Working as a Maternity Nurse in Hong Kong has blessed me with the opportunity to give welcome advice on a huge list of new mommy concerns - topping that list is the subject of Poo.
"Has she pooped?" "What time did he poo?" "Why is her poo green?" "He pooped 3 times today, is that normal?" ... and many other similar questions related to, yes you guessed it - POO. If you're reading this as a soon to be first-time mum, the obsession with poo is something you're not likely to be familiar with, but once your little bundle arrives you'll too be joining the ever growing list of stool gazers - trust me! Everything that goes in must come out, and being responsible for the "everything that goes in" will rightly have you obsessing over the "everything that comes out" ... not surprisingly really, where by the end of year one you'll probably have changed in excess of 2,300 diapers! It's a dirty job but someone has to tell you, so without further ado let's get down to discussing poo.
Newborn Baby Poop:
Greeny-black, tarry, sludgy, sticky
For the first few days after the birth, your new baby will pass green-black poo, called Meconium. #meconium This sticky, almost tarry poo is composed of amniotic fluid, mucus, bile, water and other products your baby ingested while in your uterus. Although quite a disgusting sight for first-time parents, it's appearance signals that baby's bowels are working normally.
Fortunately it has no smell which is wonderfully beneficial for easing you slowly into the diapering game, however because of its high viscosity it does have the tendency to cling to baby's skin. To avoid the extra elbow grease required during meconium diaper changes you may want to apply a little organic coconut oil to baby's bottom, which will not only help in removing the meconium in one sweep, but is also very nourishing for baby's skin.
Frequency:
During the meconium phase, your baby may have four or five stools spread out over two or three days. Once your colostrum develops into mature milk, he/she should have at least two to five bowel movements in a 24-hour period for the first six weeks. It is possible, and actually quite likely for baby to have a bowel movement every time you change his/her diaper.
Transitional Baby Poop:
Green, less sticky than meconium
Around 2-4 days after birth, baby's poo will begin a
transitional phase, and you'll notice that it has taken on a less sticky texture and be brown/green or slightly lighter than the meconium in colour. It may also contain whitish curds. This transitional stage usually presents itself in 3 stages, each lasting
a varying amount of time, but becoming less sticky and lighter in colour through each stage. The timing of this transitional
phase is largely dependent on when your milk comes in, and how much of it your baby is ingesting.
Breastfed Baby Poop: Yellowish, seedy, curdy
A breastfed baby’s poop will be yellowish-green and grainy, or seedy. Those little “seeds” are undigested milk fat, and are totally normal. Unlike formula-fed baby's poo, breastfed baby poo doesn't have an offensive smell as such, and can be described as having an almost sweet/yeasty type aroma.
Diapering, or removing breastfed baby poop from skin is easier than meconium, however I should add that it can (and will at times) be messy business! Which brings us on to the subject of Projectile Poo - aptly coined as it most definitely comes with some force behind it!
Please heed this advice:
Have a new diaper ready for use, as soon as you remove the soiled one.
Slipping the new diaper underneath before removing the soiled one, even better.
Not having to clean baby poop off those newly painted nursery walls, priceless.
Projectile poo is explosive, and the truth is, you haven't been officially initiated until you've had to deal with a diaper blow-out. Be prepared!!
"I once worked with a family who had decorated their new baby's nursery Beatrix Potter style - beautiful pastel tone-on-tone in feminine shades, wallpaper design featuring Peter Rabbit along with his friends Benjamin Bunny and Jemima Puddle-Duck, long flowing white drapes hung at the windows and plush wall-to-wall white carpeting covered the floor. Exquisitely decorated ..... until that first projectile poo that literally flew about 8 ft across the room, drowning poor Peter Rabbit and Co and staining the curtains (and carpet!)"
Your breastfed baby's stools may change in colour, and you may even notice the occasional green poo, which is all quite normal. Should you notice an increase in green poops however (these can also be quite frothy), it could suggest a foremilk/hindmilk imbalance, or an intolerance to something in your diet, like cow's milk.
Frequency:
Pooping after every feeding is especially common in breastfeeding newborns, and is a good sign that your milk has come in and that baby is feeding well. The typical average for babies under the age of 6 weeks, is at least 3 soiled diapers a day. Less than this, could suggest problems with your milk supply and that baby's intake is insufficient - this would especially apply to those babies who are failing to gain weight. At around the age of six to eight weeks weeks, the pooping pattern of a breastfed baby may change, and it is not uncommon to skip days, or even 1 week between bowel movements. This does not mean that they are constipated, but more that breast milk compliments your baby's nutritional needs so perfectly that it results in very little wastage. Consistency is often more meaningful than frequency, and provided your little one is gaining weight, the odd missed poo should be no cause for concern.
Formula Fed Baby Poop
Light brown, pasty
The texture, colour, smell, amount, frequency, and colour of a formula fed baby's poop is different to that of breastfed babies. 'Formula poo' is thicker, it's light brown in colour (opposed to yellowish), and it has more of a pungent smell (although less offensive than a baby already eating solids)
Frequency:
Formula-fed babies often have bowel movements less frequently than breastfed babies. But it's normal for them to poop after every feeding as well. Exclusively formula-fed babies are more prone to constipation than their breastfed counterparts, as formula bulks up poop much more than breast milk does. The possibility of an intolerance or milk-protein allergy also exists with formula feeding which could in turn result in constipation. Again, as is the case in breastfed babies, consistency is often more important than frequency. If your baby shows no signs of discomfort (crying in pain, rigid or distended tummy), and is gaining weight, then skipping a few days here and there between poops should be no cause for alarm.
