot recall ever seeing it in a baby who is receiving
breastmilk as a sole source of nutrition, as are most babies in
the first six months. It could be related to a food allergy.
Formula fed babies get constipated much more often and may even
have harder bigger stools like older kids and adults. Getting
these stools softer is a balancing act of great proportions.
Black stools
often accompanied by constipation
This is the result of iron supplementation. Iron fortified
infant foods and infant vitamins can cause constipation. A healthy
breastfed baby does not need iron supplementation. The iron in
breastmilk is much more bioavailable than any other form.
Red streaked
stools
This usually comes from bleeding in the lower intestine or
rectum. Most often it is caused by rectal fissures which
are tiny "cuts" around the circumference of the anus.
This can be a reaction to dairy in mom's diet. Elimination
of all dairy is the first line of defense in this situation.
I have seen countless babies who had blood in their poop which
resolved when mom stopped all dairy products and returned with
even a small amount of milk or cheese. Other dietary changes
may be needed for breastfeeding moms. Formula fed babies
lose blood from the lower intestine when they drink cow milk formula
and some have the same losses on soy formula. Occasionally,
this "micro-hemorrhaging" can become visible as blood
streaking on the surface of the stool. Persistent or increasing
blood in the stool or blood mixed with mucus (described as "currant
jelly" stool in the texts) requires an immediate call to
your doctor.
Green, frothy
stools
This can be a result of a hindmilk/foremilk imbalance. A true
imbalance is rare. It is often seen accompanying a forceful letdown.
Lactation consultants will help moms find a nursing pattern which
works to combat this problem. If letdown it too forceful
in the early weeks, the solution can be to allow milk to leak
into a cloth diaper during letdown, then latch baby back on.
Feeding two to three times off the same side may also show improvement.
Caution should be used with same side feeding as it can decrease
supply.
Green, mucousy
stool
This can be a result of a virus. Often the only sign we see
of a virus is in the green stool. This is evidence of malabsorption
in the intestines. Watch for how many days and with what consistency
it is occurring. With a virus, it will run its course over a few
days and begin to improve.
Another cause of
malabsorption in the intestines can be teething. The profuse saliva
of a teething baby can cause irritation in the intestines interfering
with proper absorption. When babies teethe, we can see lots
of drooling. Large quantities of saliva is swallowed which
can irritate the intestines causing runny, acidic stools. This
can also cause a rash in the diaper area.
There is something
important to point out regarding frequency of stooling in an exclusively
breastfed baby. Many parents are concerned when after the
early weeks where they may have been seeing a little bowel movement
in almost every diaper, they suddenly begin to see days go by
without any. This is perfectly normal. There is a
great range of frequency of bowel movements with exclusively breastfed
infants, ranging from a couple of times a day to several days.
There are completely healthy nursing babies that have a bowel
movement once a week, once every ten days, or even a few that
go a bit longer. If your baby is healthy, developing well, nursing
well and the consistency of the bowel movement when it does make
its appearance is soft or loose, then do not be concerned.
It is not constipation if it arrives in soft form. Constipation
would arrive in pellets and hard formed pieces.
In summary, stools
in breastfeeding babies are predictably green, brown, yellow or
orange. It is runny and has curds almost every time.
It changes color with viruses, may have a small amount of blood
(call your doc) and may come once a day and even taper off to
once a week or more after a few weeks of age. Formula feeding
babies may show a little trickier set of changes involving constipation
and diarrhea. This is just one small reason to strongly
recommend and support breastfeeding your baby.
04/2004 |