Baby Poop – PediaCast 016
- Baby Poop
- Let's Eat, by Amy Jo Doty
Announcer 1: This is PediaCast.
Announcer 2: You're listening to the Tripod Network. What's on?
Announcer 1: Hello moms, dads, grandmas, grandpas, aunts, uncles, and anyone else who looks after kids. Welcome to this week's episode of PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here's your host, Dr. Mike Patrick Patrick, Jr.!
Dr. Mike Patrick: Hi, everyone and welcome to this week's edition of PediaCast, a pediatric podcast for parents. This is Dr. Mike Patrick, coming to you from Birdhouse Studio and I like to welcome everyone to the program this week. Things are going to be a little bit different on the show this week. And the reason for that is because there is a topic I really feel the —
Actually, you really feel the need to address and I'll explain that in a minute. But, this topic is going to require us to do things just a little bit differently. Now, I have had quite a bit of email and people getting a hold of me to the contact page of this last week and thanks to everyone who did that and if there's more of you out there that would like to put in some questions, that would be definitely appreciated because next week, the entire show is going to be devoted to answering your questions. So, everybody, sort of, fire away and if there's a particular issue that you're interested in, you can go to the contact page at our website which is pediacast.org and click on the contact link and get a hold of me that way and then we can include your question next week and we'll get to as many of those as we can. Now, I have the honor of the number one search term that people use that lands them at PediaCast —
— is the term "poop". Now, I'm not kidding. I mean, by far and away, the number one thing that brings new people to PediaCast who've never heard of this program before, it's about poop. And… that's the search term that they're using. Now, the interesting thing is, do you know how many questions I get emailed about poop?
None. So, I think, you know, people want to know about poop but obviously, they're not… they're coming to the website and looking around but they don't really want to talk about it, which is usually the case. So, I thought what we would do is do an episode called "It's All About The Poop" and this is going to be part one. Instead, of being an hour long like the last couple of episodes have been, these are going to be three episodes, each of them about 20 minutes and we're going to have one them coming out every day or every other day until we get the three of them done. The first one, which is this podcast, is going to be about infant poop and we're just talk a little bit about what's normal, what's not normal, some of the more common questions that I get in the office regarding baby poop, and I do.
I get asked a lot of questions about that. So, we are going to discuss that and then in the next episode, we're going to talk about constipation in older kids, not just constipation but also encopresis and, you know, what causes it, what things, what kind of symptoms you see associated with constipation and then we'll also discuss encopresis, which is when kids have accident in their pants with their bowel movements after they're already potty trained. So, we'll talk about that in the second one and then the third one, we'll talk about chronic diarrhea…
— and… I have to laugh. I mean, here I am doing this podcast and, you know, I'm going to do three episodes on poop, just great. I got a great job, folks.
I don't know. OK. So, we'll talk about chronic diarrhea in the third episode and loose stool and what sort of things cause that and what you can do about it, but again, I cannot talk about bowel movements for an hour straight.
So, we're going to limit this to about 20 minutes or so and then end it at…
that because that's about as much as I am able to do. Now, I do want to remind you, in addition to the contact page at the website, you can also email me at firstname.lastname@example.org. You can submit your question that way or you can call in to our Skype line which is (347) 404-KIDS, that's (347) 404-K-I-D-S. And you can give us a question that way too and we'll try to get to some audio questions and the ones that people have sent it to the contact page or through email and again, that will be coming up on the program next week. All right. Before we get into baby poop, I just want to mention, last week, I had this guilt thing going because of the manic mommies and the fact that Kristen's husband, Steve, has to do laundry at their house.
And when I got home from a football game last Saturday, my wife had left a note asking me to put the towels in the dryer from the washer and when I did that, they were already closed in the dryer and I took the clothes out of the dryer and then have this guilt feeling about just leaving them in the basket for her to fold and I went ahead and folded them for her. OK. I just want to let everyone know what that sort of thing actually leads to. Tonight, my son has… the beginning of his second week of play productions. He's in "Surviving the Applewhites" and he has a show tonight. So, I get home from work and as I'm getting home, Karen and Nick are basically packing up to leave and we're just sort of crossing paths and my wife says, "I left you a note about laundry again", you know, because you did such a good job with the note that I left last time and, in fact, you went above and beyond what I had asked you to do. So basically, she's putting a little bit more trust in me.
