Hard Stools In Newborns: What's Normal?

Newborns can pass stool multiple times a day, or every few days. While the frequency of a newborn's bowel movements can vary, it is important to monitor their diapers as it can indicate their health and whether they are consuming enough milk. Newborns typically pass meconium, a black, sticky, and tar-like substance, in the first few days after birth. After this, their stool becomes lighter and runnier, and may be light brown, yellow, or yellow-green in colour. Breastfed newborns tend to have softer and more liquid stools, while formula-fed newborns have firmer and more paste-like stools. However, neither situation should be a cause for alarm. If your newborn hasn't passed stool in four days, or you notice hard, pellet-like stools, it could be a sign of constipation and you should contact your pediatrician.

What is meconium?

Meconium is the name given to a newborn baby's first poop. It is typically dark, thick, sticky, and tar-like, and can be passed by the baby after birth or while they are still in the uterus. It is made up of water, cells, protein, fats, intestinal secretions, hair, mucus, pee, and other materials that the baby has swallowed in the womb.

Meconium builds up inside a baby's intestines when they swallow amniotic fluid in the womb. It is ideal for a baby to pass meconium shortly after birth, but it is not harmful if they swallow it in the uterus. However, if the baby breathes meconium into their lungs, it can cause a dangerous condition called meconium aspiration syndrome (MAS), which can lead to respiratory distress, infection, or other serious complications.

Meconium aspiration happens when a baby is stressed and gasps while in the womb, during birth, or when taking their first breaths. It is more likely to occur if the mother has a health problem like diabetes or high blood pressure, the mother smoked or did drugs during pregnancy, or the baby didn't grow well before birth. MAS can be treated with oxygen, surfactant to help open the lungs, inhaled nitric oxide, or extracorporeal membrane oxygenation (ECMO). Most babies with MAS recover completely.

Meconium staining refers to when the fetus passes meconium before birth, which is present in 12-20% of deliveries and is more common when a pregnancy goes beyond the due date. It can be identified by green or brown streaks in the amniotic fluid, and healthcare providers will check the baby for respiratory issues after delivery.

How often should newborns poop?

The frequency of a newborn's poop varies from baby to baby, just as it does for adults. Some newborns poop every time they eat, while others only poop every few days. In the first few days after birth, a newborn will pass meconium, a black, sticky, and tar-like substance. After about three days, newborn bowel movements turn into a lighter, runnier stool, which may be light brown, yellow, or yellow-green in colour.

During the first few weeks of life, the frequency of a newborn's poop largely depends on whether they are breastfed or formula-fed. Breastfed newborns typically have several bowel movements each day, while formula-fed newborns may have fewer. If you switch between breastfeeding and formula-feeding, you can expect changes in your newborn's stool consistency.

Breastfed babies may pass seedy, loose stools that look like mustard in colour and texture. Their poop may also be looser and runnier, indicating that they are absorbing the solids in the breast milk. Formula-fed babies, on the other hand, may have firmer and more paste-like bowel movements, but they should not be firmer than the consistency of peanut butter.

As a general rule, it is considered normal for newborns to poop at least once a day during the first five days of life. After this period, the average breastfed newborn will have about five dirty diapers a day, though anywhere from several per day to one every two to three days is usually normal. Formula-fed babies typically poop three to four times a day, but some may go as long as three to four days without a bowel movement.

If your newborn is pooping less frequently but eating regularly and their stool is soft and appears typical, then that is normal for your baby. However, if they go more than a week without pooping, contact your pediatrician.

What colour should newborn poop be?

The colour of a newborn's poop can vary depending on their diet and age. Here's a guide to help you understand the different colours of newborn poop and what they might indicate:

Meconium

In the first few days after birth, a newborn's poop is called meconium. It is typically thick, sticky, and greenish-black in colour. Meconium is a mixture of cells, amniotic fluid, bile, and mucus that the baby ingested while in the womb. It is normal for meconium to be black, and it should gradually change to a green-yellow colour by the fourth day.

Transitional Stools

After the first 24-48 hours, when all the meconium has passed, you will start to see transitional stools. These are usually dark, greenish-yellow, and loose in texture. They may also be "seedy", especially in breastfed infants. It is common for transitional stools to contain mucus or traces of blood, which could be due to the baby swallowing blood during delivery. If you notice blood in your baby's poop, it is a good idea to save the diaper and show it to a healthcare professional.

Breastfed Babies

Breastfed babies typically have mustard-coloured poop, ranging from yellow to green-gold or brown. Their poop is usually runny but can vary in texture, sometimes resembling toothpaste or cottage cheese. It is normal for breastfed babies to have frequent bowel movements, often after each feed. However, as they get older, they may start skipping days between bowel movements.

Formula-Fed Babies

Formula-fed babies' poop is typically light brown, yellowish-brown, or brownish-green. Their poop tends to be firmer and more paste-like than that of breastfed babies, but it should not be firmer than the consistency of peanut butter. Formula-fed babies may have fewer bowel movements than breastfed babies, and it is normal for them to go a few days without a bowel movement.