If your baby seems uncomfortable however, shows signs of excessive straining during a bowel movement, or presents hard, solid poops, then they are probably constipated and advice should be sought from your doctor. In the interim, you can try the following:
Massaging your baby’s tummy. Applying light pressure, begin at the base of the rib cage, massaging in a circular, clockwise motion, gradually decreasing the size of your circles until you reach the navel. (This should not be attempted if the umbilical stump is still in place, or not fully healed.)
Holding baby’s knees and feet together, gently press knees up towards the abdomen. Release, and repeat.
To help release trapped gas, gently rotate baby’s hips a few times to one side, then to the other side.
Green, Frothy Poop:
A fore-milk/hind-milk imbalance is a possible sign of green, frothy poo. I'll say again - possible, not definite.
The composition of breast milk and it's production is a subject that deserves it's own post, but for the purposes of slight elaboration it's worth having a quick rundown. Consisting of a low fat content, and high lactose content, fore-milk is the thinner more watery milk that your nursing baby gets first. (If pumping, you'll notice that this has a bluish-grey colour to it, opposed to the creamy white colour of the hind-milk.) This milk helps quench your baby’s thirst before moving on to the higher-fat, more creamier milk that follows, which is known as hind-milk.
In the case of your milk production being too high, your baby may fill up sufficiently before the hind-milk is released, thereby ingesting an unbalanced amount of each type. This is sometimes referred to as oversupply - something to be proud of really, as it's always better to have too much than too little!
Should this be the case (confirmed by your doc, or breastfeeding counsellor) it can easily be rectified by allowing your baby to "drain"one breast entirely before switching sides. This will ensure that he/she has enough time to reach the hind-milk of the one side, before being offered the fore-milk of the other side. You may also consider a few minutes pumping the second breast before offering it to baby.
Green poo, may also indicate an intolerance to something in your diet; Rotavirus (a virus that infects the bowels, resulting in inflammation of the stomach and bowels - gastroenteritis); or in some cases, can simply be normal.
Hard, Dry, Pellet-shaped Poop:
Although it's quite rare for a baby on an all-liquid diet to experience constipation, it can occur. Formula-fed babies are much more likely to suffer from constipation, as formula takes longer to digest and firms up poo considerably more than breast milk does.
A constipated baby will show signs of discomfort, and the extra straining can result in a small amount of blood being passed with the poo. This is by no means to say, that all signs of straining are related to constipation, so don't be alarmed if you see your little one bearing down. Babies lack abdominal muscle tone, so even soft poop takes work to expel!
Unless instructed to do so by your doctor, don't give your newborn any water - this is something you may hear older relatives suggesting, but it does pose the risk of causing electrolyte imbalances which can sometimes be fatal. Breast milk and formula contain the perfect balance of potassium, sodium, and other electrolytes, and giving water can upset this delicate balance and put undue strain on baby's kidneys.
Black Poop:
Black poop is ONLY common during the early days in the form of meconium, OR in the case of baby receiving iron-fortified formula or supplementation - and even then, poo takes on more of a dark-greenish tinge opposed to black. Should you notice black poo, please consult your doctor.
Chalk-coloured, Pale Poop:
It is quite normal for formula fed babies to have light-brown poo. What is NOT normal, is pale, ivory/whitish-coloured poo. This could signal a very serious underlying problem caused by lack of bile, and would need immediate consultation with your doctor.
Blood Stained Poop:
Seeing blood in your baby's poop is without a doubt quite alarming, however it may be comforting to know that virtually all babies will have small streaks of blood in their poo at least once during their infancy. The small streaks of blood you're seeing are most commonly caused by a tiny tear to the inside skin of the anus - more commonly known as an anal fissure. This can occur through the abrasive effect of the movement of large amounts of stool through the anal canal. It's usually nothing to worry about, rectifies itself, and you're likely to only see it once or twice. It is also possible that baby may have ingested some blood, in the case of you having cracked nipples. Both situations, quite normal.
If you're seeing more than just streaks of blood, and his/her poo seems mucousy, it could signal an irritated intestine (colitis) - the most common cause being an intolerance or allergy.
Occasionally, young babies will react to proteins in breast milk so if your little one is experiencing these symptoms it's time to filter out the culprits from your diet. The most common of these being cow's milk, and any secondary products of this, as cow's milk protein allergy has been linked to the colitis experienced by some babies. Other offending products you may consider eliminating are eggs, wheat and peanuts.
Elimination diets can be particularly stressful for a new mum, so it's definitely worth having a chat to your doctor first, to establish whether this is really necessary.
Blood Stained Discharge
It's common for baby girls to have a blood-stained discharge during the first few days of their life, and should be no cause for alarm. This mini period, or pseudo-menstruation is the result of the withdrawal of your hormones following the birth. Should this occur in a boy baby, he is likely to have undergone circumcision and the presence of a few drops of blood during the healing process is absolutely normal.
"Maternal instinct holds a lot of weight. If something doesn't seem right, reach out for advice."