Newborn Poop: Understanding The Color Change

Newborns have very different poop from older babies and children, and it can be surprising and even alarming to new parents. The first few diapers will contain a sticky, tar-like substance called meconium, which is a dark green or greenish-black colour. This is a mixture of mucus, skin cells, hair, and other particles the baby has swallowed, along with amniotic fluid, while in the womb. After a few days, meconium will be replaced by transitional stools, which are green and less sticky. After this, the colour of a baby's poop will depend on their diet and whether they are breastfed or formula-fed. Breastfed babies tend to have mustard-yellow, seedy, loose stools, while formula-fed babies have thicker, darker, tan-coloured stools.

Greenish-black, tar-like meconium

The first time you change your newborn's diaper, you will likely encounter a sticky, tar-like, greenish-black substance known as meconium. Meconium is a baby's first stool, and it is composed of materials swallowed by the infant while in the uterus, including amniotic fluid, intestinal epithelial cells, lanugo, mucus, bile, and water. It fills the lower bowel of all newborns and is a completely normal sign that your baby's bowels are functioning.

Meconium gets its distinct colour from bile, a fluid produced in the liver that aids digestion. In addition to bile, meconium contains amniotic fluid, lanugo (the fine hair that covers your baby's body while in the uterus), dead skin cells, mucus, and bilirubin. While most of these ingredients are harmless, high levels of bilirubin can lead to jaundice, a common condition in newborns that can have serious consequences if not addressed.

It is important to note that meconium should only appear in the first 3 days of your baby's life. If your baby continues to have black stools after this period, it may indicate bleeding in the digestive tract, which can be dangerous. However, iron supplements or iron-fortified formula can sometimes cause stools to turn dark brown or black, so it is always best to consult your pediatrician if you have any concerns.

Meconium is typically thick and sticky, resembling tar or sludge. It is almost odourless, and unlike regular poop, it does not have a strong smell. It is important to ensure that your baby passes meconium within the first 48 hours after birth. Failure to pass meconium within this timeframe could indicate a condition or disease, such as intestinal blockage, an underdeveloped rectum, or Hirschsprung's disease.

Mustard yellow, seedy, loose stools

Breastfed babies tend to have three to four bowel movements every 24 hours during their first week of life. However, it is not uncommon for them to continue pooping after each feed or to go a whole week without pooping.

The texture of a breastfed baby's poop is usually loose, and at times, grainy or seedy. These little "seeds" are undigested milk fat, which is entirely normal.

Darker, tan and strong-smelling formula-fed baby poop

Formula-fed babies tend to have thicker and darker stools, usually once a day or more, from the first day. Their poop is typically tan but can also be yellow or greenish. The consistency is similar to peanut butter or hummus.

The colour of baby poop comes from bile, which is produced in the liver. Formula-fed babies' digestive tracts take in more of the nutrients and water from their food, resulting in firmer and darker stools.

Yes, darker and tan-coloured poop is normal for formula-fed babies. The colour and texture of baby poop can vary dramatically and alarmingly over the first few days and months of their life. Formula-fed babies' poop will be darker than that of breastfed babies, which ranges from yellow to green or brown.

When to Worry

While darker and tan-coloured poop is normal, you should contact your doctor if you notice any of the following:

• White or chalky-coloured poop, which could indicate a liver or gallbladder problem
• Red streaks in the diaper, which could indicate blood in the stool
• Black, tarry stools after the first few days of life, which could indicate bleeding in the digestive tract
• Diarrhea, which could lead to dehydration

Frothy, bright green stools

Foremilk-Hindmilk Imbalance:

This occurs when a breastfeeding baby tends to have short nursing sessions, switches breasts too frequently, or the lactating parent has an oversupply of milk. As a result, the baby consumes more foremilk (low-fat, high-sugar milk produced at the beginning of a nursing session) than hindmilk (high-fat, high-calorie milk produced as the breast empties). This can lead to gassiness and bright green, frothy stools. To address this, try keeping the baby on one breast per feeding or hand-expressing a bit of milk before latching.

Dietary Factors:

The lactating parent's diet can influence the colour of the baby's stools. Consuming leafy greens or green food colouring might result in green stools in the baby. Additionally, once the baby starts eating solids, green foods like peas or spinach can also contribute to the green colour.

Iron Supplementation:

Dark green baby poop might be caused by iron supplements, which are sometimes found in formula or given as a separate supplement.

