What's okay -- and what to worry about -- in your baby's diaper.
A Newborn's Diaper
Dirty diapers are a part of any new parent's life. But it's still hard to imagine how a little baby can generate more than 2,000 messy diapers in the first year alone. With all the possible variations in the appearance, texture, and smell of baby's bowel movements, it's no wonder that many parents wonder and worry about what they find in their baby's diaper. Although there are typical patterns, infants and toddlers are individuals. Learning your child's patterns will help you interpret what's normal and what's not.
Most babies have their first bowel movement within the first two days of life. These stools, called meconium, tend to be thick, sticky, and tarlike. They consist of skin cells the baby shed and then swallowed while he was in the womb. After the meconium is passed, stools will vary depending on whether your newborn is breastfed or formula-fed. Breast-milk stools tend to be soft, seedy, and mustard colored, and babies will pass many small stools each day. It's normal for a breastfed 2-week-old to have eight to 10 stools a day. A formula-fed baby's stools are yellow to brown in color and firmer (think thick pudding) than the stools of a breastfed baby. Formula-fed newborns also pass fewer -- but larger and smellier -- stools.
By 1 month of age, your baby will poop less, regardless of how he's fed. The number of stools for breastfed babies drops to about four per day; formula-fed babies may pass a stool two times a day or as infrequently as once every three or four days. However, if your formula-fed infant goes more than five days or your breastfed infant more than three days without a stool, let your pediatrician know.
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When your baby starts solid food, at about 4 to 6 months, you'll notice new colors in his diaper. For example, green foods (pureed peas, spinach, beans) can produce green-colored stools, and orange foods (carrots, squash), can produce orange to yellow stools. Don't be alarmed -- orange, yellow, green, or brown stools can all be normal.
Baby food tends to make the stools of breastfed infants firmer and the stools of formula-fed infants softer, but in either case the stools will probably smell worse. Normally, when you introduce solids, you'll start your baby on rice cereal and foods such as bananas and applesauce, all of which tend to firm up stools. In most cases this poses no significant problem for your baby, but sometimes she can develop constipation. To combat constipation, balance your infant's diet with foods that soften stools, such as pears, peaches, plums, apricots, peas, and prunes.
Red-colored stools can often be explained by something your child ate or drank, such as fruit punch or tomatoes. But occasionally, a red spot can be blood. This is a frequent cause of alarm for parents, but in most cases blood in the stool is caused by nothing more than a fissure -- a tiny tear along the rectum that will heal by itself. Fissures can result from a parent's being a little too aggressive with a rectal thermometer or from a recent bout of constipation or diarrhea. However, blood in baby's stool can also be a sign of an allergy to cow's milk formula. Other signs that your child may have an allergy to formula include diarrhea, vomiting, skin rashes, and poor weight gain. Let your doctor know if your baby experiences any of these symptoms. If your baby has an allergy, she'll probably need to get switched to a hypoallergenic formula.
Once your child is 9 months to a year old, her menu expands to table food. Age 1 is also when your baby can start drinking whole milk. During this time, your baby's stools start to take on the familiar form and more consistent brown color of an older child's or adult's stool. And because toddlers don't always chew their food well, it's not uncommon to find pieces of undigested food, such as corn or peas, in their stool.
Many toddlers have fluctuating appetites, so problems with constipation become more apparent. Too much milk (more than 32 ounces a day) can also cause constipation. Constipation is simply defined as having stools that are difficult to pass because they're too hard. But how do you know if your baby's constipated? Many babies will grunt, push, or strain when passing stool -- these exertions are normal. When your baby is straining, you can try picking him up so gravity helps his efforts, or lightly hold his knees against his chest to help him squat -- the natural pooping position. However, although a certain amount of straining is normal, crying while straining may mean your baby is constipated and in pain from trying to pass hard stools.
Birth to 4 months: In infants up to 4 months old the most common reason for constipation is not getting enough fluid. Breast milk or formula should provide enough, but if you're using formula, make sure you're mixing enough water with the formula according to the manufacturer's directions. If that's not the problem, encourage your baby to take in more fluids, whether that means nursing more or offering more formula than usual. You can even give a few ounces of plain water or a rehydration solution, such as Pedialyte. Your doctor may also recommend adding a sugary substance, such as Karo syrup, to breast milk or formula. Sugary substances draw water into the gut, softening the stool, and are gentle on a baby's stomach. Besides giving your baby fluids, you can also tickle his anus with the tip of your little finger to help what's in there come out.
