New babies don't come with an instruction manual, but they do leave clues about the state of their health. Hiding in a baby's diaper is a wealth of information, and many new parents understandably find themselves spending a lot of time and energy trying to decode the messages left for them -- the amount, the color, the consistency -- and what it all means.
So what does the content of a baby's diaper say about his or her health? And when should you be worried about what's in the diaper? Here's expert advice.
How Much Poop Is Normal?
"A lot," says Kenneth Wible, MD, associate professor of pediatrics at the University of Missouri and pediatrics medical director at Children's Mercy Hospitals and Clinics in Kansas City, Mo.
"It depends somewhat on diet," Wible says. "Babies who are breastfed generally have more and thinner stools than babies who are formula fed. But five to six stools per day is pretty normal."
While it's a good idea to expect a lot of poop in the early stages of a baby's life, the frequency of bowel movements among children varies widely, notes Barry Steinmetz, MD, a pediatric gastroenterologist at Miller Children's Hospital Long Beach in Long Beach, Calif.
"Some kids will go up to seven or eight times a day," he says. Other infants may go every other day.
Many parents become concerned when an infant's bowel movements suddenly drop in frequency. But particularly for breastfed babies, this is a common occurrence as a mother's milk becomes more mature.
"The mother's milk is so well balanced and the baby's digestive processes are so good, there's not a lot of residue," Wible says.
The key, Steinmetz says, is that the stool is soft and the child is eating well and gaining weight.
There's often a large amount of liquid content in babies' stool because before six months, doctors recommend that babies get their nutrients exclusively from milk.
"It kind of looks as if you took a jar of mustard and mixed it with cottage cheese, especially for formula-fed babies," Wible says. "With breastfed babies, there is a lot more liquid and the milk curds in the stool are a lot finer and smaller."
Is It Constipation?
It's not simply the absence of stool but stool that is formed or looks like pellets that should tip you off that your child may be constipated.
Very firm or pebble-like stools require a call to the doctor. This can sometimes indicate that the child is dehydrated. Other signs of dehydration might include decreased tears, lack of saliva, and a sunken look in the eyes and the infant's soft spot. The soft spot, also called anterior fontanelle, is a space between the bones on the top of an infant’s skull. The soft spot can be present until about 2 years of age.
Most parents are concerned that the pained, red-faced look their baby gets while pooping means straining and constipation. That's usually not the case.
"A baby doesn't know how to ... contract the abdominal musculature and push," Steinmetz explains. "Plus, they don't have gravity helping them like when you sit on a commode."
By the age of 1, most kids have it worked out and lose the tortured look.
Signs of Diarrhea
When it comes to diarrhea, parents sometimes have a hard time knowing what they're dealing with because infants' stools are naturally loose. But looking for subtle changes in a baby's poop is often a waste of time, Steinmetz says.
"Blow-out diarrhea that goes up the back is not that subtle," he says. And it's just the kind of outburst that is common when diarrhea strikes very young children.
Call your doctor right away if there is diarrhea, especially with newborns, Wible advises. It can signal something more serious, such as a virus or other systemic illness dangerous for very young children.
What Does Color Mean?
Baby poop changes color and it's a constant concern for parents. But for the most part, it needn't be.
"Color has not much to do with anything except the transit time of food [in the baby's system] and the bile coming through the GI tract," Steinmetz says.
The poop color timeline works like this: Yellow means milk is moving through the baby's system quickly. When the process slows down, poop becomes green -- and can unnecessarily worry parents. Even slower, poop turns brown.
"That's why infants often have yellow stools, because they have a very fast transit time," Steinmetz says.
Colors of Concern
The main colors that should concern a parent and prompt an immediate call to the pediatrician are white, red, and black.
White poop can indicate an infection or a problem with bile, which is a fluid produced by the liver that aids digestion. Black is a sign of digested blood in the gastrointestinal (GI) tract, and red indicates fresh blood that could be coming from the colon or rectum.
That's no cause for alarm, and your doctor may be able to perform a test to tell who the blood belongs to.
Occasionally, green, mucus-like poop can be caused by a virus commonly seen in babies. If your child has green poop and symptoms of diarrhea, fever, or irritability, call your pediatrician.
Solid Food and the Changes They Bring
When your child begins eating solid food, expect a firmer consistency and a change in the color of your child's poop, notes Wible.
"How it will change is unpredictable, but it will change," he says.
In general, it's a good idea to pay attention to the contents of your baby's diaper, as long as you keep it in perspective, Steinmetz says. Typical signs of an issue of real concern -- blood in the stool, vomiting blood, abdominal distention -- are hard to miss.
Still, if an issue is keeping you up at night, don't hesitate to call your doctor's office.