So I admit, this is not something you would usually want to read about whilst eating your favourite alfredo pasta or drinking your hot chocolate tea but the reality is we all poop and we should know about it. At some point in time, most parents have concerns about their child's stooling pattern: colour, consistency and frequency. So today we will discuss what you need to know about your little one's "pooping" habits.
Spoiler alert- we will be using the words: "poop", stool, "pooping", "stooling" and defecation quite a lot during this article. So finish your meal and set aside 4 minutes to read more about poop.
1. Let's discuss the colour of poop.
"My baby's poop has changed colour! Is this serious?"
The first day of birth and for a few days afterwards the colour of your child's stool will usually be a dark forest green colour. This is called meconium and it is normal. It will usually begin to change after breastfeeding begins, to a yellow colour.
Once formula is introduced or complementary feeding begin, the stool will again change colour. This time it could range from shades of green to yellow/brown. Then by the time they are introduced to the family pot it will change to brown. These are the usual colour changes of stool that does not require worrying and does not necessarily follow this order. It is also quite normal for colours to interchange.
There are a few colours however, that if you see them you MUST visit your paediarician immediately. It may actually be an emergency. As a Trini, it's easy to remember these colours- RED, WHITE, and BLACK.
1. Black- If you see black tarry stool that has an abnormally offensive scent then this can indicate bleeding from the upper gastrointestinal tract. See your paediatrician at once.
2. Red- Certain foods and dyes may cause the stool to appear red. However if blood is evident or mixed in stool then it could be a lower gastrointestinal bleeding and you need to see you paediatrician to evaluate further.
3. White/Grey- This is not a colour that a parent should see and leave alone. This is a red flag for any paediatrician and warrants further examination and evaluation immediately. It can be associated with a biliary tract disorder, one of which is called Biliary Atresia. This is a serious condition characterised by the absence of the gallbadder. It is associated with prolonged jaundice (yellow eyes and skin). It rapidly progresses to liver failure. It is a condition that requires surgery within the first 60 days of life to prolong the function of the liver. But as time progresses without early surgical treatment, it can lead to the baby requiring a liver transplant or die from liver failure.
2. Let us look at the consistency of poop.
As babies, meconium (first stool) is runny and soft. This is normal in the first few days of life.
Next, the breastfeeding baby's stool can appear pasty but with some grainy seed-like material inside. This is also normal.
As solids enter your little one's diet, his/her poop becomes a thicker paste like peanut butter. (Okay it's probably not the best example to use, but don't think of this article on your next peanut butter sandwich).
Then by toddlers it can become firm and solid.
Now when the consistency gets too hard and it begins to form into pellets or obstruct the toilet bowl in the older child then we are looking at constipation. In which case you would need to address this with the physician of your child.
If the stool becomes ribbon-like in shape with constipation, this is something to consult your paediatrician.
Another important feature to look for is if the stool floats on the surface of the water and does not flush after one attempt. This could represent fat malabsorption and also requires evaluation.
3. Lastly, let us discuss the frequency of poop.
Stool frequency varies vastly in paediatrics and depends on age and diet- whether formula fed or breast fed or on solid foods.
Newborn babies who are formula fed can go off once every 1 to 3 days, whilst breast fed babies can pass stool once every 5 to 7 days and this can be normal. Yes it can. For the baby who is pooping once every 5 days this is because they absorb all the substance from the milk itself. Adults will be petrified if they pass no stool for 5 days, but in paediatrics we may not be as worried.
However, there are some instances when you and your paediatrician should be concerned if your baby does not pass stool in 5 days.
I will list them:
1. If your little one's belly is increasing in size or looking puffy.
2. If he/she is vomiting more than normal and it the vomit is green in colour.
3. If they are not passing wind down below.
4. If they have fever or more fussy than normal.
5. If the baby has not passed meconium (first stool) within the first 24 hours of life.
These may be signs of intestinal obstruction and warrants further evaluation of your child by your paediatrician.
For parents who are mathematically inclined, remember this formula:
constipation + no gas + green vomit + swollen tummy = go to my paediatrician at once!
On the other side of the spectrum, breast-fed babies can also pass stool up to 8 times a day just after each feeding. Isn't babies special beings? Even this is also quite normal for them. In adults we would be panicking if we were going off 8 times a day. Only if the baby's poop is clear and watery, and not related to feeding, then it would be considered diarrhea.
In the older child/toddler, they can also have multiple episodes of defecation in a condition known as toddler's diarrhea. It is not diarrhea from a bacterial or viral infection but it is actually diet related. These toddlers, would pass lots of stool frequently and rapidly with undigested pieces of food like peas and carrots noticeable. It is easily rectified though, by looking at the diet and adjusting what might be causing it in consultation with your paediatrician.
So whilst you may quickly toss your babies dirty pampers in the bin or flush that stool down the toilet without thinking twice, it is a good habit to start inspecting that poop carefully before discarding or flushing. Keep a note of its colour, its consistency and its frequency. It might just have important information that can help your paediatrician diagnose an emergency in your child.
Dr. Zafir W. Latchan
BMedSci (Hons), MBBS,
PGDip Paediatric Emergency Medicine (Dist) (Edin)
MRCPCH (Lon)
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