Your baby's stool: what's normal and what's not

It's amazing how much time we parents spend inspecting our babies' nappies! We tend to worry that our baby's stool is the wrong colour or texture, or that she's passing stool too often, or not enough.

First of all, what's normal for your baby will depend on:

• how old she is
• whether she's breastfed or formula-fed
• whether she's started solids

Your baby's stool will change as she develops from a newborn through her first year. They may also change from one day to the next! You'll soon be able to tell what's usual for her.

There's no need to worry if your baby's pooping pattern stays fairly consistent, she's acting like her usual self and steadily gaining weight. But if there's a sudden change or you notice signs that she's uncomfortable or unhappy, give your doctor a ring.

What will my newborn's poos be like?

For the first couple of days after the birth, your baby will pass meconium. Meconium is greeny-black in colour, and has a sticky, tar-like texture. It is made up of mucus, amniotic fluid, and everything your baby has ingested while she was in your womb (uterus).

Meconium may be difficult to wipe off your baby's tiny bottom, but its appearance is a good sign that her bowels are working normally.

What will my baby's stool be like if I'm breastfeeding?

Your colostrum, or first milk, acts as a laxative, helping to push meconium out of your baby's system. Once your milk comes in, after about three days, your baby's poos will gradually change. They will be:

• At least the size of a coin.
• Lighter in colour, changing from a greenish-brown to bright or mustard yellow. This yellow poo may smell slightly sweet.
• Loose in texture. The poos may seem grainy at times, curdled at others.

In the early weeks, your baby may poo during or after every feed. On average, she will do about four poos a day in the first week. This will slowly settle down and her bowels will work out their own routine. You may then find that she poos at a similar time each day.

After the first few weeks, some breastfed babies will only poo once every few days or once a week. This is not a problem as long as your baby's poos are soft and are passed easily.

Your baby's routine may change:

• when you introduce solids
• if she is feeling unwell
• when she starts to take fewer feeds

Will formula-feeding affect my baby's poos?

If you are formula-feeding your baby, her stool may be different from a breastfed baby's. You may notice they are:

• Bulkier in texture than a breastfed baby's (a bit like the texture of toothpaste). This is because formula milk can't be digested as fully as breastmilk.
• Pale yellow or yellowish-brown in colour.
• Strong-smelling, more like an adult's.

Formula-fed babies are more prone to constipation than breastfed babies. Talk to your doctor if you feel your baby has a problem.

Will my baby's potty change if I switch from breastmilk to formula milk?

Yes, they will. You may notice that your baby's poos become darker and more paste-like. They will also be smellier!

While you're making the change from breastmilk to formula, try to do it slowly, ideally over a period of several weeks.

This will give your baby's digestive system time to adapt and help to prevent her from becoming constipated. It will also reduce the risk of painful, swollen breasts and mastitis for you.

Once your baby has adapted to the bottle, she may settle down into a completely different potty routine!

What will my baby's poos be like when she starts solids?

Starting your baby on solids will have a dramatic effect on her poos. You'll find that her poos are affected by the foods she eats. If you feed her pureed carrot, the contents of her next nappy will be bright orange.

You may find fibre-rich foods such as kidney beans (rajma), peas (matar), shredded raisins (kishmish) pass straight through your baby and end up in her nappy. This will change when she gets older and is able to digest fibre more efficiently.

As she moves on to a wide variety of foods, your baby's poos will become thicker, darker, and a lot more smelly. Learn more about how your baby's potty changes when she starts solid foods.

What sort of potty is not normal in babies?

Diarrhoea
Your baby may have diarrhoea if:

• her potty is very runny
• she is pooing more often, or passing larger amounts than normal
• the poo is explosive or spurts out of her bottom

If you are breastfeeding your baby, she is less likely to suffer from diarrhoea. This is because your milk helps to prevent the growth of the bacteria that cause it.

Formula-fed babies are more prone to infection, which is why it's so important to sterilise equipment and always wash your hands thoroughly.

If your baby has diarrhoea, the cause could be:

• an infection, such as gastroenteritis (stomach flu)
• too much fruit or juice
• a reaction to medication
• a sensitivity or allergy to a food

If you're formula-feeding, feeds not made properly can cause diarrhoea. Your baby could also be reacting badly to the brand of formula you're using. But talk to your doctor before you switch brands, in case there is another cause.

If your baby is teething, her poo may be looser than normal but it should not cause diarrhoea. If your baby has diarrhoea, don't assume that her teething is the cause. It's more likely to be an infection.

In an older baby, diarrhoea can also be a sign of severe constipation. Fresh poo may be leaking out past a blockage of hard poo.

