Of the many things a new baby does, there’s nothing that causes as much stomach distress as her bowel movements. Wait—we’re not talking about the baby’s distress here. It’s the parents who have that uneasy feeling in their stomachs over whether that poop is normal! The variety of stooling patterns, shapes and colors can be, in a word, unsettling.
Many a parent is moved to totally change a little one’s feeding regimen in the hope of producing “the perfect poop.” There’s at least one infant formula out there that’s marketed to those who wish to “normalize” stool production. Perhaps more concerningly, some parents may discontinue breastfeeding or iron-fortified formula with the sole purpose in mind of having a perceived positive effect on the bowels.
If you’re a poop-perturbed parent, let me reassure you. Most infant stooling patterns are normal. Of those that aren’t, most are minor variations that might just need minimal treatment. True infant bowel problems are quite rare; here’s the lowdown.
A First Time for Everything
Among the many things a newborn doctor will look for in a new arrival is a bowel movement within the first day or two. Characteristically, those first stools, known as meconium, are sticky and black. Over the first few days of life, they’ll transition to green or yellow and usually become pasty or seedy. However, what they look like at this stage usually isn’t as important as the fact that the baby is stooling at all; if there’s been no poop by the time the baby is otherwise ready to go home, the doctor will likely consider keeping the baby for tests rather than discharging him. (At this stage, some rare but serious diseases can show up. Newborns with cystic fibrosis often have trouble passing meconium from the beginning. Even rarer is Hirschsprung disease, where the colon doesn’t possess enough nerves for the bowels to effectively move.)
If the baby has passed meconium, but the stool isn’t transitioning, sometimes it’s a sign that the baby isn’t feeding well. Generally, the pediatric provider will look for other signs of poor feeding, such as poor growth and failure to urinate. In other words, where frequency is concerned, the pee is more important than the poop.
A Home Bowel Movement Primer
You may have already heard that breastfed babies tend to have small, yellow-to-mustard stools which can be seedy or pasty. You might also know that formula-fed infants characteristically have greenish-brown, more formed stools. However, there are many variations on the baby poop theme. What this means is that for the most part, if your baby’s stool doesn’t closely resemble that of her comrades of similar age and feeding, it’s probably OK.
What about frequency? Breastfed babies tend to stool more often than their formula-fed counterparts. Curiously, however, many babies taking breast milk regularly skip days. A perfectly happy, healthy baby can, at times, even go a week without a bowel movement! Where breastfeeding is concerned, that’s thought to be due to the fact that breast milk is more completely absorbed, leaving less to be eliminated. It’s worth noting, however, that even babies on formula can also normally skip a day, or even a couple, and be perfectly fine.
True constipation does happen in babies. Suggestions for assessing and treating it are listed here. Providers do differ in their approach to this problem, however, so it’s worth a call to yours if you think your little one might be constipated.
When to Be Concerned
Although as we’ve seen, the majority of stool patterns can be normal, there are a few that can be concerning:
- Blood in the stool. This Is almost always a reason to call your baby’s provider. Outside the immediate newborn period, this can mean infection, intolerance to formula, or a problem with the bowels’ structure. Sometimes, a small crack at the rectal opening can cause a few streaks of blood. While this is usually not a serious problem, it’s worth seeking medical attention to rule out other issues.
- Black stools. These aren’t universally a problem as sometimes iron in the formula (or, when the time comes, certain solids) can be the cause. However, your pediatrician may want to keep an eye on things; a black color can sometimes also signify bleeding.
- White stools. This raises our suspicion for a problem with the liver or nearby structures. Many of these babies will have other problems, such as vomiting, jaundice, or poor growth, but it’s worth bringing this issue up.
- Other symptoms. Bowel movement changes might be more of a problem if the baby seems otherwise sick. For example, vomiting in combination with failure to have a bowel movement may mean the bowel is obstructed. A distended (“big”) belly is another sign of trouble.
No parent should have to suffer discomfort over a baby’s bowel movements. If there’s something about the poop that seems concerning, by all means, run it by her provider. Potentially serious issues, which are uncommon, can be addressed. Most of the time, reassurance is all that’s needed—and that will allow you to enjoy everything else she’s doing.