The Scoop
on Poop
Written By Jack Maypole, M.D.
print
single page
When I was a young pediatric resident, I thought I must have a gastrointestinal superpower over children. As I approached infants to examine them, they'd look up at me, smile a charming, gummy smile, and then, almost invariably, they'd redden their cheeks and grunt.
As the book says, everybody poops. But babies seem to poop all the time. Naturally, their parents fret and wonder about the meaning of this prodigious output. "My newborn's stool is so soft — does she have diarrhea?" (Probably not.) "I found seven cents in my toddler's poop. Is that okay?" (Now that it's out, it is, but keep an eye on your larger bills.) Parents may tend to obsess, but it is true that what comes out (or doesn't) can tell you a lot about the well-being of your baby.
What I PreachThe first weeks of life are a time of great transition, particularly in the intestine. Things literally are changing (and passing) all the time. First out is meconium, that tarry, tacky substance so difficult to remove from a baby's backside. It's a backwash of material from the gut in utero, such as the oddsy-endsy detritus of old blood cells and proteins. We medical types herald the arrival of First Poop within about 24 hours of birth: It's a sure sign the plumbing is working well. (Yes, we're an odd bunch.) Within about two to four days, greenish transitional stools tell us the intestinal tract is grinding into operation and is being colonized by normal gut flora and starting to digest food.
Breastfed infants, who tend to poop more than their formula-fed cohorts (Mom's milk digests more rapidly), then begin to pass yellow, pasty stools with a seedy appearance. These generally have a distinct — some say sweet — odor. Formula-fed babies pass more traditionally formed stools of a classic mocha color, and yes, they do stink a bit more. Still, not all babies go by the textbook, and they may pass stools that are green, a variegated yellow-green, or plain old brown — all normal. Once they're on to solid foods, babies' eliminations trend mostly to brown. (Earth tones are soothing.)
What I PracticeA parent whose child poops faithfully morning, noon, and night may freak if, like many babies, he changes his schedule radically, moving his bowels only once every few days. This could be due to the addition of formula, a shift in metabolism, or for no discernible reason at all. Most often, a new poop regime arises without fanfare or pathology.
And don't worry if your baby sounds like she's moving a piano. While many kids get truly constipated at some point, it's normal for infants to make some pushing noises as they bear down. Immature coordination of the anal muscles can cause babies to grunt or cry while passing a normal stool. Dyschezia, or painful stooling, can be relieved by laying a baby on her back and gently pressing her knees up to her belly. Check with your health care provider if these symptoms persist for more than a few days.
What do you do if you find a weird or worrisome looking poop? There is only so much a doctor can learn about the quality of a stool over the phone. If a parent is worried about an odd find, I advise her to bring the diaper to the office (in a sealed bag, please). If your appointment isn't until the next day, stick the bag in the freezer (and warn other household members!). With product in hand, I can run some simple analyses, such as testing for blood or elements that aren't getting absorbed right. In the past, I've not only come across the occasional nickel and dime but have been able to help clinch diagnoses such as formula intolerance problems or digestive disorders. Sort of like CSI meets the W.C.
By the Numbers6 to 8: stools per day by breastfed newborns (fewer for formula-fed babies)
3: rank of poop among questions I get about infant care (sleeping and eating tie for first)
18 billion: estimate of disposable diapers sold yearly in the U.S.
1.1 million: Google results of searching "baby poop color"
Up to 28: percent of children between 2 and 7 who get constipated
99.9: percent probability your child will have a diaper blowout when the number of diapers in your bag is 1 or fewer
Keepin' It Regular"Constipation in babies is not so much based on the frequency of stools but on how hard they are," says my colleague Claudio Morera, pediatric gastroenterologist at Boston Medical Center. If you notice pebbly, hard, or streaky stools, try giving your baby 1 to 2 ounces of prune juice. Glycerin suppositories also are safe to use.
Dr. Morera also says to remember that in breastfed newborns, soft poop likely doesn't mean diarrhea. Instead, watch for frequent, watery, voluminous stools. If diarrhea occurs, try an electrolyte solution like Pedialyte (call the doctor if you're worried about dehydration) or the BRAT diet (bananas, rice, applesauce, toast), if your child is old enough.
About the Author
Jack Maypole is a pediatrician at Boston Medical Center and director of pediatrics at the South End Community Health Center. He would like to ask parents: If he's examining your child and she poops, is it his job to change her or yours?
Next page: A color-coded guide to baby poop
