I have often asked parents not to bring poop samples into my office. While there is a lot of information to be gleaned from studying full diapers, I think I can do most stool analysis on the phone or online unless an emergency situation occurs.
There is a wide variety of color and consistency of bowel movements. In my glamorous job as a pediatrician, I discuss this hot topic every day.
A change of pattern can throw the most confident mom for a loop and can even confuse an experienced pediatrician. Babies have blood in their stool fairly often and it virtually never is the sign of serious illness, but I pay a lot of attention to this because it alarms parents and requires that a reason be found.
We shouldn’t be any more surprised to see a variety of bowel movements in our babies than we would in anyone of any other age. In breastfed babies, the mom’s diet can affect the color or consistency of a baby’s stools, particularly if the baby is showing an allergic reaction to a certain food or food group.
Sticky, tar-like and green or black
This is meconium. The first stools of a newborn will be this consistency and color. It is what is present inside the bowels of a newborn upon birth and will clear itself out within the first couple of days and represents the “byproducts” of building an entire human being for nine months.
Greenish or Yellow/Brown, grainy or seedy
This is the transition between meconium and a regular breastfed stool and begins as mom’s milk is coming in on the second, third or fourth day of life. There may be three stools each day, ten, or even twenty. Occasionally, even a baby in the first week of life will skip a day and have no bowel movements at all. Call your doctor to discuss this even though it is normal. This does not require a dietary change or supplementation of a breastfed baby.
Light yellow to bright green, loose/runny, curdy, lumpy, seedy, creamy, mustard-like
These are normal breastfed stools. The consistency, frequency and color vary from day to day. My wife described the smell as “curried yogurt”. Opinions on this odor description differ widely.
Frequent Watery Stool often “Greener” than usual
How can you spot diarrhea in a baby who has loose frequent stools every day? This type of poop is “diarrhea” in a breastfed baby. It can be due to a virus, a bowel infection, stress, anxiety or a food intolerance.
Hard, pellet – like, presence of blood or mucous
This is constipation in a breastfed baby and is so very rare that I cannot recall ever seeing it in a baby who is receiving breastmilk as a sole source of nutrition, as are most babies in the first six months. It could be related to a food allergy. Formula fed babies get constipated much more often and may even have harder bigger stools like older kids and adults. Getting these stools softer is a balancing act of great proportions.
Black stools often accompanied by constipation
This is the result of iron supplementation. Iron fortified infant foods and infant vitamins can cause constipation. A healthy breastfed baby does not need iron supplementation. The iron in breastmilk is much more bioavailable than any other form.
Red streaked stools
This usually comes from bleeding in the lower intestine or rectum. Most often it is caused by rectal fissures which are tiny “cuts” around the circumference of the anus. This can be a reaction to dairy in mom’s diet. Elimination of all dairy is the first line of defense in this situation. I have seen countless babies who had blood in their poop which resolved when mom stopped all dairy products and returned with even a small amount of milk or cheese. Other dietary changes may be needed for breastfeeding moms. Formula fed babies lose blood from the lower intestine when they drink cow milk formula and some have the same losses on soy formula. Occasionally, this “micro-hemorrhaging” can become visible as blood streaking on the surface of the stool. Persistent or increasing blood in the stool or blood mixed with mucus (described as “currant jelly” stool in the texts) requires an immediate call to your doctor.
Green, frothy stools
This can be a result of a hindmilk/foremilk imbalance. A true imbalance is rare. It is often seen accompanying a forceful letdown. Lactation consultants will help moms find a nursing pattern which works to combat this problem. If letdown it too forceful in the early weeks, the solution can be to allow milk to leak into a cloth diaper during letdown, then latch baby back on. Feeding two to three times off the same side may also show improvement. Caution should be used with same side feeding as it can decrease supply.
Green, mucousy stool
This can be a result of a virus. Often the only sign we see of a virus is in the green stool. This is evidence of malabsorption in the intestines. Watch for how many days and with what consistency it is occurring. With a virus, it will run its course over a few days and begin to improve.
Another cause of malabsorption in the intestines can be teething. The profuse saliva of a teething baby can cause irritation in the intestines interfering with proper absorption. When babies teethe, we can see lots of drooling. Large quantities of saliva is swallowed which can irritate the intestines causing runny, acidic stools. This can also cause a rash in the diaper area.
There is something important to point out regarding frequency of stooling in an exclusively breastfed baby. Many parents are concerned when after the early weeks where they may have been seeing a little bowel movement in almost every diaper, they suddenly begin to see days go by without any. This is perfectly normal. There is a great range of frequency of bowel movements with exclusively breastfed infants, ranging from a couple of times a day to several days. There are completely healthy nursing babies that have a bowel movement once a week, once every ten days, or even a few that go a bit longer. If your baby is healthy, developing well, nursing well and the consistency of the bowel movement when it does make its appearance is soft or loose, then do not be concerned. It is not constipation if it arrives in soft form. Constipation would arrive in pellets and hard formed pieces.
