Among parents of newborns, few things generate as much discussion as poop. In my office, parents document and have questions about their infants’ stool: the frequency, amount, color, consistency, smell, and on occasion, the feel.
But despite their obsessiveness, parents are wise to focus on the stool. It can tell them quite a bit about their baby’s health.
The most important lesson is that there is wide variation in newborn poop, not only from baby to baby, but also from day to day in the same baby. Baby Laura who has nine yellow, mustardy, mild-smelling smears of stool each day is normal. But so is her neighbor, Baby Luke, who has one stool every other day that is green, bad-smelling, looser than Laura’s, and fills the diaper.
So most descriptions of baby poop will ultimately fall into the normal range. The key is to identify the abnormal stool and discuss this with your baby’s doctor. Let’s look at each of those characteristics mentioned above.
This is the most mentioned characteristic by parents, and the most variable. I tell parents that I rarely care about how frequently their newborns poop, as long as it comes out soft and painless. It fine if they go seven times a day or once every seven days. As long as the stool is soft and painless, it’s OK.
Breast-fed babies tend to poop more frequently in the early days after birth, but even breast-fed babies can have infrequent stools. If the newborn is not in any pain and the stools are soft, then no change in mom’s diet or therapeutic action on the infant should be attempted.
Similarly, the amount is widely variable. However, there are rare disorders that can reduce or even prevent normal passage of stool. Very delayed passage of baby’s first stool can indicate some medical problems. If this happens, be sure to ask your baby’s doctor about it.
After the first few days, the amount of stool is usually directly correlated to the amount of breast milk or formula the baby is taking. If you are concerned that the amount in does not correlate with the amount out, the bottom line is always growth. If baby is growing fine, seems content, doesn’t have an increasingly protruding abdomen, seems satisfied after eating, and is developing normally, then all is well.
In the first few days after birth, the stools may still be primarily meconium. That’s the black, tarry, sticky stool that the baby makes while in the womb. But these quickly change to a more “normal” color of yellow or brown.
Parents seem to get very concerned when the stools are green or dark brown. But I tell parents that there are only three colors of stool to worry about in newborns: red, black, and white.
Red stools indicate bleeding, which may result from a milk protein allergy or a problem like hemorrhoid or anal fissures, which are small superficial cuts on the anus.
Black stools indicate older blood, from a source higher in the GI tract, like bleeding from the esophagus or even swallowed blood from mom’s nipple.
White stools (or gray or clay-colored) may indicate a problem with the liver. Babies with liver problems usually are also jaundiced (yellow-skinned). Since this can be difficult to see in darker-skinned babies, and since many babies are jaundiced anyway, the whitish stools are usually the key sign that something is wrong. Be sure to call your doctor immediately if your newborn produces white stools.
After the meconium stools are passed, newborn stools are most frequently described as having the consistency of mustard. With time, the stools will become more formed.
Breast-fed babies usually have softer stools than formula-fed babies. Their stools may also be seedier. These little “seeds” are undigested milk fat, which is entirely normal. Formula-fed babies’ stools are usually a little firmer, often the consistency of peanut butter.
Extremely loose, watery stools may indicate that the baby is not absorbing nutrients as well as they should. This can occur in milk protein allergy or other more serious conditions. Sometimes this is due to an infection in the gastrointestinal tract. These infections are usually viral, and resolve without any medicine, but a newborn can be prone to dehydration in these cases. Make sure to call your doctor if your newborn seems ill.
Very hard stools may indicate true constipation. This may be caused by a medical problem, but more likely is caused by something benign like an improper formula.
Likewise, mucus in the stool may be a sign of infection or improper digestion, or may be due to a disagreeable formula. Call your pediatrician if you see mucus in your baby’s poop.
If you see any of these warning signs or are otherwise worried about the consistency of your baby’s stools, discuss this with your pediatrician. Take a picture of the stools in the diaper to demonstrate how loose or hard they are, or bring in a fresh diaper to the doctor.
In the first few days, newborns’ stools have very little odor. As their gut becomes colonized with bacteria, the stool becomes smellier. This is a normal process. Breast-fed babies usually don’t have very smelly stools, while formula-fed babies often have a more pungent odor. Generally speaking, poop stinks, and there’s not much we can do about it.
In some cases, extremely foul-smelling stool may be an indication of inadequate absorption of nutrients. But if the infant is growing fine and the stool color and consistency are normal, then this may just be normal.
There is no need to feel the stool.
But we can focus on how the baby feels, not how the stool feels. All babies will grimace and get red in the face at times when passing a stool, especially in those first few months. This is normal. But if the baby truly cries with each stool, and this persists, then call your doctor. It may just be a sign of harder stools, but it may signify a problem with the anatomy of the rectum.
There is great variation in newborn stool. If you’re worried, talk to your baby’s doctor.