5 to 11 months: For constipated babies older than 4 months who have started solids, you can help soften stools by increasing the fiber in their diet by adding more fruits and vegetables at each feeding. Some babies may also benefit from 2 to 4 ounces of additional fluid in the form of apple juice or diluted prune juice. Your doctor might recommend over-the-counter infant glycerin suppositories too.
Age 1 and up: For babies older than 1, your doctor can prescribe enemas, laxatives, and stool softeners, although these are used only in severe cases. If you suspect too much milk is the reason for your toddler's constipation, limit the amount she drinks to 24 to 32 ounces a day.
You may have heard that iron in formula causes constipation, but there's no evidence that this is true. Infants should never be placed on a low-iron formula unless it's advised by their pediatrician. Babies born at full term have enough stored iron to last four to six months, but by 6 months of age these stores are too low. Then the baby is at risk for anemia over the next several months. Iron-enriched formula (and iron-fortified cereals once your baby's on solids) can ensure that he will have enough iron for the first year.
Diagnosing diarrhea is tricky, because every baby's normal stools vary in how watery they are, but we usually define diarrhea as a sudden onset of frequent bowel movements that are more watery than usual. The main concern with diarrhea in infants and toddlers is the risk of dehydration. Contact your doctor if you see any signs of diarrhea, especially if your baby is under 4 months old, or is showing signs of dehydration (dry mouth, crying without tears, or going eight hours without producing urine).
Common causes of diarrhea are changes in diet, use of antibiotics, and various stomach viruses. Your baby is most susceptible to stomach viruses that cause diarrhea if she has older siblings who may pass them on, or if she's in day care. Since viruses are transmitted from hand to mouth, the best prevention is frequent hand washing.
Birth to 4 months: Diarrhea is most dangerous for babies 4 months old and younger because they can lose a lot of fluid very quickly. If you're breastfeeding, continue to do so; it helps prevent the diarrhea from worsening and aids your baby's recovery. You may need to supplement breast milk with water or Pedialyte to keep your baby well hydrated.
If your baby is on cow's-milk-based formula, ask your doctor about switching to a soy-based formula, which can help slow diarrhea down. You only need to do this until the diarrhea goes away, usually within seven to 10 days. You can also supplement the formula with Pedialyte. But if your baby's diarrhea is not getting any better while she's on formula, your doctor may recommend giving her only clear liquids for at least six but not more than 24 hours before trying formula again -- this lets the bowels rest and facilitates healing. If after up to 24 hours of clear liquids the stools are still very watery, call your pediatrician.
5 months and up: If you have an older baby who takes solid foods, combat her diarrhea with clear liquids, bananas, rice cereal, applesauce, and toast, all of which slow down the stools. This combination of binding foods is known as the BRAT diet. Pedialyte, grape-flavored Kaoletrolyte, or frozen Pedia-Pops will help your baby stay hydrated. Avoid fruit juices, pears, peaches, plums, prunes, and apricots until the stools are back to normal.
Toddlers can sometimes resist eating and drinking when they're sick. They may be more willing to drink ginger ale or eat Jell-O or flavored Pedia-Pops, but you can also try crackers and the BRAT diet. Other helpful foods include chicken broth or soup and plain pasta. Avoid spicy, fatty, and citrus foods, and possibly dairy, until the diarrhea passes.
The most widespread and serious infectious cause of diarrhea is rotavirus. It's an extremely contagious virus and hits children younger than 2 the hardest. The rotavirus high season is December to April. Children attending day care or those with older siblings are at an increased risk.
What differentiates rotavirus from the run-of-the-mill stomach virus is that its onset is more dramatic. The infection starts with a fever, followed by vomiting and irritability. The vomiting goes away in one or two days, followed by watery diarrhea that lasts from three to nine days. The most important thing is to keep your baby hydrated; vomiting and diarrhea can put her at high risk for dehydration. To determine whether your baby has rotavirus, your doctor would have to perform a test on her stool. If it's positive, he'll advise you to be more aggressive about making sure your baby gets plenty of fluids.
Copyright © 2003 AmericanBaby.com.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.