In summary, stools in breastfeeding babies are predictably green, brown, yellow or orange. It is runny and has curds almost every time. It changes color with viruses, may have a small amount of blood (call your doc) and may come once a day and even taper off to once a week or more after a few weeks of age. Formula feeding babies may show a little trickier set of changes involving constipation and diarrhea. This is just one small reason to strongly recommend and support breastfeeding your baby.
Hello,
My one month old has had green, mucousy poops since almost day one. After the meconium was finished (about day 2) he had a handful of normal diapers: yellow, seedy, wettish poops. Within the first week they started to be green (varying shades) and mucousy, never with any curds or seeds. Since then they have been just the same- always more or less mucousy and never really any seeds. (I am very familiar with 'normal' poops- I am the oldest of 10 children and a midwife myself!) I had a cesarean and strep throat at 5 days postpartum, so I was on several pain killers and 2 antibiotics so figured his abnormal poops might have been caused by the medications and really didn't worry much. However, I have been off of everything for 10 days and things are the same.
His other symptoms include: every other day very fussy time for 3-4 hours; lots of gas; lots of spit up- seems to be worse every other day and seems to come 'in waves' where he spits 4+ large amounts in an hour time span; severe baby acne- progressed from his face down to his shoulders and back and arms down to his wrists. He has been gaining weight very well and has lots of wet diapers.
One week ago I realized I needed to take action and decrease my milk supply as I have every symptom associated with too much milk. It has decreased in the 8 days I have nursed between 8-12 hours on one side exclusively. I pump 2-3 oz foremilk off of the 'new' side when it is time to switch sides (after 8-12 hours of not using that side) before feeding him so he doesn't intake solely foremilk. I also pump a little off when I feel excessively full so as to limit his foremilk as well. All that do say, I feel fairly sure that we are not dealing with fore/hind imbalance at this time, though I am sure past one week ago that was a problem.
I am on day 2 of a non-dairy diet. I don't usually eat much diary, but I have small amounts of cheese, yogurt, or butter daily. Of course, I am hoping that might be the problem and diary elimination will do the trick! If it doesn't help, what other suggestions might you have? For having such abnormal poops he is a fairly happy baby! But I am sure that his fussiness and sessions of spit-up have to do with something being off in his system. Any other ideas you have would be great!!
Thanks, Shayna
Is the baby acne that you speak of actually eczema? Eczema is a classic symptom of a reaction to dairy. The reflux and colic are also common symptoms of a dairy reaction. You've made a good choice to eliminate dairy as it is certainly the most suspect. It will take up to six weeks to be undetectable in your breastmilk, but the dairy protein will begin to lower right away and most moms see improvement in two days to two weeks.
Are you seeing signs of overactive milk ejection reflex (overactive letdown) from oversupply while he is nursing? While the reflux and colix can be related to oversupply, OMER carries with it notorious other signs with baby often gagging from letdown, pulling off and crying/fussing and not wanting to latch back on and feedings going more smoothly with mom lying down or baby in football/clutch hold. Even with OMER I would not recommend going 12 hrs without nursing on a breast. Milk staying in the breast is the quickest way to reduce supply, however at one month you are still establishing your supply. Nursing 2 feedings from one breast and then switching to 2 feedings on the other side, etc., is a much better place to start. Make sure that you are not creating more stimulation by pumping before a feeding. If foremilk/hindmilk imbalance were an issue the BMs would not only be green but also frothy. While a "normal" newborn BM post meconium is often described to be mustardy and seedy, all babies do not produce the seedy texture.
Hope this helps.
My infant is 2 weeks shy of 6 months. She is exclusivly breastfed. She has had blood in her stool since about 9 weeks despite my taking milk, soy, egg, fish, and sesame out of my diet. (I am an RD so I am confident that they have been removed) I have talked about it with her Ped. MD as well as a Ped. GI MD. Their feeling was that she is growing, happy, and eating without complaint…thus I should just keep doing what I am doing. She seemed to be getting slightly better…less specks of blood. I introduced solids at 5 mos, 1 week. She didn't seem to do well with Rice cereal, let it rest for a week and now introduced Oatmeal, which seems OK. BUT, she does have lots of gas, green mushy stool with some miniscule black flecks. I just introduced pears. I don't know if I am causing more problems, or if this is just part of the process of introduction to food. I hesitated even introducing foods till she was 6 months, but she just seemed so hungry and has been eating the food fine. Any suggestions?
A few suggestions…
I would eliminate the other "big" food allergies as well, at least temporarily. Citrus, shellfish, peanuts/tree nuts and wheat.
