For the first few days, the stools will be dark and sticky. This type of stool is called meconium. After a few days, the stool will become yellow and seedy. A breast fed baby can have anywhere from 6 to 8 stools in a day that are mustard yellow and seedy. A formula fed baby will have stools that are yellowish-tan. It is normal to have anywhere from 8 STOOLS A DAY TO ONLY ONE EVERY 5 TO 7 DAYS. Let me repeat, YOUR BABY MAY HAVE ONLY ONE STOOL EVERY 5 DAYS AND MAY STILL BECOME A DOCTOR, LAWYER OR THE PRESIDENT. Most grandmothers were scared by their pediatricians into believing that babies should have one stool a day, or that baby might die. Your grandmother will then scare you to death with the same belief, but this is absolutely not true. Babies will often turn red, grunt and strain while having a bowel movement and this also is normal. So long as your baby's stools are not so hard that they cause bleeding, not so loose that they cause a diaper rash and your baby is healthy, then you need not worry about the stools. Never give your child enemas or laxatives until consulting me first. These treatments can be extremely dangerous if improperly used in a small infant. Should the stools become unusually loose or hard, then refer to the sections on diarrhea or constipation respectively.DIARRHEA
Diarrhea is consistently liquid stools that are different from the usual stools. Breast fed babies will normally have mustard-yellow, seedy and slightly runny stools for the first few weeks (called transition stools). Diarrhea has a great many causes, but most of these viral and are short lived. The most common complication of diarrhea is a diaper rash that can be prevented and treated by using a thick cream on the bottom like Vaseline. The most worrisome complication of diarrhea is dehydration. Dehydration is essentially losing so much water that the body cannot function properly. Young children are at a greater risk for dehydration due to their small size and you should not wait till morning to call me for signs of dehydration in your baby. During an episode of diarrhea, think of your child as a pitcher of water. Diarrhea is a hole in the pitcher and your job is to keep the water level at its usual healthy level. In the past, we used to recommend giving clear liquids at first and then advancing the diet as tolerated. We now realize that changing the diet does not greatly affect the stools and babies actually may do better with the extra calories offered by their regular diet. You should offer your baby more clear liquids during the diarrhea episode to make up for the losses from the diarrhea. The clear liquids you give your baby should only be Pedialyte. Neither Pedialyte nor anything else will "clear up" the diarrhea. Pedialyte contains electrolytes and sugar that your baby's still immature kidneys will not retain properly. Giving plain water alone in this situation may make your baby seriously ill because a babies kidneys cannot retain sodium and potassium and giving too much plain water will cause levels of these to go too low and could cause seizures or worse (this is the same reason you dont let a young baby drink pool water). I do recommend switching to a lactose free formula (Isomil or Isomil-DF), if you are not breast feeding, until the diarrhea resolves. Lactose is a milk sugar that cannot be digested during a diarrhea attack and may actually lead to a prolonged diarrhea. Isomil-DF also contains extra fiber to make the diarrhea go away slightly quicker, but make sure to switch back to your regular formula when the diarrhea resolves. The signs of dehydration are dry lips and mouth, sunken eyes, less urine output. If you are worried about dehydration, then always keep tract of the number of times your child urinates and the relative amount of urine your child makes as I will ask you this when you call. Call me if your baby has diarrhea and; your baby is under two months of age, has any of the signs of dehydration listed above, has more than 8 stools a day for more than 5 days, has bloody stools, has a fever above 100.5 F, has vomiting more than three times, has not made urine in more than 6 to 8 hours, is acting very ill or if you are worried or unsure of what to do.
(in children under 1 year of age)
If your child is over 1 year of age, then please read the other constipation information page first.
Constipation is only present if your baby's stools are very hard or are causing bleeding. Remember it is normal for a baby to have anywhere from 8 stools a day to 1 stool every 5 to 7 days. Constipation usually results from not getting enough liquids. It is especially common during unusually warm spells when we lose more water through sweating. You and I know to drink more water, but your baby can only do this if offered more water. First, if you breast feed, try drinking several more glasses of water a day. If this doesn't work, then try offering your baby 1/2 to 1 ounce of sterile water in between or after meals. You will often find that you can regulate the consistency of the stools with the amount of water you give. Usually 1-2 oz per day from 0-2 mos. and 3-4 oz thereafter is enough (do not give more without checking with me). Last, try giving your baby HALF strength baby prune juice or apple-prune juice instead of water between meals. NEVER GIVE YOUR BABY ENEMAS OR LAXATIVES BEFORE CONSULTING ME. These treatments often cause more harm than good. GLYCERIN SUPPOSITORIES may be used if your baby has not had a bowel movement for a while and the bowel movement appears to be hard. All the suppository will do is lubricate the rectum to make the bowel movements travel easier. Lubricate the suppository with plenty of Vaseline before insertion and be slow and careful when inserting it. You can tear the rectum if you are too forceful. You might also have to cut the suppository down to size for your baby. Also do NOT add Kayro syrup, honey or sugar to the formula or breast milk. These will add too many solutes to the liquid or cause an infection and can make your baby quite ill.
Copyright 2006, Joe Matusic, MD, FAAP, AME