poop emoji with a smiley face

There’s nothing like the arrival of a new baby to have parents talking about all sorts of topics they’d never have dreamed of in their single days. Stool (poo) is generally taboo but once you have a baby, it becomes a hot topic.

Passing a stool not only relieves a lot of discomfort but is also a very important function for the body. Passing a stool allows the body to excrete undigested food, gastrointestinal lining (which sheds its top layer every couple of days), as well as bacteria, which are naturally found in the digestive tract. The stool itself can tell you a lot about the overall health of your baby’s gut, as well as give warning signs of allergy, illness and food intolerances.

Should I be worried about the colour or consistency of my baby’s poo?

Parents are often concerned when the colour or consistency of their baby’s stool changes. In some instances this can be an indication that your baby is unwell but other times it may just be due to a new phase in your baby’s life, like the introduction of solids. So having some idea of what is normal and what isn’t may help parents distinguish between illness and natural stools.

Normal types of baby poo

  • Meconium

Soon after birth your baby will pass a dark, sticky stool which resembles tar or car oil. This stool is made up of skin cells, amniotic fluid, mucus and other products ingested while baby was still inside mommy’s tummy. Often a baby who is in distress during the birth will release meconium and this alerts the doctor or midwife that the baby may be in trouble.

Once born, your baby will pass the meconium. This usually occurs on the first or second day of life. It is important to notify the medical staff if your baby does not pass a meconium stool in this time.

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  • Breastfeeding stools

These stools can be explosive! They are usually bright yellow in colour with what looks like little mustard seeds in them. Parents often worry that their baby has diarrhoea but it’s normal for these stools to be runny. Breastfed babies may pass a stool after every feed, so eight times a day or as little as once every eight days. This is a very big range of normal.

If your baby is uncomfortable because of a lack of stools, try doing some tummy massage or knees to tummy. Breastfed stools also have a sweet smell to them, so not what you would expect from a child eating a solid diet.

  • Baby poo when they’re formula feeding 

Formula-fed babies generally have a normal brown or yellow coloured stool. The consistency should be closer to that of peanut butter. Formula-fed babies are prone to constipation and this can be distressing. It’s really important to ensure that the formula is mixed correctly – if mixed incorrectly, this may cause constipation. If your baby really struggles, please discuss various options with your healthcare provider.

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  • Baby poo when they’re on solid food

Once a baby starts eating solids the stool will become more formed. The colour is usually brownish but this may be influenced by whatever vegetables the child is eating. As the child grows up and moves to a predominantly solid diet it’s important for parents to still keep an eye on what’s going into the toilet. Children often see a doctor for severe tummy pain – parents often report that the child does go to the toilet but an x-ray or ultra-sound reveals severe constipation.

To make identification easier, below is a chart known as “The Bristol Stool Form Scale (for children).” It shows in picture form what the stools may look like. The sausage (type 4) or chicken nugget (type 5) stools are what we want to achieve – they are easy to pass and the child experiences no discomfort.

Bristol poop chart. baby poo: what's normal and what's not

The colour of baby poo: what’s normal & what’s not?

What does it mean if my baby has yellow, orange (the colour of butternut) or brown poo?

  • This is the normal colour for stools as described under breast and bottle feeding.

What does it mean if my baby has green poo?

  • Parents get very distressed by green poo.
  • It may be related to an iron supplement.
  • Green vegetables given from 4 to 6 months of age may also cause this colour change.
  • Food rich in fibre may cause the stool to pass through the digestive tract quicker than normal and, as a result, may have a greenish colour.

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What does it mean if my baby has black poo?

  • If stool is black or has black specks in it then this is often as a result of digested blood.
  • Breastfed babies may have black flecks in their stool if mommy has cracked nipples which may have blead while baby was feeding.
  • It can also be an indication of something a little more worrying so it is best to have this assessed.
  • Older children may also get a black stool from eating things like liquorish so keep that in mind.

What does it mean if my baby has red poo?

  • A child may pass a red stool if they have eaten foods like beetroot or berries. It does give parents a big fright because they think their child is bleeding so keep diet in mind whenever the stool colour changes.
  • Flecks of red blood may be as a result of a little tear in the anus especially if the child is constipated. This is known as an anal fissure and can be treated with a specific ointment.
  • Red blood in a stool may also indicate that the baby has a milk protein allergy and requires medical intervention.
  • A baby with red blood in the stool with diarrhoea may indicate a bacterial infection. In this case medical advice is necessary.

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What does it mean if my baby has white or clay-coloured poo:

  • This colour stool may be a sign that your child is not producing adequate bile. Bile is a digestive enzyme produced by the liver. Bile gives normal stool its brownish colour.
    White stool may indicate that the little tube which takes the bile from the liver into the intestine is blocked and should be evaluated as a medical emergency.
  • Certain medications may also cause a white stool.

Baby poo: what is NOT normal & when should you worry?

Diarrhoea

  • The stool may be brown or green but is very liquid and frequent.
  • This may be caused by illness or allergies. One needs to be very cautious that the baby does not dehydrate so medical attention is always advisable.

Hard or pebble-like stool 

  • Babies may become constipated when solids are being introduced, formula is changed or when the diet lacks fibre.
  • Constipation leads to excessive gassiness, sore tummies and stools may be painful to pass.
  • There are dietary interventions that need to be made but in the acute phase a baby may need medication. It is always best to discuss these issues with your healthcare provider.

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Mucus in the stool 

  • Babies who are drooling excessively or have a cold may be swallowing the mucus and this finds its way into the stool.
  • The stool may be a bit slimy and green in colour. It may also appear to have strings in it.
  • Certain infections may result in mucus in the stool. If you are uncertain of the cause it is definitely something that should be attended to by your healthcare professional.

Bad smell 

  • Stool never smells great but if your baby’s stool suddenly has a very strong smell, this may indicate an infection. Again it is something that needs to be assessed.

Colour

  • We have discussed the colour of stool above. It is really important that medical care is sought urgently for white stool.
  • If you cannot attribute the black or red colour to something your baby has eaten then medical attention is necessary.

Poo is often not spoken about until there is a problem. Pay attention to changes in bowel habits as this is often an indication that something is going on. It is really important that parents pay close attention to diarrhoea, constipation or colour changes.

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In older children, changes in bowel habits may be due to stress. As a paediatrician I often see these children for query appendicitis when in fact the child is suffering from acute anxiety resulting in severe constipation. Older children need to be drinking good amounts of water and eating adequate fruit and vegetables to keep the stool soft and easy to pass.

Ultimately, stools – or the lack thereof – can be a clue to many other concerns but when all is normal both baby and parents are happy and healthy.

References:

https://pediatrics.aappublications.org/content/10/4/414

https://www.pedialliance.com/page/newborn-care-bowel-movements

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1545825/

https://www.jpeds.com/article/S0022-3476(08)00878-0/abstract

Affectionately known as “Dr Rico” by his patients, Dr Maraschin is passionate about preventative medicine and building trusted relationships with parents and patients is a priority to him. Well-known among the community, he is highly regarded with providing the best care for babies, toddlers and kids. He has played a pivotal role in creating his well-deserved prestige, with a particular interest in neonatology, allergies, immunology and vaccinology. Dr Enrico F. Maraschin, MBBCh (Wits), FCPaed (SA)