Facts verified by Dr Scott Dunlop.
Because there are many things that can affect a baby’s bowel movements ranging from whether breastmilk or formula is being given through to changes caused by teething or sickness, it can sometimes be difficult for mums to tell when things aren’t normal. Here’s a simple guide to help mums decipher the contents of their baby’s nappies in the first twelve months.
First few days after birth
A newborn baby’s bowel movements in the first few hours of life should be meconium, a dark green to black coloured stool that is the combination of all the waste the baby has accrued in their intestines throughout the nine months of pregnancy, including amniotic fluid, bile, mucus and discarded skin cells.
By breastfeeding soon after birth, the colostrum that a mother produces in the first few days helps the baby to pass this meconium soon after being born, by prompting the baby’s digestive system to start performing so that the bowels are emptied numerous times a day, sometimes up to ten times in twenty four hours.
If breastfeeding is not possible, and a baby is being given formula, meconium should still be passed, although it may take a little longer. It is only after the first few days that the stools between breastfed babies and formula fed babies will appear different and they can often remain quite similar in appearance.
If a baby is still passing meconium after a few days or has not passed meconium at all after 24 hours, you should advise your doctor because it could be a sign of an intestinal blockage or other problems.
Next few weeks
Once a mother has started producing milk instead of colostrum, a breastfed baby’s bowel movements will change from meconium to a smoother brown substance initially and then a yellowy-greenish one and be of a loose, runny consistency with a very light odour. The frequency at which a baby is nursing will speed up the process of change in colour and it’s not unusual for some breastfed babies to empty their bowels after every feed in the first few weeks. Watery stools may indicate that your baby is consuming more of the foremilk than the hindmilk when breastfeeding so mothers should adjust breastfeeding techniques so that the baby’s intake of hindmilk is increased, if this is happening.
Formula fed babies stools can be yellow, light to dark brown and green, with a texture similar to peanut butter, depending on the amount of formula the baby is having. They will have a slightly stronger odour than a breastfed baby’s stool and formula fed babies will probably poop less too, although they can still go several times a day. Constipation is more common in formula fed babies, and consequently constipation can occur when switching a baby from breast milk to formula. It is important to ensure formula is being made correctly if constipation does become a regular problem.
One month onwards until starting solids
Both breastfed and formula fed babies will have less bowel movements as they grow, but it varies between babies. Some babies may only go once a week or once every few days, and some other babies will still poop at least once a day. It is more important that a baby is frequently urinating and eating.
After starting solids (generally six months onwards)
Upon introducing solids to a baby’s diet, bowel movements can alter in colour, odour, consistency and frequency on a day to day basis, and there is usually nothing to worry about unless the stools appear different in any of the following ways, for which there can be several reasons:
- Diarrhoea could mean that the baby is insensitive/intolerant to a food that has been eaten (lactose is a common culprit) or in babies who are still being breastfed while starting solids, it could also be something the mother is consuming (either food or medication) and adjustments will need to be made to the diet of the mother or the baby. Diarrhoea that lasts longer than a day should be reported to the doctor as it could be related to an infection or a virus.
- Blood in a baby’s stool is not normal and could be a sign of broken skin caused by diaper rash, food or milk allergies, infection or even intestinal problems. Small streaks of blood are often caused by skin tears when passing stools due to constipation but it’s always best to confirm the reason with the doctor if there is any blood present.
- If a baby has a bloated stomach and strains or cries while passing stools that are very hard and cause a lot of discomfort, it is likely to be because of constipation. Babies are more prone to constipation in the early days of being weaned onto solids, until their digestive systems adjust to the new foods they are eating. This can often be helped by boosting fluid and fibre intake, but can also be a sign of an underlying medical condition such as hypothyroidism or coeliac disease, so it shouldn’t be overlooked. But do not give your baby laxatives for the constipation, unless you have been told to do so by a doctor.
Dr Scott Dunlop is a consultant paediatrician at Sydney Paediatrics, Woollahra.