What Goes in Must Come Out!
By Lisa A. Goldstein
When you become a parent, you might find yourself obsessed with personal hygiene – not yours, but the baby’s. You’ll walk out the door with your hair looking like it’s been electrocuted, but your baby will be snot-free and in a clean diaper.
Your heightened sensitivity to Baby’s hygiene and personal care may lead to panic attacks when your breastfed baby seems to be having too many bowel movements – or not enough. To avoid the stress, here’s a handy primer.
The foods you eat can play a role in your child’s stooling pattern.
Load After Load
The first thing to expect is that initially, both bottle- and breastfed babies will pass rather unique first stools, called meconium. These stools are thick, sticky and greenish black, says Maureen Brown-Ginsberg, a registered nurse and International Board Certified Lactation Consultant at Women & Infants Hospital of Rhode Island. Baby will likely have one to two stools on the first two days of life. Around the third day, you’ll see transitional stool, which is greenish brown and will be softer. Two a day is typical for this time.
During day four, Brown-Ginsberg says there will be a color change to a mustard yellow color. Baby will probably have three stools on days four and five. The seedy, mustard-colored stools will continue from day six through the first four to six weeks. Four a day is average.
“These numbers are the minimum we’d expect to see,” says Brown-Ginsberg. “Many breastfed babies have bowel movements with each feeding, [about] eight to 12 per day. [The] odor is not offensive [and] is milder than that of stools of a formula-fed baby.”
Between 4 to 6 weeks of age, the pattern can change to less frequent bowel movements, Brown-Ginsberg says. The quantity per movement will be greater, though. “Some breastfed babies can have a bowel movement every few days or even once a week,” she says. “As long as it remains soft, it is not constipation.”
The Key to Baby’s Wellness
The first month of baby’s life is the most difficult, as you’re both learning breastfeeding and the milk supply is being established. During this period, frequent, yellow bowel movements are reassuring. Brown-Ginsberg advises if the diaper count isn’t meeting your expectations to check your baby’s weight gain.
She also suggests exploring the whole breastfeeding picture – comfort with latch, frequency of feeding, presence of engorgement and so on – to determine if breastfeeding phone support will resolve the problem or if a visit with a lactation consultant is needed.
After about 6 to 8 weeks, “most breastfed infants have a bowel movement at least every other day, and most have one to three bowel movements per day,” says Dr. Colin Rudolph, professor of pediatrics and chief of pediatric gastroenterology, hepatology and nutrition at Medical College of Wisconsin and Children’s Hospital of Wisconsin. “As infants grow older, and especially as other foods are introduced, infants have fewer bowel movements that are more formed or pasty.”
What Mom Eats
The foods you eat can play a role in your child’s stooling pattern, but not to any significant degree. “We recommend that mothers eat a well-varied diet, foods that she generally likes and tolerates,” says Brown-Ginsberg. “The key is moderation, avoiding overindulgence in any one food. For the most part, baby’s bowel movements [will] remain soft, mustard-yellow color despite variety in Mother’s diet.”
When it comes to food, it’s easy to lose focus of the bigger picture. “Spicy foods have always gotten a bad reputation, but remember that in many parts of the world, very spicy foods are eaten by breastfeeding mothers, and the majority do fine!” says new parent Dr. Susan Dulkerian, a neonatologist at Mercy Medical Center in Baltimore, Md.
One time to be concerned is when the bowel movements are consistently green. This can occur when baby is getting lower fat content milk – foremilk – that usually is available at the beginning of the feeding. Brown-Ginsberg says that having Baby finish on one side before switching to the second side will ensure that Baby gets the higher fat content – hind milk – at each feeding. “Parents should call Baby’s pediatrician if stools are consistently green [or] contain mucus or blood,” she says.
If the infant has a soft, non-tender abdomen without distension, apparent pain, lethargy, vomiting or fever, then no intervention is necessary, says Dr. Rudolph. Grunting, pushing or turning red in the face while passing a stool is normal in infants and should not be of concern if the stool doesn’t contain blood or mucus. “If the infant has a hard distended tummy, fever or apparent pain that is not associated with passage of a bowel movement or vomiting of blood or greenish-colored vomitus, the infant should be evaluated by a physician,” he says.
A Visit to the Doctor
Dr. Rudolph also says it is common for infants between 1 to 10 weeks of age to be seen by a pediatrician because parents are worried about bowel movement problems in their infant. Parents describe children straining for several minutes and crying prior to the passage of a normal soft stool. After defecation, the infant is comfortable again.
“This is most likely explained by the infant’s difficulty coordinating the process of defecation, which requires increasing the intra-abdominal pressure while relaxing the pelvic floor in order to allow passage of the bowel movement,” says Dr. Rudolph. “Learning this process occurs faster in some newborns than in others, but almost always occurs in the first few months after birth. The use of enemas or suppositories or manipulation of the anus should be discouraged since it is potentially painful or frightening to the infant, and since learning defecation takes practice, this may delay the learning process. In fact, repetitive manipulation of the anal area may result in the infant learning that external intervention is required to pass stools.”
Natalie Schuhler, a 28-year-old Santa Clarita, Calif., resident and mother of two, had to seek outside help with her children. “Even though one pediatrician told me that it was OK for my babies to go several days without having a bowel movement, I knew that they were in pain because of it,” she says. “I knew the cues of my children and therefore when to call the doctors.”
Ultimately, as a parent, you’re the watchdog. “I was left to trust myself and listen to my baby,” says Schuhler.