So, this note says…
— "Close to dryer, medium high heat, 55 minutes". OK. So, that's got to be spelled out for me, you know, the exact amount of time, what temperature we put the setting on, and we do have… we have front loading washer and dryer, and there are more buttons on these things than, I think, are inside the cockpit of a space shuttle, and more lights, you know. So, I'm looking at her note and I can't do this by the way until 9 o'clock. So, at 9 o'clock is when I have to move the clothes to the dryer and make sure it's on medium high heat and then put it on for 55 minutes. Why 9 o'clock? You know, we got this energy sentry thing and some power management doohickey that I really don't quite understand, to be honest with you, but it makes our electric bill lower.
The "no second rinse" thing, there's not really a button there. There's these toggle switches and lights and I don't know. I'm just… I know I'm going on here but I'm not going above and beyond…
with it this time, please. I got to take care of the dead animals that the cat brings to the back. OK. That's my job. And believe me, there's something, like, everyday out there. OK. Let's move on. One other thing, and this is… you know, as I get this… in the office, I get lots of comments from kids and, you know, I could do a whole show on "Kids Say the Darndest Thing", but this was my favorite comment this week. I had a little guy. He must have been three or four years old and he had an ear infection and it was a pretty bad one. So, we're going to treat him with an antibiotic and I got out my prescription pad and I started to write and he…
He says, "Hey, doc" and I kind of look up at him, he says, "Doc, don't give me penicillin." And I look at him and –
I said, "Why don't you want me to give you a penicillin?" And he says, "Because it will kill me." OK.
So, sure enough, you know, I glance up at the top part and he's allergic to penicillin. So, he had drilled in his head. So, we, you know, we skipped the penicillin thing. All right. Let's go ahead and move on to baby poop. Now, those of you who don't have babies at home or you're really just not interested in baby poop, you're not going to offend me. Tomorrow or the next day, we should have another episode out, another 20-minute one, which will address constipation in kids and encopresis. So, you know, you're not going to offend me if you turn me off now although there is a cool song coming up at the end. It's one that your kids will probably really enjoy but, you know, fast forward, I don't care, Just, you know, listen tomorrow. All right. OK. Those of you who are still with me… baby poop.
You know, newborn babies don't do much, right? I mean, they cry, they sleep, they look around, you know, they eat, they spit up, they pee, and they poop, and really, that's about it. So, it's easy to see why new parents focus on their infant's bowel habits, right? Now, relatives are also responsible for this because everybody has got an Aunt Betty or maybe it's your mother-in-law or, you know, someone like that whose goal in life, it seems, is to voice concern about, pretty much, everything. You know, they say, "He poops too much. He doesn't go enough. It's too hard. It's too soft. You know, why is he always grunting like that?" And honestly, a lot times, new parents aren't even really concerned about their kid's bowel movements until someone convinces them that there is a so-called "problem" of one sort or another. Well, the trouble with baby poop is that there's a wide degree of variation. You know, some infants are going to stool shortly after every time they eat while others are only going to go once a week and there's also a wide range of what can be normal for a thickness.
It can be a thin liquid. It can be more formed or like a clay patty. And… yes –
So, the amount of stool is dependent on two variables: How well your baby's intestine absorbs the food and how many bacteria are living in the gut because a large portion of bacteria… of stool, including in adults, is made out of bacteria. So, you got your food residual that doesn't get digested… kind of the bulk and then you have a whole bunch of bacteria that also make up a good degree of the poop. Now, since the baby's ability to absorb food changes over time as the gut matures over the first couple months of life, the amount of residue that's left over is also going to change. So, typically, there's more residue to stool out in the first few weeks of life and then as your baby's intestine, sort of, matures and absorption improves, then the amount of residue is going to decrease.
