Newborn babies don't do much. They cry and sleep. They gaze around some. They eat and spit-up. They pee and poop. Really, that's about it. So it's easy to see why new parents focus on their infant's bowel habits. Of course, relatives are also responsible. Everyone has an Aunt Betty (or maybe it's your Mother-in-law) whose goal in life it is to voice concern about everything. "He poops too much. She doesn't go enough. It's too hard. It's too soft. Why's he always grunting like that?" Often new parents aren't concerned until someone convinces them of a so-called problem.
The trouble with baby poop is the wide-degree of variation. Some infants stool shortly after every feeding, while others go once a week. There's also a wide-range of thickness--from thin liquid to clay patties. And then there's color: yellows, greens, browns, reds, and blacks. Let's take a quick look at each of these factors and discuss what's normal and what's not.
Stool frequency depends on how much stool your baby makes and how quickly the intestine moves it down the pike. The amount of stool is dependent upon two variables--how well your baby's intestine absorbs food and how many bacteria live in the gut. Since a baby's ability to absorb food changes over time, the amount of residue left over also changes. Typically there is more residue to stool out in the first few weeks of life. Then, as your baby's intestine matures, absorption improves and the amount of residue decreases. Thus, babies who used to poop several times a day may slow production down to once every couple days.
On the other hand, bacteria may have the opposite result. As a baby matures, more and more bacteria populate the gut. They are important to the digestion process and are one of the reason baby stool changes in character over the first few months of life. But as their numbers increase, the body eliminates more and more of them in the stool. Stool bulk increases as the number of bacteria increases, and increased stool bulk leads to more frequent bowel movements.
Another factor affecting stool frequency is transit time. Some guts work faster than others. So what's normal? Well, some newborns will have a stool every time they eat, while others will go every few days. If your infant's stools are more than three or four days apart, it may still be alright, but you should give your child's doctor a call and let him know.
Stool consistency is another important consideration. If your baby's stools are always slimy like mucus or thin like water or thick like clay, talk to your doctor. The ideal consistency of newborn stool is like mustard, but some variation on this may be okay.
Also pay attention to color. Bright red usually means blood. Bring this to your doctor's attention right away. Possible causes include milk allergy, a crack in the skin around the anus, or (rarely) a more serious internal problem of the intestinal tract. Black tar-like stool is normal during the first few days of life. But if it remains this way long or becomes this way again, talk to your doctor. It could be a sign of bleeding in the gut.
Other colors depend on diet and the make-up of intestinal bacteria. Normal colors can range from pale yellow to dark green and light tan to dark brown.
Putting this all together, normal baby poop should be the consistency of mustard. It may be yellow, green, tan, or brown and it may come several times a day or once every several days. Reasons to call your doctor include black tar-like stool, presence of blood, watery diarrhea, constant mucus, and thick or formed stool. Also let your doctor know if your baby routinely goes several days without passing stool.
A word about fussiness is in order. Many parents assume a fussy baby who has a bowel movement every few days is constipated. This may not be the case. Keep in mind that upset babies, whether they are upset from hunger or the pain of an ear infection or heart burn, will stiffen their bellies, draw up their legs, and pass gas as they bear down. You should not assume this behavior is from constipation, even if their bowels move irregularly. Instead, make an appointment with your child's doctor for a thorough examination.
Okay, let's say your infant is constipated. She has thick formed stool that is difficult to pass and she goes infrequently. Your doctor agrees your infant is constipated. What will he have you do? Here are some options:
RECTAL STIMULATION: Put a glob of lubricant on a rectal thermometer or Q-Tip. Insert the tip a quarter to half inch into the rectum, give a little twist, and pull back out. Often, this will stimulate a bowel movement within a minute or two.
GLYCERIN SUPPOSITORIES: These are available at most pharmacies. Use half a suppository to start, inserting it into the rectum. This works by increasing the water content in the stool through a process known as osmosis (think back to high school science class).
JUICE: Processed apple or prune juice from a grocery store (not fresh from a fruit stand) will also increase the water content of stool through osmosis. This works because undigested sugars make it all the way down to the large intestine and draw water into the bowel. Baby juice probably won't work because it's so dilute. Start with an ounce or two of full-strength processed juice. If it works, you may need to continue giving an ounce or two of juice once or twice a day to keep your baby regular.
ORAL MEDICATION: There are several of oral medications that work the same way as juice. Milk of Magnesia is available over the counter, while Lactulose and Miralax require a prescription. Oral medications are rarely necessary for young infants.
It's important to consult your doctor before trying any of these methods. There are diseases, some of them serious, that mimic constipation--so don't treat it without your doctor's help.
Finally, a word is in order concerning some things you shouldn't use to treat constipation. Kayro syrup and honey have the remote possibility of transmitting botulism to infants, so don't use these products in children less than a year old. Likewise, unprocessed juice may contain harmful bacteria, such as E. Coli. Also, enemas are not recommended for infants--save those for the older kids and use them only under the guidance of your child's doctor.
Baby poop is funny because it can be so different from one child to the next. And for some crazy reason, well-meaning relatives always seem to gravitate toward a newborn's bowel habits. But don't let Aunt Betty (or your Mother-in-law) get to you. Armed with the knowledge of what's normal and what's not, if she keeps pushing, feel free to teach her a thing or two.
Copyright 2006 Mike Patrick Jr, MD
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