Excreting

Normal bowel and urinary function varies considerably from baby to baby. Regularity and frequency of bowel movements varies not only between babies – it can even change in the same baby from day to day.

During the first six weeks, newborns generally have at least one bowel movement per day, and may have as many as fifteen. Stool frequency in breast-fed babies can vary even more – from as many as fifteen per day to just one bowel movement every few days, after a few weeks. The passing of only one stool every few days does not necessarily indicate constipation. Neither does grunting, pushing, or turning red in the face while passing a stool. This is normal behaviour, as long as stools are soft, do not contain blood, and do not appear to be causing pain.

“Changing” Stools

The color, consistency and odor of bowel movements also vary with age and diet. During the first 36 hours after birth, the newborn should pass a greenish-black, sticky stool called meconium. Over the next few weeks, once the baby’s bowel is cleared of meconium, and milk feeding – whether from the breast or from a bottle – has begun, “changing” stools will be passed. As the name suggests, their rather peculiar character is due to the changeover from transfusion feeding in the womb to ordinary digestion.

An infant’s changing stools are likely to be semi-liquid, green-brown and frequent. The semi-liquid consistency of stools at this age is normal, and shouldn’t be confused with diarrhea, in which stools are abnormally frequent and very watery. Peculiar-looking stools are a feature of these early days.

If the stools really worry you, take the baby to the doctor, with one of the soiled diapers in a sealed plastic bag, so that he can check that there is no infective diarrhea (gastroenteritis). If the baby is being breast-fed, gastroenteritis is extremely unlikely. If feeding is by bottle, it is a possibility, but it is still a remote one if the baby seems contented and sucks well.

It may be three weeks or even more before your baby settles to passing normal or “settled” stools.

“Settled” stools

After about the third week, the stools of breast-fed babies tend to be orangey-yellow with the consistency of mustard, fairly loose and have a mild sweet-sour milk smell. But he may sometimes pass stools that are greenish, full of mucus or otherwise peculiar without being in any way unwell. Try not to take too much interest in his diapers: concentrate on his general wellbeing.

He may have so many movements each day that you never change a diaper that is not soiled as well as wet. On the other hand, he may have only one movement every three, four or even seven days. Both extremes and everything in between them are absolutely normal. And it is normal for him to swing from one to the other.

A breast-fed baby’s food is always perfect for him. A bottle-fed baby’s food may not be. If the formula you have chosen is not right for him, then you may get your first clue from your baby’s stools. Don’t switch back and forth between formulas without medical advice, though.

Stools of formula-fed babies at this age tend be pale brown and somewhat more solid because formula leaves more residue than breast milk. Odor is generally stronger than with breast-fed babies, and varies with different types of formula. As babies grow older, they have fewer bowel movements, and their stools become more formed or pasty. This becomes more pronounced when solids are introduced into the diet.

Constipation

A baby is considered to be truly constipated only if the bowel movements are hard and/or associated with signs of abdominal pain or discomfort, such as crying while passing a stool. If this is the case, parents should consult their doctor.

Generally, once a constipated baby has been evaluated and the child’s health is found to be otherwise normal, the problem can be treated by simply giving your child more liquid (lack of fluid is a common cause) or by adding some table sugar (sugar loosens the stools by fermenting in the intestine and hurrying the passage of waste) to the child’s milk. In babies older than 3 months, strained prunes or prune juice may help relieve constipation. To find out which method is most appropriate for your baby, consult your physician. Never give your child laxatives, enemas, castor oil or mineral oil unless advised to do so by your doctor.

Diarrhea

Diarrhea is sometimes a sign of other problems such as infection, allergy, or food intolerance. It is characterized by abnormally frequent and liquidy bowel movements. Unlike normal bowel movements, diarrhea often has a particularly offensive or unusual odor. Bowel movements may be so watery that they leave a water ring in the diaper. If diarrhea is persistent, or if it is accompanied by other signs of unwellness, such as fever, crying, or abdominal pain, consult a doctor.

Diarrhea in an infant needs to be monitored carefully, even if there doesn’t appear to be other signs of unwellness, because it can lead to dehydration. The baby should be offered as much cooled boiled water as he will drink. Dehydration is a dangerous condition in which excessive loss of body fluids results in a potentially life-threatening imbalance of water and essential body salts. Signs of dehydration include decreased urination, dry mouth, lack of tears, lethargy and sunken eyes. If you suspect your baby may be dehydrated, get medical attention immediately.

But most loose stools will be found to be due to diet not to infection. Too much sugar can cause diarrhea, just as extra sugar corrects constipation. Are you adding cereal to the bottles instead of giving the formula exactly as the manufacturer recommends? Are you giving the baby lots of fruit juice? Or giving him drinks of sugar water or a pacifier dipped in something sweet?

Too much fat can also cause loose stools. If your baby is not digesting the particular fats in his formula, the stools will smell very nasty. Once again, take the baby and a soiled diaper to the doctor. If he feels that the fat in the milk is not agreeing with the baby, he may recommend that you change to a different formula. Don’t switch formulas before you consult your doctor.

Color Changes

Even before you introduce any solid foods, some “extras” can cause quite alarming color changes in the stools. Grape juice, for example, may turn the stools reddish or purple. Various over-the-counter medicines will color the stools, while if the doctor has prescribed iron for the baby, the stools may be blackish.

Urine

Newborns generally urinate up to ten times per day. Urine typically ranges in color from clear to pale yellow, and has little or no odor. It does not matter if the baby wets himself very often; it may matter if he wets himself infrequently.

A new baby who is dry after a couple of hours needs watching. His body may be using up more fluid than usual because he is starting a fever. Or he may need more than usual because it is a hot day or because he is wearing a very warm blanket. Give him plenty of extra drinks of water or juice, and see if he is still dry after another two hours. If he is (and he almost certainly will not be), phone your doctor. The baby just might have an obstruction.

Too little fluid, especially when the weather is hot or when he has fever, can make the urine extra strong and concentrated. If it is really strong, it may stain the diaper yellow and redden the baby’s skin. Once again, he needs more to drink. If the urine goes on being very strong, even though the baby is drinking plenty, and especially if it begins to have a nasty fishy smell, then you should take him to the doctor. It is possible he has a urinary infection.

Of course if your think there is blood in your baby’s urine, you will make an immediate appointment with the doctor. But pause to think for a moment. If your baby is a girl and the redness you can see is blood, it may be coming from the vagina rather than from the bladder. Vaginal bleeding is quite normal during the first few days of life, and on a wet diaper can easily look as if it is part of the urine. Equally, the redness on the diaper may not be blood at all if, for example, it follows the baby’s first drink of diluted grape juice.

As the baby grows older, he will urinate less frequently, but in larger amounts. An odor of ammonia may become more apparent in the urine. This longer the urine is left in the child’s diaper, the more intense the odor becomes. Blood in a baby’s urine may indicate infection, and should be evaluated by a doctor.

Consult your doctor if there are any sudden variations in the pattern of your baby’s bowel or urinary habits. Any streaks of blood or mucus in a baby’s stool should also be evaluated.