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Poop Scoop: Infant Stooling Patterns
By: Laura Weidenfeld, M.D.

Admit it, new parents, you worry about this stuff.

It’s amazing how much your life changes once you have a child. Things you use to do you can no longer find time for, and subjects you thought you would never speak of in public become lunchtime conversation topics.

For instance, infant stooling patterns.

Don’t turn away. You know what I’m talking about. I, too, never thought I’d be sitting over toast and tea uttering the phrase, “Yes, you’re correct. It can be green and runny. Please pass the butter.”

Let’s face it, new parents do a lot of thinking about this stuff. And a lot of worrying. As a pediatrician, I get more calls about baby “poop” than almost any other issue.

To know what is abnormal, you first have to know what is normal. So let’s start from the beginning. A baby’s first stool is called meconium. It is the intestinal contents of the fetus, and it is usually evacuated in the first 24 hours of life. It is a thick, black, tarry mess of a stool. Next comes what is called transitional stool, which tends to be greenish and somewhat runny. Eventually, babies end up with a “normal” looking stool that is mustard yellow and seedy looking.

Of note, there are differences between the stools of formula-fed and breast-fed babies. Initially, breast-fed babies tend to stool after each feeding. This averages out to 6-8 times a day. The stool is usually quite watery and resembles diarrhea. Luckily, despite its appearance, there is no foul odor from the stool of babies who are strictly breast-fed. For obvious reasons, detecting diarrhea in breast-fed infants can be difficult. Therefore, if your baby is stooling more than eight times a day, is fussy, lethargic or has a fever, you should certainly contact your pediatrician.

Even if a baby is strictly breast-fed, the frequency of stooling varies among infants. While a frequent stool is most common, babies may stool only one time every other day and still be completely normal. Constipation in fact refers not only to the frequency of stools, but also to the consistency. Therefore, if an infant poops every third day but it comes out soft, this would not be considered constipation, and no therapy is indicated. In fact, at 3-6 weeks of age, breast-fed babies may only have one stool a week. This is because breast milk leaves very little waste in the intestines to be passed. Again, if the stool, when passed, is not hard, this is completely normal. In general, it is almost impossible for strictly breast-fed babies to become constipated.

In contrast, formula-fed infants may have problems passing stool. Although uncommon, such problems can occur. Therefore, it is best if these infants pass a stool at least once every 24 hours, with a consistency no thicker than peanut butter. Occasionally, these babies will stool every other day and usually this is not cause for alarm. However, if you think your child is having a hard time passing a stool, and the stool is unusually thick, you should call your doctor. It is important to know, however, that almost all infants grunt, groan and turn red at this moment. Remember, they have to poop while lying down, without the assistance of gravity. Therefore, if they seem to have a hard time passing, but what comes out is soft, it is most likely to be normal.

Occasionally, there will be some blood in the stool. This should always be reported to your doctor. However, don’t be alarmed. If your baby seems otherwise well, it is most likely not a serious problem. The most common cause for a small amount of blood on the stool is an anal fissure. This is simply a small tear in the anus that bleeds slightly when the stool is passed. This is often noted in constipated infants and usually resolves once the stool is softened.

Another common reason is milk intolerance. As a general rule, this only occurs in formula-fed infants. In addition to blood in the stool, mucus may be present. If this is the cause of the problem, your pediatrician will likely recommend changing the formula to either a soy-based or elemental product, which usually corrects a problem. If, as in rare cases, milk intolerance occurs in a breast-fed baby, mom has to work to modify her diet. Finally, if a mother’s nipples are cracked and bleeding, this small amount of blood can be passed to the infant’s stool. Bloody stool can, of course, be a sign of more serious problems, but more often than not, it is related to one of the aforementioned issues.

If you’ve had children, this probably sounds all too familiar. If you are caring for your first child, it may sound overwhelming and, frankly, a little explicit. Either way, it impacts our lives as parents and can be a big cause of anxiety. So get to know your baby and her patterns. Try to relax, as most infants feed well without problems. Certainly, however, if you have a concern, talk to your doctor. No question is too strange or silly if it helps you become more comfortable with another aspect of your infant’s life.

Laura Weidenfeld, M.D.
Sunshine Valley Pediatrics in Summerlin