Bowel movements – Poo - change as babies’ bowel mature but also depending on their diet. There are also a few important health related issues that modify colour, consistency and frequency of the poo. So, parents are often concerned not knowing what is normal or not. The following aims at helping parents understand when to worry and when not to.
On days 1-3 of age: Baby must be seen to pass the first poo - meconium: brown/black sticky thick tar-like poo made of mucus and amniotic fluid that baby ingested while in the womb. It is important to notice it has been passed as some serious illnesses are associated with meconium not having been passed during the first 3 days of life. But remember that over 10% of babies pass meconium before birth, and this needs to be taken into account before getting worried.
Then for the next few days, poo colour changes looking green as baby is taking in more milk. The first week of life, baby should pass at least 2 stools a day, at least the size of a £2 coin. Otherwise it may be that baby is not receiving enough feed but if weight gain is normal then it is just a case of waiting to see if the poo frequency changes. Baby girls may have some blood: this is the presence of a very light bleed from the vagina that comes from the effects of mother’s hormones being withdrawn after birth and it soon stops.
Within the first week, onward: As baby establishes feeding, the stool will change to soft green and then a yellow colour. Breastfed babies’ stools often look bright mustard yellow and have a bird-seed texture or look curdled. Formula fed babies’ poo is firmer, yellowish-brown and stronger smelling. Breastfed babies may go from passing 12 poos a day to once a week without producing any poo at all. As long as baby is growing well and the poo produced is soft, poo frequency is irrelevant. Babies who are formula fed will have darker stools and are more likely to be prone to fussing when passing stools – this is commonly diagnosed as constipated.
When starting solids: Starting baby on solids will affect the contents of the poos depending on what has been eaten. As baby moves on to a wide variety of foods, the poos will become thicker, darker, and more smelly.
Abnormalities/ Things to Look out for
• Not passing meconium within the first 3 days: A doctor needs to be informed.
• Diarrhoea: Poo is runny, more frequent or larger in amount than normal. It can be explosive. Very frequently normal breast milk poo is mistaken as diarrhoea – but in any event if you are worried do ask your local health advisor. If it is diarrhoea, for any reason, but usually infection, it is important to control it as it can lead to dehydration. Diarrhoea is most often due to an infection and to reduce risks, hand washing before feeding baby is essential. Breastfeeding babies are less likely to suffer from diarrhoea because mother’s milk helps prevent growth of bacteria. Formula-fed babies are more prone to infection and it is important to sterilise equipment before feeding. Infective diarrhoea should clear up within 24 hours and if not, it may require treatment to avoid dehydration. Causes of diarrhoea other than infection are dietary, a reaction to medication, a sensitivity or allergy to milk or food. Teething may cause poo to be looser than normal but not diarrhoea. In an older baby, diarrhoea can also be a sign of severe constipation with dark liquid leaking out past a blockage of hard poo – called overflow diarrhoea.
• Constipation: Many babies turn bright red and push hard when they do a poo. This is normal. Constipation is when babies seem to have real difficulty doing a poo with irritability, cries while straining or if poos are small, dry, like rabbit droppings. If the tummy feels hard to the touch it is necessary to get urgent care. Poos may have streaks of blood in them from tiny cracks in the skin, called anal fissures, caused by passing hard poos. If an anal fissure happens to an older baby, constipation can worsen because baby refuses to pass stool to avoid the pain. This can become a vicious cycle. Constipation must be treated. Mixing up formula milk with too much powder can lead to constipation so it is important to follow the instructions when making up a bottle. Constipation can also be caused by not getting enough water or if there is fever. A change in diet and certain medications can also be cause of constipation. Treatment may only require an increase in baby's water intake. Small babies can be given a bit of orange juice. Older babies benefit from an increase in the amount of water and fibre in the diet and pureed prunes or apricots can be a good way to do this. Sometimes medications need to be given as well.
• Green poo: During breastfeeding, the occasional green poo is nothing to worry about. But if baby is consistently doing explosive green poos, it may be because baby is feeding too fast and not digesting well. With formula milk, the brand used could be turning baby's poo dark green and a different brand may be better at obtaining the yellow colour. But sometimes green poos indicate a food sensitivity, side-effects of antibiotics or a stomach bug. Usually then, there are also other signs and symptoms related to the cause. In general green poo with no other symptoms and adequate weight gain does not indicate a major problem
• Very pale poo: This can be a sign of jaundice, which is common in newborns. Jaundice usually clears up within a couple of weeks of birth. But very pale, chalky white poos may be a sign of liver problems especially where jaundice lasts beyond three weeks.
• Blood in poo: Any blood in poo is abnormal apart from the small vaginal blood seen in newborn baby girls. In the majority of cases, blood is due to anal fissures which are tears in the skin around the anus, resulting from passing a larger or hard poo, to milk intolerance or more rarely as a result of some infections. In some rare situations, blood in stool is an emergency but in these situations baby also looks very unwell, refuses to eat and cries inconsolably.