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Before you had your baby, it’s likely you rarely discussed your bodily functions aloud. Now that you’re changing dozens of diapers each week, you find yourself obsessed with the frequency, color, and consistency of everything coming out of your baby’s body. And this obsession can also lead to worries about whether or not what you see is normal.
Think of gut maturation as a process. Your baby is born with an immature digestive system that will adapt as they grow. This process can be affected by whether your baby was born early, the type of birth they experienced (vaginal versus cesarean), if their mother had antibiotics during labor, what they eat (breastmilk versus formula), and even their mom’s gut health before and during pregnancy.
There are hundreds of human milk oligosaccharides (HMOs) found in breastmilk only and they help the gut maturation process along. These sugars feed the good gut bacteria, increasing the antimicrobial activity of the baby's own gut as well as forming a mucus layer that will serve as a barrier to protect the baby from some pathogens.
A baby born by cesarean surgery may miss out on the microbial transfer that vaginally-born babies get, which seeds their gut with mom’s own mix of microbes to keep the baby healthy in their home environment.
Antibiotics during labor can also disrupt the microbiome a baby is introduced to during birth.
"As you begin to breastfeed, colostrum acts as a laxative and helps to rid the baby's system of the meconium, which can also lower your baby’s risk of jaundice."
Babies typically pass their first stool - meconium - within 24 hours of birth. For the last weeks of pregnancy, your baby had been practicing their swallowing skills - so their gut was full of byproducts from the amniotic fluid, as well as a general build-up of bile and mucus from the digestive system itself, at birth. Meconium is the name for this waste product accumulated in your baby’s gut during pregnancy. These first thick, black bowel movements have a tar-like consistency and can be difficult to wipe from your baby’s sensitive body parts.
As you begin to breastfeed, colostrum acts as a laxative and helps to rid the baby's system of the meconium, which can also lower your baby’s risk of jaundice. In the first few days after birth, your baby’s bowel movements should change from meconium to possibly a greenish transitional stool to a yellowish non-formed stool by day four or five. For babies born prematurely, this process can take a few days longer (though most premature babies have passed meconium by day 9).
Breastfed babies need to eat often, and they likely poop so much as a direct result of this feeding frequency, but the ingredients of breastmilk can also play a part. There are dozens of HMOs, fatty acids and beneficial bacteria in breastmilk that all play a part in keeping your baby’s gut functioning optimally. Formula-fed babies, on the other hand, tend to have less frequent bowel movements due to the lack of these important ingredients.
"Gassiness is normal and a sign that your baby’s digestive tract is maturing and working. But it’s not always comfortable for babies. "
Breastfeeding should be evaluated for babies who have fewer than four bowel movements per day by day four, as this is a sign of poor intake and may warrant supplementation. It’s normal for a breastfed newborn to have a bowel movement every time they eat. As your baby gets older, the frequency of stooling can decrease, but your baby should continue to have at least one dirty diaper per day.
People always ask if it’s normal for their two-month-old to poop only two to four times per week. While it’s common for babies to occasionally go several days without stooling, common doesn’t necessarily mean healthy. Infrequent stooling likely points to a gut microbiome that is out-of-whack. Heal the gut AND mom, and the baby will start stooling more regularly.
"As your baby gets older, the frequency of stooling can decrease, but your baby should continue to have at least one dirty diaper per day."
Breastfed babies typically have mustard-yellow, non-formed, soft stools that can look pretty watery. They may or may not contain curds or seedy-looking pieces. Yellow, orange, brown, and dark green are the most common colors for a healthy infant’s poop. And the consistency can range anywhere from pasty to spreadable to mucusy to watery. But you can find many shades of this rainbow when you open a baby’s diaper. And once your baby starts eating solids, be prepared for more changes. Ever seen blue poop? Blueberries and food coloring can do that!
Any change in your baby’s stool color can be a signal for investigation. Often the change is transient - your baby has one or two oddly colored bowel movements, then goes back to what is normal for them. Frequent green stools in a breastfed baby, especially if they are frothy, can indicate that your baby isn’t getting enough fatty breastmilk found toward the end of feedings. Or it could be a sign of sensitivity to something you’re eating, or just a manifestation of the ingredients you’re eating (such as food colorings, spinach, or kale).
If your baby’s stools are light tan, gray or white, or if you notice any blood in your baby’s diaper, this can indicate a problem that needs to be addressed by a healthcare professional. Cystic fibrosis, Hirschsprung’s disease, cerebral palsy, and other conditions can cause changes in the gut that will show most obviously as changes in the baby’s stool. Any time you’re unsure, let your baby’s doctor know.
"Yellow, orange, brown, and dark green are the most common colors for a healthy infant’s poop."
Gassiness is normal and a sign that your baby’s digestive tract is maturing and working. But it’s not always comfortable for babies. While products like gripe water and anti-gas drops are often recommended, infant massage can also be a helpful tool. Probiotics are another option that may help if a baby experiences frequent fussiness, especially if it's associated with gassiness or increased spitting. Another option to help keep your baby comfortable is chiropractic care. Choose a chiropractor who has experience working with babies.
The more we learn about gut health, as well as the maternal and infant microbiomes and epigenetics, the better we can keep babies comfortable. Knowing there is a wide range of normal that you’ll see in your baby’s diaper can give you peace of mind, remembering that changes from what’s normal for your baby can signal a problem that needs further investigation.