So, babies who used to poop several times a day when they're first born, you know, may slow down their production to just once every couple of days and that can be normal. Now, on the other hand, the bacteria effect is going to have the opposite result. As the baby matures, more and more bacteria are going to populate the gut. And the bacteria that are there, they are an important part of the digestion process and that they're really one of the reasons that baby stool changes in character over the first few months of life. And as the numbers of the bacteria in the intestine increase, the body starts to eliminate more and more of them in the stool and the stool bulk then is going to increase as the number of bacteria increases and then increased stool bulk leads to more frequent bowel movements. So, those are two factors; how much residue is left over, how much bacteria is in the gut, and then a third factor effecting how often their going to have bowel movements is how fast the intestine moves things through.
So, some guts, basically, just work faster than others. So, what's normal? Well, some newborns are going to have a stool every time they eat and others are going to go once every few days. And if you're infant stools are, you know, more than three or four days apart, you know, that… even that may be all right, but you should give your child's doctor a call and let him know and just get their opinion on things. So, it's one of those things where if all the people that you know, if their babies were all the kind that who had bowel movements every time that they ate and you're baby is only going to the bathroom with poop every two or three days, you know, you start to get concerned. You know, are they constipated? Why aren't they going to the bathroom? And then suddenly, the only thing that matters in a mother's life is: "When is my baby going to poop?" I mean…
It's like the most important question in the world.
And I do… you know, we understand that and… you just… please don't get so worked up over frequency of baby poop. It is OK if they go three or four days without having a bowel movement. Now, if they go three or four days without having a bowel movement, the next question is: "What is the consistency of the stool like?" So, if the… if your baby has a consistency of their stool that's like a mustard, in newborn babies, that's pretty much what you would expect. So, it's loose but it's not quite watery and yet it's not really formed like clay either. So, you want it to be… I always describe it as kind of a mustardy and if it's a mustardy stool and they're going every three or four days, that's fine. If… on the other hand, if they're going every three or four days and it's really hard and formed or like clay, then you're probably going to want to do something to help loosen it up a little bit.
So, stool consistency, you know, it can run the gamut of, like I said, like water. It can be thick. And the ideal consistency though is going to be like mustard and some variation and that's gonna be OK. All right. So, we got frequency can be anywhere from every time they eat to once every three or four days and sometimes it can be longer than that. I'm just saying after three or four days, you'd want to talk to your doctor. I have… I see some kids who have a nice healthy bowel movement once a week. And, you know, as long as they're growing OK and there's no other problems, that may be OK for some babies, others, you know, you're going to want them to go a little bit more often than that. But I think once every three or four days is fine. If it goes longer than that, you probably want to give your doctor a phone call. Now, also, I do want to mention, if they're… and if they haven't pooped in a couple of days and they're really fussy and inconsolable or their belly seems hard to you, obviously, don't wait on that. Call your doctor and to have him… have him take a look. All right. The next thing to pay attention to after the consistency of it and the frequency of it is going to be color.
What color should a baby's poop be? Well, bright red is really something that will bother you a little bit. Bright red usually means that there's blood and you want to bring this to your doctor's attention right away. Now, blood in the stool can be caused by lots of different things; milk allergies, one thing that can do it; a crack in the skin around the anus or anal fissure or rectal fissure. And then rarely, there's going to… it could be caused from a more serious internal problem of the intestinal track or it could also be caused by an infection, a bacterial infection inside the intestinal track. So, any time you see blood in your baby's stool, you want to let your doctor know about that right away. It may be something serious or it may not be anything serious at all. It may just be a little… a fissure around the anus and that's OK. By the way, do I… is this still… do I still get a clean rating? I… since this is a medical podcast, I think I can still… does it make this a clean rating?
Hopefully, I won't get any complaints. All right. So, you want to let your doctor know if there's blood. Now, black tar-like is normal during the first few days of life. That's that meconium you probably remember. But if that remains very long or they have mustardy stools and then you get sort of a black tar-like stool again, you want to talk to your doctor about that right away because that could also be a sign of bleeding inside the intestine, usually a little bit further up, like, up in the small intestine or up in the stomach. By the time that blood makes its way all the way down then it's going to be black and tar-like. So, those… definitely, those are two concerns that you'd want to bring to your doctor right away; bright red blood and black tarry stools. Now, other colors are going to really depend on their diet and the makeup of the intestinal bacteria. And normal colors in babies can range from pale yellow to dark green and from light tan to dark brown. That can be… all those colors are OK.
