Color of the Day: Solving Bowel Movement Mysteries

Color of the Day: Solving Bowel Movement Mysteries

  • Posted by Dr. Jay Gordon

Stools in breastfeeding babies are predictably green, brown, yellow or orange. 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.

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.

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.

 

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.

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.

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.

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.

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.

215 Comments

  1. Hana

    I have a 4-month old boy who I exclusively breastfeed. At 5 weeks, we tested his stool and found blood in it. I was told to eliminate any obvious dairy from my diet which I did and soon after that I even tried to cut out any hidden dairy. Unfortunately, his stools are still runny, green, mucousy and they again tested positive for blood. He is otherwise a happy baby with no other symptoms and reaches 99 percentile on all three measurements, so he is certainly gaining plenty of weight. I assume now that he is sensitive to more than dairy, but would such sensitivity to soy, eggs, corn, or something besides dairy also cause blood in his stool? I was told that it is almost always dairy. Please advice. Thank you!

    1. Cheryl Taylor

      It is most commonly dairy, but that doesn't mean that other food allergies can't cause GI bleeding as well. The blood is from irritation of the allergen passing through the GI system. If it is irritated enough, there become little fissures that can bleed. My first choice if complete dairy elimination for at least two weeks hasn't eased symptoms is to keep ALL dairy out and also take out the other 6 top allergens which are soy, egg, wheat, shellfish, nuts and citrus (I include any acidic fruit or vegetable). I give it at least another week with these top 7 allergens eliminated before considering approaching it from the other direction with an allergy elimination diet.

  2. Amanda

    My 3 1/2 month old has been having regular BM for the last 6 weeks with the exception of this last week. She has started having BM only once every 3 days and they are almost orange in color. They are a thick soft consistency. She is strictly breastfed and I can think of anything that I have consumed out of the ordinary that would account for the change. She is also quite gassy and it has a very foul odour. Is this normal? Should I take her to the paediatrician?

    1. Cheryl Taylor

      You are right to consider what you have been eating that may have changed. You may want to consider keeping a food diary for a few days until you figure it out. I wouldn't be concerned since it is soft in consistency. With the odor, I might suspect egg or soy? It doesn't sound like an allergy or trouble digesting since it isn't green in color, showing malabsorption in the intestines. It wouldn't hurt to jot down consistency and color in your food diary also. It will help you narrow it down to the most likely suspects and then can try eliminating them for a while to see the difference it makes.

  3. Dyan Raymond

    My grandson is 6 weeks old. He's had some BM complications. He's completely breastfed, now. His first BM in the a.m. is the most difficult for him. He struggles with it for about 30 mins to an hour. Why do you think that is? Also, my daughter and her husband eat late at night, because of his work schedule. Do you think that eating dinner, heavy foods late would have anything to do with his constipation in the morning?

    Thanks,

    Dyan

    1. Cheryl Taylor

      Is it larger in quantity than other bowel movements? Sometimes they can have their largest BM of the day first thing in the morning and they simply are unfamiliar with the feeling of it moving through their bowels when they are newborns. If it is soft in consistency when it makes its appearance there is no need for concern.

  4. Elysia

    My daughter, age 3 months suffers from reflux disease and is being treated with zantac. Today she had streaky blood in her stools which she has never had before. I understand this can be a food allergy but my diet has not changed (absolutely nothing new)so could it be something else? The GI specialist does not think that she has a food allergy. Also, I had my flu shot yesterday, could this have any affect? She is otherwise very happy and alert.

    Thanks

    1. Cheryl Taylor

      Do you have dairy in your diet? Your diet may not have changed but her reactions to a food may have increased. This is pretty common to see reactions increasing after six weeks of age. My first recommendation for a child with blood in stools is to eliminate ALL dairy from your diet.

  5. Allyson Philip

    Hi. I have a 3 1/2 month old little girl who has had loose watery/seedy stools since first born. She usually had up to 6 per day. Over the past month we have found red blood flecks in her stools. Her stools consist in color from yellow to green. Over the past few days they seem to be mucousy as well. When she was around one month we thought we saw a small fissure but when we saw our doctor recently he did not see or feel anything.

    I am strictly breastfeeding my daughter and I do not wish to supplement formula. I have read many different opinions on the internet as to what may cause this (fast let down, high milk supply, too much fore/hind milk, drooling, etc). I am one who has fast let down and an extremely high milk supply. My daughter is constantly drooling as well.

    She is an extremely active baby and is healthy, happy and gaining weight.

    Does anyone have any ideas or thoughts??

    1. Cheryl Taylor

      I would first suspect a reaction to dairy and eliminate all dairy in your diet. Secondly, have you experimented with nursing positions that helps to slow the flow of milk? If not, try nursing in football/clutch hold in a recliner or propped up leaning backward so that baby's head is ABOVE the level of the breast instead of below it. That is a position that often helps with oversupply or a fast letdown.

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