Once solids are introduced, you may start seeing small pieces of food in your baby's poop. The colour and consistency may also change, becoming more formed and darker.

Colours to Watch Out For

While most colours of newborn poop are considered normal, there are a few colours that may indicate a potential health issue:

• Red: Red poop usually indicates the presence of blood and requires immediate medical attention. It could be a sign of allergies, bleeding in the gastrointestinal tract, or swallowed blood from cracked nipples during breastfeeding.
• White or Clay-Coloured: White or very pale poop could signal a liver condition or jaundice. It is important to consult a doctor if you notice these colours.
• Black: After the first few days of life, black poop could indicate bleeding in the digestive system. If your baby passes black stools after the initial meconium, consult a doctor.

In summary, the colour of newborn poop can vary from yellow to green, brown, or even black, depending on their diet and age. Most colours are considered normal, but it is important to watch out for red, white, or black poop, as these could indicate potential health issues. Remember to always consult a healthcare professional if you have any concerns about your baby's poop.

What does it mean if there's blood in my newborn's stool?

It is important to consult a doctor if you notice blood in your newborn's stool. While it is usually harmless, it can sometimes indicate a more serious health problem.

Common causes of blood in infant stool

• Constipation: This is a common cause of blood in a baby's stool. It can be caused by a milk protein allergy, starting solids, or not getting enough fluids. Telltale symptoms include a prolonged absence of stool, hard stool that looks like pebbles, fussiness, discomfort, and a firm-feeling belly. Constipation can cause tiny tears in the anus (anal fissures), which lead to bloody streaks or flakes on the stool's surface. Anal fissures are usually caused by the passage of a large or hard stool and can be treated with ointment or cream.
• Food allergies: Food sensitivities or allergies, most often to cow's milk, may cause small streaks or flecks of blood in a baby's stool. Breastfed babies can also react to something in the lactating parent's diet.
• Parental nipple injuries: If a breastfeeding parent has cracked or bleeding nipples, the baby may swallow blood during feeding, leading to dark red or black flecks in their stool.
• Gastrointestinal tract bleeding: In rare cases, dark red, black, or tarry stool can indicate bleeding along the upper gastrointestinal tract. This can be caused by severe illness or injury and requires immediate medical attention.
• Other causes: Bloody baby stool can also be caused by bacterial infections, colitis, Crohn's disease, or necrotizing enterocolitis. In rare cases, the intestine can fold in on itself, resulting in a medical emergency called intussusception, which causes blockage of the intestine and severe cramping pain.

When to seek medical care

While small amounts of blood in the stool are usually not cause for alarm, it is important to monitor your baby's overall health and behaviour. Seek emergency medical care if your baby is younger than 12 weeks old or if you notice any of the following symptoms in addition to bloody stool:

• An excessive amount of blood in the stool
• Bloody stool with mucus
• Dark red blood in or on the stool
• Fussiness or inconsolable crying
• Tarry stool
• Refusal to eat or drink
• Fever or other signs of illness

How to treat newborn constipation

Newborn constipation can be worrying for parents, but it's important to remember that most of the time, your baby is not really constipated. They may not have developed a routine for pooping yet, or they might not have a bowel movement pattern.

If your baby's stool is hard, pebbly, or thicker than peanut butter, this could be a sign of constipation. Other signs include a distended abdomen, vomiting, and blood in their stool. If you notice any of these symptoms, it's important to contact your baby's healthcare provider.

• Dietary Changes: If your baby is formula-fed, try switching to a different formula. For babies eating solid foods, introduce high-fibre foods such as pureed broccoli or carrots, whole grains like oatmeal, wheat, or barley cereal, and pureed fruits like peaches, pears, or prunes.
• Exercise: Move your baby's legs in a gentle, circular motion while they lie on their back to mimic riding a bicycle. This can help stimulate the bowels.
• Warm Bath: A warm bath can relax your baby's abdominal muscles, helping to ease straining and providing relief from constipation discomfort.
• Fruit Juice: For babies over six months, offer 1-2 ounces of prune, pear, or apple juice. The sugar in the juice is hard to digest, so more liquid enters the intestines, increasing the frequency and water content of stools. Do not give juice to babies under six months without consulting a doctor first.
• Massage: Gently massage your baby's stomach in a clockwise circular motion. Hold their knees and feet together, pushing the feet gently towards the belly.
• Rectal Thermometer: Your baby's doctor may recommend taking their rectal temperature with a lubricated thermometer to stimulate a bowel movement. However, this method should not be used frequently, as it can make constipation worse.
• Medication: In rare cases, a doctor may prescribe medication to treat constipation if home remedies are unsuccessful.

Remember, always consult your baby's healthcare provider before trying any new treatments for constipation. They can advise you on the best course of action and ensure your baby's health and well-being.

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