The Scoop on Poop...

With a rush of new babies being born both in my medical practice and in my personal circle, the questions about poop begin.  Along with sleep, it seems to be the most talked about subject by parents of newborn babies.  In fact, even with parents of young kids, poop seems to be a very popular subject. 

There may be too much of it.  It may be loose.  It is always smelly.  It can be green, yellow, black or brown.  It may be like a ball or a gooey mustard seed-like mess.  Sometimes it doesn’t come, for days.

But whatever its consistency, it seems to cause much distress. 

So, don't STRESS...

Let’s start with the beginning….

When babies are born the first type of poop that is passed is called MECONIUM.  Meconium is the black tar like poop; it is made up of all sorts of different debris like dead skin cells, hair and amniotic fluid that was swallowed by the baby in utero.  Some babies can pass meconium in the amniotic fluid prior to being born (usually babies that come late); which can cause some problems in the newborn period.  But most babies do not do this and will pass the 1^st meconium stool within the first 24 hours of life.  This is the ONLY type of black stool which is NORMAL, other black stool later can signify digested blood (or can be seen in patients taking iron supplements).

BREAST FED BABIES:

After the initial passage of meconium, breast fed baby's poop changes to a soft, runny mustard seed like consistency that some parents confuse with diarrhea (because it is so loose).  Most breast fed babies poop with each feed for the first couple (2-4) weeks of life.  Stool frequency tends to drop off quite quickly after the first 2 weeks of life in breast fed babies and then can BE AS INFREQUENTLY AS ONCE EVERY 2 WEEKS.   This is the cause of much stress and distress by parents because their baby went from a “frequent stooler” to an "infrequent stooler" and the question of constipation and colic arises (see below).  It is very uncommon for a breast fed infant to be constipated, so do not stress if they are not pooping every day.

FORMULA FED BABIES:

Formula fed babies can have a variety of different stools, but they are usually tan colored and soft, and should be no thicker than a peanut butter type consistency.  Stool in formula fed babies can vary, but in general, most babies after the first month will poop 1-2 times per day.  The key here is: IF YOU CHANGE WHAT IS GOING IN, YOU WILL CHANGE WHAT IS COMING OUT.  So, if you switch from breast to formula or change formulas, the consistency of the poop will change too, and that is NORMAL.  Formula fed infants are more likely than breast fed infants to become constipated, so be on the lookout for hard stools. 

SOLID FOOD POOP:
When your child begins solids, their poop will again change.  By this time, stools should be fairly consistent, but again, will vary between children.  Poop will change fairly frequently depending on what is fed.  Click here for a picture of solid food poop (in case you are faint of heart).  Sometimes you may see pieces of digested food in poop that can even look like blood.  Also, beware of blueberries; kids can eat a ton of these and get a dark purple or black colored poop that looks kind of scary!

Is it Constipation?  Is it Colic?

Once there is a decrease in the frequency of infant stools parents naturally wonder if their child is constipated.  The answer is usually NO.  Constipation is NOT defined by how frequently you poop, but rather what the stool looks like when it comes.  If it is soft and mushy, this is NORMAL.  Even if it is once a week.  Do not sweat it.  You don't need suppositories, prune juice or the rectal thermometer; all you need is patience.  Your child is only considered constipated if the stool coming out looks like dried out balls of poop (which is UNCOMMON in newborns).

Now on colic or fussiness and its relation to poop:

            

Unfortunately, the frequency of a baby’s poop slows down at the same time where babies are “waking up” and becoming more alert.  Parents often make the association between less frequent stools and fussiness, but the relationship is likely NOT causative, it just happens at the same time. 

On drawing the legs up and crying:

I frequently hear from parents that their baby appears uncomfortable, cries, grunts and draws up their legs when they poop.  This is actually NORMAL and PHYSIOLOGIC.  When adults go to the bathroom, they sit on the toilet with their legs bent at 90 degrees and bear down to have a bowel movement.  Well, we all know that babies don't (consciously) know how to do this.  So, what they do is draw up their legs (like sitting on the toilet), which lowers the rectum; and cry or grunt, which increases the intra-abdominal pressure (like bearing down).  This is the only way they know how to pass stool.  So, it is not that they are uncomfortable, it is that the crying actually gets the poop out.  In fact, if you feel like your baby is having a hard time having a bowel movement, you can help them by rubbing their tummy and drawing up their legs for them. 

Now that we know about NORMAL poop...stay tuned for an upcoming posting on ABNORMAL poop....