Kid's Health topics

Fifty shades of brown – all your baby poo questions answered.

Well folks, today we are here to talk about every parents’ favourite topic… Poo! Nothing says new parent like an obsession with all that comes out of their baby’s rear end. If you have yet to welcome a little one you might well think that I am kidding. During those last few weeks of your pregnancy it is hard to imagine that the high point of your day is soon to involve bowel movements (and not even your own). You cannot yet forsee the eagerness with which you will await your partners return home from work so you can regale them with details of the colour, consistency, smell and volume of excrement produced by your little bundle of joy. My husband and I have both had times where we wondered what we even talked about before baby poo figured into our evening discussions. Oh the depths to which we fall, lol.

So let’s get it out there and talk about it then, as concern about baby poo is a common topic with the parents I see in my general practice. I will try to frame the discussion with the sorts of questions I commonly get asked.

What colour should my baby’s poo be?
This really depends on the age of your baby. In the first few days of your baby’s life, they will pass what is called meconium, a thick tarry black poo which is essentially what has been sitting in their gut whilst in the womb. After a few days this becomes what my husband delightfully referred to as chicken korma poo (never eating that again thanks hubby), but what is medically described as ‘transitional poo’. It is a sort of dark yellow poo and is generally pretty runny, not sticky like the meconium. It suggests that the milk your baby has been receiving is beginning to make it right through the gut. Pretty soon this becomes the ‘wholegrain mustard’ (why is it always food?) poo that is typical for newborn babies. Normal pre-solids baby poo may range in colour from brown to yellow, to green or grey.
Later on once your baby starts solids poos may be any colour of the rainbow depending on what they have eaten prior – that rainbow coloured ice cream is always a fun one to see the next day!
Black poos, white poos, and red poos are not usually considered normal (assuming they haven’t eaten anything prior that could explain it) and it would be worth seeing your babies’ GP if you are noticing poos of these colours.

I have heard green poos are not normal, is this true?
There is definitely a common myth that green poos in babies always mean a problem such as dairy allergy. Though green poo may be a sign of cows milk protein allergy, this is not always the case. If your baby is otherwise well and thriving, gaining weight well and has no other signs of intolerance it is unlikely that it would be the cause. Most likely the colour green is to do with the speed of the movement through your childs’ gut, or their particular gut bacterial flora, and is not a problem. Green poos seem to be a little more common in babies who are formula fed, but again do not on their own indicate a problem.
Green frothy poos may be a sign of a functional lactose overload, which is common when mums of breastfed babies have an oversupply of milk. You should ask you GP or lactation consultant about this if you suspect it as there are ways that this can be managed if problematic.
Green and/or runny poos are also very common after your child has received the oral rotavirus vaccine at their 2 and 4 month vaccinations. This can persist for a few weeks. Please remember to wash your hands religiously during this time as you can transfer the virus particles to yourself as the vaccine will shed in their poo for a few weeks after receiving it.

What about mucus?

Many people believe that mucus in baby poo marks an abnormality in their baby’s gut.  This is not necessarily true.  Certainly mucus poos can be associated with allergies or intolerances, though this is not usually an isolated finding in these cases.  It will often be combined with blood in the poo or failure to gain weight for example.  Again in an otherwise thriving infant, mucus in the poo is likely to be related to the speed that milk passes through the gut and nothing to be concerned about.

My baby has had blood in their poo. Is this a problem?
Blood in stool is never normal and may be a sign of a number of possible issues such as anal fissues, cows milk protein intolerance, or surgical issues such as intussusception. If you notice blood in your baby’s poo then please book in to see your GP, or head to the emergency department if they are unwell or it is a large volume of blood.

My baby only poos every 5 or 6 days. I’m worried they may be constipated.
This is totally my kids… all of them! I think my record with baby number one was 15 days without poo. This then led to a massive poo explosion where we went through 4 nappies, 2 sets of clothes and once car seat in the space of half an hour!
My first question for you is how soon after birth did your baby pass their first black meconium poo? It is normal to have passed this within the first 48 hrs and if that happened then it suggests normal initial function of the bowel.
My second question is how is your baby fed? It is completely normal for breastfed babies to go a long time between poos, even up to 2 weeks. Don’t stress about it, but do pack lots of nappies and a few changes of clothes for both of you whenever you go out as the resulting poonami is likely to be epic when it finally does arrive! Formula fed babies may also go quite a few days between poos but usually more like a week or so. If your baby is otherwise well and healthy, generally happy, feeding, weeing, and sleeping as well as expected, then I would just go on about my day and the poo will come when ready. It is unusual for a fully breastfed infant to be constipated. Formula fed babies may become constipated a bit more readily, but often you will see hard or firm poos that may also be infrequent and/or painful to pass. Babies who are eating solids are a bit more prone to constipation which again will usually present with firm stools that may also be infrequent.

If you think your baby is constipated then have a chat with your GP or child health nurse as if they truly are then there are multiple things that can be tried to help.

My baby gets very distressed when passing wind or bowel motions. She grunts, goes red in the face, pulls up her legs and sometimes cries. She seems to be in pain and surely this is not normal?
The good news is that yes, it is likely to be completely normal. If the poos are soft and your baby is otherwise feeding and growing well, then this is likely to be something called infant dyschezia. It is common in babies under about 6 months. Despite the fact that passing bowel motions may seem natural and effortless to many of us adults, it is actually quite a complex process involving muscle relaxation and contraction of different areas at the same time. Babies just don’t know how to do this process effectively yet. When they strain, go red in the face and scream, they are increasing the pressure in their little tummys to help push out the poo the only way they really can at that age. Certainly have your baby examined if you are concerned to rule out any issues, but if it is deemed to be infant dyschezia then be reassured that it is normal, not harmful, and you baby will grow out of it.

My baby has very smelly wind, is this normal?
Oh my, this is definitely my baby! She absolutely stinks, and usually let them rip while I’m breastfeeding and in the optimal positon for it to drift right up into my nostrils. I’m not sure I understand exactly how such a small thing can produce such smells, but she is oblivious to it all. The answer is yes, it can be totally normal to have smelly wind in babies.

I think I saw worms in my baby’s poo, could it be?
Certainly pinworms are common in pre-school/school aged children and we do sometimes see these passed on to little babies. If you see little wriggling worms in the poo or around the bottom then it is likely that your baby has worms and depending on their age and weight they may need some worming medication that your GP can prescribe (prescriptions are not usually required for worming medications, though some cannot be used in small babies so best to see your GP to ensure it is suitable).
Just a note on this one to beware of ‘worms’ in the poo the day after feeding your baby banana. Quite commonly the little fibrous bits of the banana come out looking like tiny little black worms and this can be a trick for young players.  This is normal and you can just add it to your list of foods that produce interesting results at the other end along with the sultanas that present themselves as rehydrated grapes, and the blueberries that produce an almost black deposit.

Anyhow, I think I may have talked enough about my favourite subject for one day! Hopefully I’ve been able to address a few concerns. As always if you are worried about your baby’s poo, please make an appointment to see your friendly GP. It is never a waste of time and I can assure you that cuddling babies is often the highlight of our work day.

That’s all from me folks.
‘Til next time.

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