And it just really… the color of it is going to depend on; what they're eating, what formula, what solid food you've started them on, and what mix of bacteria that they have colonized inside the intestine. So, putting these all together, normal baby poop should be the consistency of mustard. It can be yellow, green, tan, or brown and it may come several times a day or it may come once every several days. And reasons to call your doctor about baby poop that you're worried about include a black tar-like stool, the presence of blood, watery diarrhea, they constantly have a mucus or if it's a thick and formed stool that your baby seems to have trouble passing. Those are all reasons to let your doctor know about it, you know, right away and let them take a look if they go for several days without passing stool or if there's any of those issues that we're talking about. Now, a word about fussiness is in order. You know, many parents assume that a fussy baby who has a bowel movement every few days is constipated and this may actually just not be the case.
Keep in mind, that upset babies, whether they're upset from hunger or the pain of an ear infection or if they have acid reflex and they have a little bit of heart burn, these babies are going to stiffen their bellies when they're in pain, draw up their legs and bear down because their upset for some reason. And when they draw up their legs and bear down, often times, they'll pass gas and you should not assume this behavior is from constipation even if they move their bowels irregularly. You know, make an appointment with your child's doctor, really, for a thorough examination and that's what you really need to do. I can't tell you how many kids I have come in, the parents call, they say, "You know, my baby is constipated. They're very fussy and they're just… they look like they're trying to have a bowel movement. They're passing gas all the time." And, you know, I always have those parents bring their babies into the office because, you know, sometimes, it is constipation. Sometimes, it's a baby who's having a hard, solid stool every four or five days, and it's thick and you really got to do something to help loosen it up a little bit for him.
But often times, they'll have a little ear infection or we'll… well, you know, we'll look into the history of it a little bit more and decide that they have some acid reflex and heart burn problems and that's what's really causing their fussiness. And then what the parents are mistaking for the baby trying to have a bowel movement is really just how babies appear and act when they're in discomfort or pain or upset about something and it's not really that they're trying to pass a bowel movement. They just look like they're trying to pass a bowel movement. And the reason that, you know, that I can tell the difference is because, you know, you try to treat them for whatever thing that you suspect and if the symptoms go away, then you are probably right. So, if it's a baby who, after doing the history and physical, I feel like, nah, I don't think they're constipated. I really think this is more of an acid reflex problem. You know, we tried the strategies for dealing with acid reflex and if the symptoms go away, then you know that's probably what the answer was.
All right. So, let's just say though that you're infant is constipated, that they have thick form stool, and it's difficult to pass and they're going in frequently and that your doctor examines the baby and agrees that, "Yeah, it is constipation." So, what do you do about that? Well, here are some options. And again, these options should be decided upon with the input of your personal physician. But here are some things that I do; number one, especially in young babies, you can try a little rectal stimulation. You know, you put a glove of lubricant like a Vaseline on a rectal thermometer or a Q-tip and basically just insert the tip a quarter to half inch into the rectum, give it a little twist, pull it back out, and this will often stimulate a bowel movement within a minute or two. Part of the work up with… as a pediatrician in babies who are having trouble going to the…
having bowel movements is to do a little rectal exam where you just, you know, you put glove on and get a little lubricant on the pinky finger and insert that into the anus just a little bit just to make sure that tone is OK because there are some inherited diseases where there's too much of rectal tone. It's called a Hirschsprung disease and that can cause a really bad constipation. And that's one of the reason that you want to… if you're concerned about constipation, you want to have your doctor take a look and examine your baby. But any… in any case, a lot of these kids, when you do that rectal exam, Boy! They end up having a big bowel movement. There's been a couple of times, you just got to –
do the rectal examine… and then jump out of the way because the poop is going to come right back… right out at you. So, rectal stimulation is one thing you can do. Now, this is something… again, if you need to provide your baby with rectal stimulation, you don't need to do it three or four times a day. You know, once they have their bowel movement… well, you know, wait a couple more days before you do it again.
