Rules of Poop

For parents new and old, stool gazing is more than a spectator sport. With the first sticky, black poop, you’re hooked. Maybe it’s because newborn baby poop changes so much in the first week of life. Maybe it’s because the pooping frequency is so impressive. Maybe it’s because pediatricians and nurses use your baby’s dirty diaper count as an indicator of healthy growth and development.

Babies generally pass meconium–the thick, black poop from intrauterine life–on the first day of life. As the baby nurses or bottle feeds, the meconium thins and turns the green‑brown color of “transitional” stools. After that, breast fed babies have watery, yellow stools that look a lot like mustard‑olored cottage cheese. Formula‑fed stools vary in color and consistency. Healthy babies can poop fourteen times a day or once a week.

Expect as many poops as the baby is days old the first week. After that, a breast fed baby will wet at least six diapers a day and poop anywhere from fourteen times a day to once a week. Bottle fed babies may poop less often because the formula isn’t as easily digested as breast milk.

Faced with a fussing baby, parents often look to the diaper to divine the cause. They report grunting while pooping, green poop, and poop that doesn’t come at the same time each day. The following Rules of Poop can help parents rate the importance of any given dirty diaper.

Rules of Poop

When it comes to poop, you will see amazing colors, consistencies, and frequencies. Three things, however, can raise concerns:

  • blood in the poop
  • lots and lots of poop
  • rock hard poop

Let’s take these one by one.

Blood in the poop can be a sign of bleeding in the digestive track. Red blood in the poop generally comes from the bottom of the digestive track. One common cause of blood in the stool is an anal fissure, which is a little crack in the skin around the rectum. These happen with poops that are big or fast. “Explosive” is a word some parents like to use.  The anal fissure behaves like a cracked lip, and it’s usually painful for a few days until it heals completely. Pediatric textbooks sometimes describe the blood striping the outside of the poop not unlike a candy cane.

When the blood appears mixed throughout the poop, it raises the suspicion of an infection with salmonella, shigella, campylobacter, or E. coli H0127. Bloody poop in a baby generally means an office visit and sometime a stool culture.

Lots and lots of poop means diarrhea. Most parents think of diarrhea as loose poop, but technically, diarrhea is an increase in poop volume. Viral infections that irritate the lining of the stomach and intestines cause food to zip through so fast that there isn’t time to reabsorb all the fluid mixed with the stool. This is why the stool seems “loose.”

A little diarrhea can be corrected with careful attention to your baby’s fluid intake.  Breast milk and electrolyte solutions (like Pedialyte) are best for diarrhea. Pediatricians do not recommend medications that slow the poop down because it’s better to let the viral particles pass out of the intestine as fast as possible. Small, frequent feedings are best. If you baby’s mouth is dry and she isn’t wetting diapers, call your pediatrician.

Rock hard poop–and I mean like little dry balls–is constipation. If the poop is that hard, it’s going to be difficult to pass. Hard poop increases the risk of an anal fissure and poop problems in general, down the line.

Your baby’s digestive system, like his motor system, for example, is not fully operational at birth. It takes your baby almost a year to organize and mature the nerves and muscles needed to take those first steps. The digestive system also contains nerves and muscles that have to work together to move milk and its breakdown products from mouth to rectum. Immediately after birth, your baby begins processing food and moving waste along. Since babies don’t walk or sit up by themselves, gravity can’t help move the poop down into the rectum to ready it for easy passage. Imagine how difficult pooping would be if you had to do it lying down!

By about the fourth month, your baby’s digestive system will be running more smoothly and pooping will get a lot easier.

If your baby is pooping hard, little balls, talk with your pediatrician. Your baby may not be getting enough to eat or there may be a medical reason for the poop’s consistency.  The older baby may not be getting enough fiber. Rice cereal, apple sauce, and bananas all thicken up the poop. If your baby loves these, you may need to increase his fiber intake with oatmeal cereal (for six months and up), and the “p” fruits: peaches, pears and prunes. Some pediatricians recommend a little juice in a cup for the older baby.

Fiber is the indigestible part of fruits, vegetables, and whole grains that bind water to itself as it passes through the digestive system. Poop that lacks fiber has all its moisture stripped away by the digestive system, leaving hard, little balls in the rectum. When the poop contains enough fiber, the water stays locked in, and the result is softer poop that’s easier to pass.

Only infrequently will your pediatrician recommend medications for your baby’s constipation.

If you think you’ve spotted something interesting in your baby’s poop, save the diaper for the doctor.

To keep baby’s digestive system humming along, offer healthy foods. If you keep the rules of poop in mind, your baby’s diapers won’t seem so cryptic.

About Lisa M. Asta, MD

Lisa M. Asta, M.D. is board-certified by the American Board of Pediatrics and is a Fellow of the American Academy of Pediatrics, for which she is also a Media Representative (she has been interviewed for “Kids Health” on Health Radio, and quoted in Parenting Magazine, USA Today, and the New York Times, among other publications). She is a Clinical Professor of Pediatrics at the University of California at San Francisco and past pediatric chair at John Muir Medical Center in Walnut Creek. She graduated from Temple University School of Medicine and the Johns Hopkins University. Dr. Asta is also a writer whose fiction has appeared in Inkwell, Philadelphia Stories, Schuylkill, and Zeniada. Her essays have appeared in the Journal of the American Medical Association, Hippocrates, the San Jose Mercury News, and The New Physician Magazine. She is an occasional contributor to KQED public radio’s Perspectives series, and has written articles for Bay Area Parent, Valley Parent, Parents’ Press, and Parents Express, as well as online at WebMD.com, Rx.com, and MyLifePath.com. She wrote a chapter in The Field Guide to the Normal Newborn, ed. Gary Emmet, M.D. BabyCenter.com currently has two how-to videos for parents in production which feature Dr. Asta. For more on Dr. Asta’s writing, visit www.LMAsta.com
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