Always call your doctor if you suspect your baby is unwell, especially if she's under six months. Loose, watery stools should be brought to your doctor's notice right away as your baby is at risk of dehydration.

Constipation
Many babies turn bright red and push hard when they do potty. This is normal.

Constipation, on the other hand, is when:

• Your baby seems to have real difficulty doing a poo.
• Her potty is small and dry, like little pebbles. Alternatively, they may be large and hard.
• Your baby seems irritable, and she strains and cries when she does a poo.
• Her tummy feels hard to the touch.
• Her stools have streaks of blood in them. This can be caused by tiny cracks in the skin, called anal fissures, caused by passing hard poos.

Breastfed babies don't tend to suffer as much constipation as formula-fed babies. Breastmilk contains all the right nutrients to keep their poos soft.

Mixing up formula milk with too much powder can lead to constipation. Always follow the instructions when making up a bottle. Make sure you put water up to the recommended level first before adding the powder.

Constipation can also be caused by:

• fever
• dehydration
• changes in how much your baby drinks
• a change in diet
• certain medications

Sometimes, older babies become constipated because they are trying to avoid pain. For example, they may have a tear in the skin around the opening of their bottom (anal fissure). This can become a vicious cycle. Your baby holds on and gets more constipated, and then the pain is even worse when she does eventually go.

Always take your baby to your paediatrician as soon as possible if she's constipated, particularly if you notice blood in her potty. He will be able to check out all possible causes.

You'll probably be advised to increase your baby's fluid intake, as well as the amount of fibre in her diet, if she is on solids. Giving her purée prunes (munakka) or apricots (khubani) can be a good way to do this.

Very rarely, constipation could be due to a medical condition. Learn more about constipation in babies.

Green stools
If you're breastfeeding, the occasional green poo is nothing to worry about.

Green poo means she's probably getting too much foremilk (the low-calorie milk) that comes first in a breastfeed, and not enough of the high fat hindmilk that comes towards the end. Altering your breastfeeding technique and letting her feed for longer at each breast should remedy this.

But if your baby is consistently doing explosive green poos, it may be because she's feeding too fast. When a fast flow of milk hits her empty tummy, it can create air bubbles, leading to poor digestion.

Try laid-back breastfeeding. This is a relaxing, comfortable position for your baby, and it also helps to stem the flow of your milk if you have a fast, powerful let-down.

If you are feeding your baby formula milk, the brand you are using could be turning your baby's poo dark green. It may be worth switching to a different formula recommended by your doctor, to see if that has any effect.

If the symptoms last longer than 24 hours, see your baby's paediatrician. The cause may be:

• a food sensitivity
• side-effects of medication (iron supplements can make your baby's stool dark).
• your baby's feeding routine
• a stomach bug

Very pale poo
Very pale poo can be a sign of jaundice. Jaundice causes your newborn's skin and the whites of her eyes to look yellow, and usually clears up within a couple of weeks of birth.

Keep in mind that in the more common form of newborn jaundice in babies the urine colour does not turn yellow, and the stools have some colour (yellow, mustard, brown and so on).

Pale stools are not normal and need to be checked at the earliest. If you're not sure what's normal and what's not, take photos of your baby's stool and show them to your doctor.

Tell your doctor if your baby is passing very pale, chalky white, poos. This can be a sign of liver problems, especially where jaundice lasts beyond two weeks.

Poo with streaks of blood
Your baby's stools may be flecked with blood if she's constipated. This is because straining can cause tiny splits in the skin around her anus (anal fissures). These bleed when she has a bowel movement.

Sometimes it could be a sign that her intestines are irritated by an infection or allergy. Always get any blood in your baby's stools checked out by your doctor.

Sometimes the blood in a baby's poop looks black, which means it's been digested. When this digested blood appears in a baby's diaper – usually in little specks that look like black poppy (khus khus) or sesame (til) seeds. It's often because a breastfed baby swallows blood from her mother's cracked and bleeding nipples.

While this is a sign that you need medical advice and some pain relief, it doesn't pose any threat to your baby. You should still call your doctor to make sure it's not something more serious, like bleeding from your baby's upper intestinal tract.

Thick black poop made up mostly of digested blood (called melena) needs immediate medical attention. It's usually dark and tarry like meconium but a bit firmer and less sticky.

Sometimes iron supplements can make the stools appear dark. You could stop the iron supplements for a few days to see if the colour returns to normal. Then restart them again to see if the stools turn dark again.

Some families also use alternative medicines that may also change the colour of their baby's poop.

Whatever the case, speak to your baby's doctor so he can reassure you that all is well.


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