And again, do this and consult with your doctor. But, no one wants to be doing this to their baby daily or even on a very regular basis. So, what are some other things that you can do if you're needing to resort to rectal stimulation on a regular basis? Well, another thing is… are these little glycerin suppositories and they're available at most pharmacies. Use, like, a little half a suppository to start and you basically just insert that into the rectum and this works by increasing the water content in the stool through a process known as osmosis. If you think back to your high school science class, remember water moves across a semi-permeable membrane and it moves from where you have less particles to where you have more particles, remember that, osmosis? Well, these little glycerin suppositories, they're just basically little… they dissolve in the rectum so now you got a whole bunch of particles, so water is going to move because the bowel lining is a semi-permeable membrane. So, water is going to move from inside the body into the actual opening of the large intestine and add more water to the poop and looser poop is going to come out a little bit easier.
So, that's how glycerin suppositories work. Now, another strategy that I often use in babies is to use some juice. And parents always look at me like, "Huh? You're going to give him a baby juice?" But you have to realize, we're not using the juice for nutrition. We're using the juice as a medicine basically. And processed apple or prune juice from the grocery store… you don't want to use fresh juice from a fruit stand because it can have bacteria in it such as ecoli. You want to make sure that this is a processed juice coming from the grocery store and you usually start out with some infant juice and, you know, we're only talking… doing a couple of ounces once or twice a day. Now, why does juice work? Well, the reason that juice works with this is because it has sugars in it that the body and babies does not digest very well and these sugars are going to make their way all the way down to the large intestine.
And, what do you know? Osmosis, our friend, is going to increase the water content in the stool and then that's going to make the stool looser and easier to pass. Now, the reason that you don't give little infants juice to begin with is; well, number one, they really don't need it from a nutritional standpoint, but also because if you have normal bowel movements and you increase these particles from these undigested sugars in the stool, you're going to end up with diarrhea. But if you have a true constipation in an infant right from the get go, then adding these sugar particles are actually going to make the stools normal. Now, the problem with baby juice is often it doesn't work because it's so dilute that there's just not a lot of these undigested sugar particles getting down to the large intestine. So, in that case, you basically just need to get as full strength processed juice, apple juice or prune juice, adult strength and don't dilute it because if you add water to it, you're just going to make baby juice and then it's not going to work.
And often times, if you start some apple juice or prune juice and give them, you know, one or two ounces of that once or twice a day, that's able to keep them pretty regular, but again, talk to your doctor. Your doctor may have a different way of doing it and certainly, I don't want to step on any toes there, but I find that the juice works.
There's nothing about juices… those kinds of juices, apples and prune juice that is dangerous for a baby other than the fact that it can give them diarrhea and the fact that from a nutritional standpoint, they really don't need those yet. In terms, of allergies, the clear juices tend not to be very allergenic anyway. You know, you certainly wouldn't want to use pulpy juices, you know, like orange juice because those are going to be much more likely to cause food allergies on down the road. In a previous edition of PediaCast, we talked about that a little bit.
And now, again… well, let me say also there's one other… and that's oral medication. There are several oral medications that basically work the same way as the juice by increasing the number of particles in the large intestine and so you increase water component in the stool to make it softer.
Milk of Magnesia is one that's available over the counter. Lactulose and MiraLAX are other ones that require prescription. And that… the oral medicines, to be honest with you, I find, are rarely necessary for young infants. It's usually older kids that end up needing something like MiraLAX. And in the next episode when we talk about constipation and encopresis, we'll get into that a little bit more. Finally, word is in order concerning some things you shouldn't use to treat constipation. Karo syrup and honey have the remote possibility of transmitting botulism to infants so don't use those produce in children who are less than a year old and likewise, unprocessed juice can contain harmful bacteria such as E. coli. Also enemas are not recommended for infants.
