When It's Time to Change, The C's Edition: Color and Constipation

By Michelle Place, CRNP-P
Before becoming a parent you probably never thought you would be so interested in the bowel habits of another person. Now that your little one has arrived what is happening (or not happening) in their diaper has probably become a bit of an obsession. Since you will change something like 3,000 diapers in the first year alone, no one can blame you. Let’s talk a little bit about what you should expect to find there.
Oftentimes the colors you find in your baby’s diaper may cause some concern. Rest assured, it is much more likely that the changing appearance of your baby’s stool is caused by what was eaten rather than by disease.
Earth Tones are Normal: Any of the earth tones are not cause for concern: yellow, green, orange, brown. A changing palette in your baby’s diaper is expected, especially as they get older and start eating a greater variety of foods.
Baby’s cold symptoms up top affect what happens down below: You know that lots of mucus in your baby changes things up top resulting in runny nose, sneezing, and coughing but did you know it also changes things down at the bottom? They are swallowing all of that mucus which passes down and out through the diaper affecting the color and consistency of stool as well.
There are three colors we do not like the stools to be:

  1. Red: can be caused by blood from lower GI tract so it should be evaluated by your doctor, although 90% of the time the red color is not from blood. Usually it is from something your baby has eaten.
  2. Black: can be caused by old blood from the stomach because stomach acid turns blood black. Note: green stool is normal, the color is caused by bile which is an important part of digestion, but dark green can be mistaken for black. Just take a close look before you panic.
  3. White or light gray: Stool that has no color at all can be an indicator of liver disease and should be checked out by your doctor.

Straining in Newborns: In brand new babies it often looks like they are working very hard to pass stool. They go all red in the face, they are clearly straining, they fuss and cry then they successfully fill their diapers and seem much more relaxed. Parents often conclude that there is a digestion problem and want to know what they should do to make their babies more comfortable. The answer is: nothing. What is actually happening is that your baby is learning how their body works. If you think about what needs to happen in order to successfully pass stool, it is a pretty complex process. You need to push in one place and relax in another. These two muscle groups are controlled by different nerves. As a result, a new baby’s immature nervous system often gets it’s wires crossed so your baby is pushing and squeezing where they should be relaxing. All that red faced straining and crying is frustration, not pain. As long as the stool comes out soft, your baby is not constipated.
In Breastfed Babies Stools Can Be Few and Far Between: As much as we dislike changing diapers, it is concerning when we suddenly do not need to. It is important to know that in infants, the definition of constipation is not how often the stools are happening but in how hard the stools are when they do. For reference, it is important to know what to expect.
Formula fed infants tend to have soft bowel movements at least once daily.
In breast fed infants things change as your baby grows. In the first month if they pass stool less often than once/day it might mean they are not eating enough and a visit to the office for a weight check is in order. After the first 4-6 weeks, however, your breastfed baby can go several days or even a week between bowel movements and THIS IS NORMAL. Stool is a waste product, what we do not need during the digestive process we eliminate as stool. Breast milk is the perfect food for babies so they often use every drop they take in to make baby and so do not have extra to eliminate as stool. No matter how long it has been, if the stool comes out nice and soft there is no reason for concern, although if a week has gone by a gas mask may be in order.
Hard Stools
Sometimes all of that straining does result in little hard balls of stool. This is not normal. It often happens after solid foods are introduced. Make sure that your little one continues to take in enough fluids (breast milk, formula, water) as their diet transitions from all liquids.
Avoid juice: As a rule juice is not a great choice as a source of fluids for babies. It is a lot of sugar with very little nutritional value. Most of us would feel uneasy about pouring soda into our baby’s bottle, but pouring juice in is essentially the same thing.
The exception to this rule is if your baby’s stools are coming out as hard balls like rabbit pellets. After the first month of age adding a little pear, prune, or apple juice may help. The sugars in fruits are not digested well so they help to draw more water into the bowel which softens stools. Babies can take up to one ounce of juice/day for every month of life. For example, if your baby is 4 months old you do not want to give more than 4 ounces of juice in one day. It is best to start with 1-2 ounces/day to see if that helps than increase the amount as needed. If stools continue to be hard call 301-279-6750 to check in with an advice nurse or to schedule an appointment with one of our doctors or our amazing physician’s assistant.