For the first day or so after the birth, the baby’s movements are composed of material called meconium, which is greenish-black in color and of a smooth, sticky consistency. Then they change to brown and yellow. If a baby bowel movements hasn’t started by the end of the second day, the doctor should be notified.
The gastrocolic reflex
The baby bowel movements take place soon after a meal in most babies because the filling of the stomach tends to stimulate the intestinal tract all the way down. This hookup is called the gastrocolic reflex (gastro = stomach, colic = intestines). The movement is more apt to occur after breakfast because of the resumption of stomach and intestinal activity after the long night’s quiet.
Sometimes this reflex works very actively in the early months of life, especially in a breast-fed baby, who may have a movement after every nursing. More inconvenient still is the pattern of the occasional babies who strain soon after the start of each breast or bottle feeding, producing nothing but continuing to strain so hard, as long as the nipple is in their mouths, that they can’t nurse. You have to let their intestines quiet down for fifteen minutes, then try again.
A breast-fed baby bowel movements may be many or few daily. Most have several movements a day in the early weeks. Some have a movement after every nursing. The movements are usually of a light yellow color and may be watery, pasty, or seedy, or they may have the consistency of thick cream soup. They are almost never too hard.
Many breast-fed babies change from frequent to infrequent movements by the time they are one, two, or three months old. (This occurs because breast milk is so well digested that there is little residue to make up bulk in the movements). Some then have one movement a day, others a movement only every other day or even less often.
This is apt to alarm a parent who has been brought up to believe that everyone should have a movement every day. But there is nothing to worry about so long as the baby is comfortable. The breast-fed baby’s movement stays just as soft when it is passed every two or three days or even less frequently.
The baby who is fed commercially prepared formula usually has from one to four movements a day at first. (An occasionally baby has as many as six). As he grows older, the number tends to decrease to one or two a day. Movements in babies fed formula are most often pasty and of a pale yellow or tan color. However, some young babies always have stools that are more like soft scrambled eggs (curdy lumps with looser material in between). The number and color of the stools is not important if their consistency is good (soft but not watery) and the baby is comfortable and gaining well.
The common disturbance of the baby bowel movements due to cow’s milk is a tendency to hardness. (See “Constipation” in “Common Childhood Illnesses” in Section VI). A very few bottle-fed babies tend to have loose, green, curdy movements in the early months. If the movements are always just a little loose this can be ignored, provided the baby is comfortable, gaining well, and the doctor or nurse practitioner finds nothing wrong.
Straining with stools
Some babies who have infrequent movements begin to push and strain a lot when two or three days have gone by, yet the movement is soft when it does come out. This isn’t constipation: The stools aren’t hard. I think the problem arises from poor coordination. The baby is pushing out with one set of muscles and holding back with another set, so nothing happens except a lot effort. As the baby’s nervous system improves, the problem goes away.
Sometimes adding two to four teaspoons of pureed, strained prunes to the daily diet helps make the baby’s bowels more regular, even though the baby doesn’t otherwise need solid food yet. There is no call for medicine and it is better not to use suppositories or enemas, lest the baby’s intestines come to depend on them. Try to solve the problem with prunes or prune juice.
Changes in the movements
You can see that it doesn’t matter if one baby’s movements are always a little different from another baby bowel movements, as long as each is doing well. It’s more apt to mean something and should be discussed with the doctor or nurse practitioner when the movements undergo a real change.
For example, green movements can occur with both breast-fed and bottle-fed babies. If the movements are always green and the baby is doing fine, there is nothing to be concerned about.
If they were previously pasty then turn lumpy, slightly looser and slightly more frequent, it may be a spell of indigestion or a mild intestinal infection. If they become definitely loose, frequent, and greenish and the smell changes, this is almost certainly due to an intestinal infection, whether mild or severe.
Generally speaking, changes in the number and consistency of the movements are more important than changes in color. A bowel movement exposed to the air may turn brown or green. This is of no importance.
Mucus in the bowel movements is common when a baby has diarrhea. It just means that the intestines are irritated. Similarly, it may occur in indigestion. It can also come from higher up-from the throat and bronchial tubes of a baby with a cold or of a healthy newborn baby—some babies form a great deal of mucus in the early weeks.
When a new vegetable is added to the diet (less frequently in the case of other foods), some of it may come through looking just the same as when it went in. if the food also causes signs of irritation, such as looseness and mucus, give much less of it the next time. If there is no irritation, you can continue the smaller amount or increase slowly until the baby’s intestines learn to digest it better. Beets can turn the whole movement red.
Small streaks of blood on the outside of a baby bowel movements usually come from a crack, or fissure, in the anus, caused by hard bowel movements. The bleeding is not serious in itself, but the doctor should be notified so that the constipation can be treated promptly.
Larger amounts of blood in the movement are rare and may come from malformation of the intestines, severe diarrhea, or intussusception. The doctor should be called or the child promptly taken to a hospital.