The infant’s first stools will be black and tarry. Referred to as meconium they are particularly thick and sticky. These stools are seen for the first 2-5 days of life.
Ultimately the infant will begin having thick slimy transitional stools. These usually continue for days 3 to 7 of life.
Finally, infants will go on to have typical breast-milk or formula type stools from day 5 of life until they start on solids. Breast milk stools are yellow and seedy, while formula stools are oatmeal consistency and yellow-green. Formula stools are generally firmer than breast milk stools.
The treatment of constipation may vary but can include the addition of juices; in particular the “P” juices which include apple, peach, pear, plum, prune and pineapple. We prefer single serving juices to prevent bacterial contamination. We usually dose at 2 oz two to three times a day. Other treatments include the use of dark corn syrup one tablespoon in to 2 to 4 oz of formula/pumped breast milk, two or three times a day and Polyethelene glycol (Miralax) 1-3 teaspoons in 4-6 oz of fluid.
Once an infant has started solids the stool will generally change in color, consistency, and smell. All earth tones yellow, green, brown, orange are considered normal even in the newborn. Black tarry stools and maroon stools are generally indicative of blood in the GI track and need to be evaluated. White or grey stools are signs of bile not being excreted by the liver. This can occur with viral gastroenteritis as well as liver disease and needs to be investigated. Black stools can be caused by exposure to Pepto-Bismol. Bright red stools can be caused by the antibiotic Omnicef. Blue stools are always caused by exposure to food colorings.
Diarrhea in infants is not defined by the looseness of stool but the number of stools per day. In general infants that stool more than the number of times they eat can be considered to have diarrhea. This may be caused by poor digestion of sugars or too much juice as well as by infections. The most common infections are viral and there is not much we can do about them except keep the baby hydrated and try and feed a modified BRAT diet which involves bananas, rice, apple sauce and toast, but also includes pasta, potatoes, lean meats, and fresh fruits and vegetables. Bloody mucousy stools, especially in the context of a fever is concerning for a bacterial or parasitic infection and requires prompt evaluation.
In the end, as they say, “poop happens” and “you can’t polish a turd” but I hope this helps with some of your questions about baby poop. Look forward to our next blog on poop in toddler’s and school aged kids.