If you do not see an elimination of the green BMs and specks of blood with these foods gone for a week also, I would suggest approaching it another way and doing an elimination diet.
How often is she nursing? How are wettings?
I would suspect that the reduction in the blood is because she is nearing a time when her gut is closing. Some of the things she may have reacted to in the past may not bother her once gut is closed. I am never a fan of giving solids prior to six months and you can find me being very supportive of waiting up to a year, particularly for a baby that is exhibiting signs of food allergies. I would not give any grains and definitely not any processed infant cereals…there are far too many risks of cross contamination in addition to the allergy potential. Remember in this process that solids in the first year are merely for experimentation with textures. Breastmilk is providing ALL the nutrition that is needed and at a much higher quality than any solid you could offer. Bearing that in mind I recommend as first foods fresh fruits and steamed veggies. If a food is soft enough that you can smash it again the roof of your mouth with your tongue then it is more than soft enough for a baby to gum it and experiment with it. Foods should not be offered until baby can sit up on their own and has a developed enough pincher grasp that they can pick up a little piece of food and get it to their mouth on their own. A smashed avocado or banana is great food for them to lick off their fingers. Get the camera ready…there are some great photos in this finger painting!
It is very possible that prior to six months you notice a baby seems extraordinarily hungry and they want to nurse very often. This is most often just a growth spurt and the biological way to increase your supply to meet those increased needs. The socialization of eating is attractive to baby, but they typically are merely exhibiting the desire to participate in what they see everyone else doing. Give them a bowl, spoon, cup, chip of ice…the tools to participate. This often delays a baby from the actual interest of consumption of foods.
Hope this helps.
My 14 week old baby passes what looks like grain/grit/sand in her poo. It even wipes like sand – hard to remove.
She is hard to wind and when she does she is sick a litle.
She also appears to have apin in her tummy at night and I have to lift her legs slightly to let her pass wind.
Any advice would be welcome.
Thanks
Is she a breastfed baby?
A typical newborn exclusively breastfed baby's BM will be mustardy yellow with what looks like curds in it. Some variation is to be expected and I would not be concerned with a greenish colored BM as long as it doesn't stay green consistently.
My daughter is eight months old and is exclusively breastfed. Her BM is typically yellow/green and loose, with at times some mucus. In the last month or so she seems to have developed some light acne on her chin. It does not seem to bother her. She is lively and reaching her regular milestones. I am concerned about too much yeast in her and whether she has some food intolerances that I am prone to.
Are you sure it is acne or could it be eczema? I would be suspect that it's a reaction to dairy with the green/loose stools. Eliminating dairy from your diet would tell you within a couple of weeks.
My 9 month old baby (primarily breastfeed with little formula supplementation) has been having somewhat formed stools periodically since he started solids at about 5 months. These are not hard pellets but look more like playdoh and about the same consistency as playdoh. Is this constipation? He has them periodically, like every few days. Initially a couple months ago he was only pooping every couple of days and that's what would come out. Now, he's pooping everyday but every other day, they seem to be more playdoh-like. Other times his poop is more loose like peanut butter mush. Sorry for the graphic. What do you suggest I try to do?
Thank you.
No this is not constipation in a breastfed baby that is eating solids, but it is telling you that some of the solids, or the quantity of solids, is more than his system is quite ready for. Bear in mind that in the second half of the first year solids are merely for experimentation with textures but not for quantity intake. Babies get all the nutrition they need in the first year from breastmilk. So establishing that, the foods you introduce should be easy on the system. Processed infant cereals are notoriously a culprit in slowing down the system. There just isn't enough whole food left in them. At 9 mo old the optimal solids to have added to a nursing baby's diet are fresh fruits and steamed vegetables. They are soft and easy for them to learn how to mash up and taste. Cut either into little bits and let baby take it and pick it up and put it into their own mouth to experiment with. I'm not a fan of spoon feeding solids because to often a much larger quantity of solids are taken in than baby would naturally eat on their own. Giving them the chance to do their own feeding (while messy!) allows them to slow the pace down. Take a good look at the foods he is eating and see if an adjustment in the solids that are added can be made that will be easier on his maturing system.
Hope that helps.
thank you for the quick response. we've been giving him organic baby food (spoon fed)and lately he seems to be eating a lot more of it. we basically feed him until he seems like he doesn't want anymore so he probably is eating more than needed (seems to be up to 2 3-4 oz jars per meal). I'll try doing the self-feed with fresh fruits and vegetables. I also like that he may pick up eating on his own this way also. we've been sort of following my pediatrician's recommendations on foods and he seems to push advancing through all the foods rather quickly. I've slowed it down a bit but maybe not enough. Thanks again.
Many pediatricians in the US don't encourage breastfeeding and give very inaccurate breastfeeding advice which sabotages breastfeeding relationship, so it isn't surprising that many of them also push solids when it isn't necessary. Sadly.