Food Intolerance or Allergy:

Green, frothy stools could be a sign of a food intolerance or allergy, although this is not typical. Most babies with a food intolerance will present with blood in their stool or red poop. If there are concerns about a possible allergy or intolerance, it is best to consult a healthcare professional.

Viral or Bacterial Infection:

Viruses or bacterial infections can cause bright green stools. If your baby is not acting as they normally do or shows other signs of illness, contact your healthcare provider.

Teething:

Teething babies tend to swallow excess saliva, which can result in green stools.

Normal Variation:

It is important to remember that green is a normal variation of stool colour, especially in newborns and babies. As long as the baby is eating enough and the green stools are not accompanied by other concerning symptoms, it is usually not a cause for concern.

In summary, while frothy, bright green stools in newborns can have various causes, it is important to monitor the baby's overall health and behaviour. If you are concerned or notice any other symptoms, it is always best to consult your healthcare provider for personalised advice and guidance.

Red blood in baby poop

Seeing red blood in a baby's poop can be alarming, but it's important to remember that it is usually harmless and often caused by something minor. However, it can sometimes indicate a more serious health issue, so it's always a good idea to consult a doctor for an accurate diagnosis and treatment. Here's what you need to know about red blood in baby poop:

Possible Causes of Red Blood in Baby Poop:

• Constipation: This is a common cause of blood in baby poop. Constipation can be due to a milk protein allergy, starting solids, or not getting enough fluids. It can lead to hard and dry stools, which can cause tiny tears in the anus (anal fissures) and result in red streaks or flakes of blood on the stool's surface. Anal fissures are typically the most common cause of blood in a child's stool, and the blood will appear bright red.
• Food Allergies: Food allergies, especially to cow's milk protein, can cause intestinal inflammation and allow blood to enter the stool. Other common food allergens include soy, eggs, fish, shellfish, tree nuts, peanuts, and wheat. Breastfed babies may also react to something in the lactating parent's diet. Food allergies usually present with other symptoms such as skin rashes, vomiting, fussiness, colic, or reflux.
• Parental Nipple Injuries: If a breastfeeding parent has cracked or bleeding nipples, the baby may swallow some blood during nursing, leading to red streaks or a reddish tint to the stool. This is not typically a cause for concern, but modifying the baby's latch can help prevent or reduce nipple abrasions and soreness.
• Bacterial Infections: Blood in baby poop can also signal bacterial infections such as gastroenteritis, salmonellosis, shigellosis, staphylococcal infection, Clostridioides difficile (C. diff) infection, or campylobacteriosis. Infections often cause intestinal inflammation and tiny ruptures that allow blood to leak out, resulting in bloody diarrhoea.
• Gastrointestinal Tract Bleeding: In rare cases, dark red, black, or tarry stool can indicate bleeding along the upper gastrointestinal tract. This can be a medical emergency and is often associated with severe illness or injury. One common cause of upper GI bleeding in babies is ulcers.
• Intussusception: Although rare, intussusception is a medical emergency where the intestine folds in on itself, causing a blockage. It can lead to severe and sudden cramping pain, vomiting, and bloody stool with mucus. Late diagnosis of intussusception can be dangerous, so immediate medical attention is necessary.

When to Seek Medical Attention:

While small amounts of blood in the stool may not be a cause for immediate alarm, it is always best to consult a doctor, especially if your baby exhibits any concerning symptoms. Seek emergency medical care if your baby:

• Is younger than 12 weeks old and has bloody stools.
• Has an excessive amount of blood in the stool.
• Has bloody stools with mucus.
• Has dark red blood in or on the stool.
• Is fussy or inconsolable.
• Has a tarry consistency in their stool.
• Is not waking up to feed or refuses to eat or drink.

Treatment:

The treatment for red blood in baby poop depends on the underlying cause. In many cases, mild constipation and anal fissures will heal on their own without intervention. However, a doctor may recommend treatments such as:

• Ointments or Creams: To ease the pain and promote healing of anal fissures.
• Dietary Changes: Adjustments to the baby's diet, such as increasing fibre intake or reducing milk products, can help with constipation.
• Sitz Baths: Warm salt water baths can help cleanse the affected area and aid in healing.
• Antibiotics: In some cases, a doctor may prescribe antibiotics to treat certain infections or, rarely, to treat an infected fissure.
• Intravenous (IV) Fluids or Electrolyte Drinks: If the baby is dehydrated due to diarrhoea, IV fluids or electrolyte drinks may be recommended.
• Surgery: In rare cases, a blockage in the intestines that causes bleeding may require surgical intervention.

Frequently asked questions