You save those for the older kids and use them only under the guidance of your child's doctor. And again, it is important to consult with your doctor before trying any of these methods that I have mentioned. There are some diseases and some of them, serious, that mimic constipation. So, you don't want to try to treat these things without your doctor's help. You know, baby poop is a funny thing because it can be so different from one child to the next. And for some crazy reason, well-meaning relatives always seem to gravitate to a newborn's bowel habits, but don't let Aunt Betty or your mother-in-law get to you. You know, armed with the knowledge of what's normal and what's not, if she keeps pushing, feel free to teach her a thing or two…
based on the information that I've given you. All right. If you can't remember all of these things I went through, I do have a post on the PediaCast blog. If you go to pediacast.org and… I'll have a link and a Show Notes to the specific article that I wrote that concerns itself with baby poop. It's called "Baby Poop: What New Parents Need To Know".
And I have to tell you it is the leading reason that people find…
PediaCast, but hopefully, once they find it, you know, they stick around. All right. Well, that wraps up the PediaCast episode number 16 on baby poop. It's all about the poop, you know. But we will have another shorter episode like this one coming out in the next day or two on constipation and encopresis and then we'll follow that up with one on chronic diarrhea or chronic loose stool type syndromes that we see often in toddlers. And then next week, we will do a listener male type show. I've got several questions lined up and we have room for several more. So, feel free to contact us and the ways to contact us, of course, are through the website at pediacast.org, click on the contact link. You can also email me at email@example.com and… or you can call our Skype line (347) 404-KIDS, that's (347) 404-K-I-D-S.
You can get to us that way as well. Don't forget, we have the blog and the newsletter. You can also sign up for that at pediacast.org. And on the website, there's also a listener survey, if you have time to fill that out. I do want to say this, you know, I'm spending a substantial amount of my otherwise free time putting PediaCast together and the reason I'm doing this is because, and I've mentioned this before, I really feel like parents do not get a lot of good education from their pediatrician. Now, and I'm as guilty of this as any other pediatrician, so this is not a slam on pediatricians in general because, let's face it, folks, your doctor is busy during the day in the office and I'm busy during the day in the office. You wouldn't… don't even want to know how many patients I saw today. And you just can't talk for 25 minutes about baby poop because if you do, the waiting time in the waiting room is going to be terrible.
So, you know, we want PediaCast to be a place that people can come and get some education and from a good source… you know, I spent lots of money and lots of years in medical school and…
residency and eight years of practice experience. And so, you can use me as a resource, where some of the things you come across the internet, you don't know if you can really trust it or not. So, I want PediaCast to be a trusted source but I've noticed that if you go into iTunes, you know, I'm in the Top 100 in the Kids and Family section and, you know, down, around 40 or 50. But the Parents Magazine podcast, I noticed that that's always way up there on top. It's always on the front page of the featured… in iTunes, Kids and Family and this is, you know, this is not a slam on Parents Magazines by any stripes.
They got a great magazine, but, you know, they're coming out with one podcast a month. And you listen to their podcast and yeah, I mean, they got some good information in there. It's nicely packaged, blah, blah, but, you know, why are they so highly ranked? I can't figure it out, you know and I'm busting myself here getting information out to you folks. So, what do you need to do for me? Well, to keep this thing going, you got to tell your friends. Tell your friends and family. We got holidays coming up later this month, you know. When you get together at Thanksgiving and you see all your cousins, tell them about PediaCast so that they can check us out. Also, there is a new resource at pediacast.org and that is our poster page. If you look up at the top bar where the links are, you'll see a link that says, "Poster". If you click on that, there's a PDF file that you can download and print. And basically, you know, hang it wherever you think parents are going to see it. You can help out that way.
On bulletin boards, in the offices, break rooms, libraries, basically, anywhere that parents are going to gather. Daycare center, gyms, you know, community announcement places, and feel free to resize it and, you know, basically, do whatever you want with it other than, you know, don't do anything too bad.
OK. I take that back. Don't do anything you want to it.
All right. But feel free to download it and hang it up so we can help to spread the word about PediaCast. All right. Well, that wraps up this week's program. Following our little conclusion here, we're going to have a song for you from the Podsafe Music Network and it's one that I just could not resist in terms of playing this week. It's by an artist named Amy Jo Doty and it's called "Let's Eat". And that there will be a link to her site at music.podshow.com in the Show Notes. So, until next time, which will be pretty soon…
this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!
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