- Let’s get acquainted with the norm
- The greens in the stool
- The white lumps in the stool
- Lactase deficiency
With the birth of a baby comes not only happiness and celebration, but also many fears. It is not uncommon for a mother to find herself often worrying about the baby’s health and whether or not she is taking proper care of him. Fortunately, it is not difficult to dispel many of the common fears a new parent experiences.
It may seem odd, but most young parents often find themselves studying the contents of a baby’s diaper with both interest and awe… does this sound familiar to you? It is indeed normal and even important to talk about the health and wellness of a child—even if that means discussing some not-so-dinner-talk-friendly topics. It’s also important to understand what comes out of your infant’s body—and why.
A baby’s stool often causes concern for parents, but if you learn to “read between the lines” and understand the normal and abnormal signs of an organism, you will be more equipped to deal with any health issues that could possibly arise.
Let’s get acquainted with the norm
While the baby lives and develops in the mother’s womb, meconium accumulates in his intestines. Meconium is a tarry, thick black or dark olive substance that is practically odorless. It consists of materials that were ingested during the time the infant spent in the uterus, including concentrated cells of the intestinal mucus, amniotic fluid, bile, water and more. Normally, meconium is passed a few days after birth. However, sometimes the meconium is expelled into the amniotic fluid prior to or during labor. This can be a warning of fetal distress, putting the infant at risk of aspirating. Medical staff may then have to forcibly aspirate the meconium through the nose or mouth of the newborn immediately after delivery.
When the meconium passes in the stool of a baby in the first two or three days, it is typically a yellow-green color. It turns this color because of the large amount of milk ingested by the infant. Colostrum is produced by the mother late in the pregnancy, which delivers nutrients to the newborn in a very concentrated, low-volume form. The colostrum has an effect akin to a laxative, which helps the baby pass his first stool. Depending on the person, it can take a few days for the first stool to pass because sometimes, right after birth, the mother does not produce enough milk to nourish the child, resulting in a lack of stool.
After the establishment of active lactation in mothers, a baby’s stool gradually becomes more mature, usually passing through a transitional stage. At this time, the stool changes from meconium to the normal yellow, seedy, sour-smelling stools that are common among breastfed newborns. Babies that are breastfed exclusively should have these transitional stools by day 4 if the feedings are adequate. The frequency of stool is higher the younger the child is: in the first weeks after birth, the bowel movements can occur after almost every feeding, reaching about 5-8, and sometimes even 10 times a day.
Gradually the stool becomes more infrequent, lowering to about 1-3 times a day when the child reaches three to six weeks old. However, some infants can have only one bowel movement a week—this is also totally normal. This can happen when breast milk leaves very little solid waste to be eliminated. Infrequent stools are not a sign of constipation; as long as the stools are soft (no firmer than peanut butter), and your child is nursing and gaining weight steadily and not in any pain, there should be no cause for concern.
Stool from formula and mixed feedings can look exactly the same as a normal, mature stool from breastfeeding. It could also have a more “adult,” putrid odor, thicker consistency and darker, brownish color. Bowel movements from mixed or formula feedings should take place at least 1 times a day. If not, this could be a sign of constipation.
Now that we understand the “ideal” bowel functions of a newborn, it is time to familiarize ourselves with the possible deviations from that.
The greens in the stool
Often times the “right” or “ideal” kind of stool doesn’t not occur for a long while, regardless of active lactation or normal feedings. The stool can retain the features of the transitional one, with a clear, greenish hue along with mucus. There are several reasons for this:
- Malnutrition (the so-called “hungry” stool). This is often due to a lack of breast milk. Factors that can complicate the baby receiving the appropriate amount of milk from the breast include the mother having flat or inverted nipples, or a tight chest, especially after the first birth.
- A predominance of fruits and vegetables in the diet of breastfeeding women.
- Inflammation of the intestinal mucosa in the baby. This can be caused by the child surviving hypoxia (oxygen starvation) while still a fetus. This pathological condition affects many tissues in the body, including the intestinal mucosa. Additionally, inflammation of the intestinal mucosa can be caused by the influence of synthetic substances— flavorings, colorings and preservatives and any synthetic compounds present in the mother’s diet can penetrate into the breast milk and directly impact the intestinal mucosa. This means that when a mother eats foods containing synthetic additives, like sausage products, smoked meats, canned foods, juices made from concentrate and dairy products with fruit and other aromatic fillings, traces of them are present in the breast milk. Finally, a very common cause of intestinal inflammation is a violation of the normal intestinal microflora (bacteria and microscopic algae and fungi)—also known as an “intestinal dysbiosis” (or just “dysbiosis”). When representatives of normal microflora are not enough, the so-called “opportunistic” microbes multiply. Pathogens forming under these unfavorable conditions can cause inflammation in the intestines. In this case, the mucous is suffering as a result of the effect of conditionally pathogenic microorganisms and their metabolic products. The risk of developing dysbiosis increases significantly if the mother and/or baby are given probiotics. This can also help to support the long-term well-being of the child as well.
So, what should you do if your child’s stool is still green at this stage? The first step is to eliminate any malnutrition that may be occurring. Of course, changes or abnormalities in the stool are not the only warning signs of malnutrition. Some other observable symptoms include: the baby is discontent from the milk not flowing properly from the nipple, he does not fall asleep after feeding and/or is resistant to more than 1 – 1/5 hours between feedings or he has reduced the speed of weight gain and growth. If there is an expressed malnutrition, the number of times your child urinates also decreases (normally it is not less than 6 – 8 times per day) the urine may also become more concentrated(typically it is almost colorless and has only a slight odor).
The best way to handle malnutrition is to act according to the situation: with insufficient lactation, consider feeding “on demand” or when the child first cries out from hunger. While breastfeeding, let him be at the breast as much as he wants, or give both breasts during a feeding. You could also breastfeed at night or take medication that stimulates lactation. If the cause of malnutrition is from an abnormality in the size or shape of the mother’s nipples, it might be worthwhile to use special pads on the nipples during feedings. Whatever the cause may be, if you suspect that your baby is malnourished, it is best to contact your pediatrician, as well as a consultant on breastfeeding.
It is also important that the mother’s diet is carefully examined. Ideally, all foods and food products that contain synthetic additives should be omitted from the diet. Synthetic additives and vitamin supplements are often the cause of intestinal inflammation in infants. You should also make sure that the amount of fruit and vegetables in the diet does not prevail over other products (though these foods are natural “gifts of land,” they contain large amounts of acid, the excess of which in breast milk can cause inflammation of the mucous membrane in the intestines of the baby).
Now that you understand how to create all of the best possible conditions for the proper nutrition of your baby, you should be able to easily monitor his health. If your child grows in height and gains weight, and he is free of any abdominal pain and allergic reactions, then generally, as a whole, he is healthy and happy and interested in the world around him. Based on his age, it’s difficult to attribute any health concerns to a single symptom—in the human body, especially in the body of a newborn, everything progresses according to its own laws and individual speeds. If dysbiosis is present in your child, it may take some time for his intestines to settle with the “correct” microbes. This may take longer than a day or even a week—even in perfectly healthy children it is possible that transitional stools may persist for up to a month or more. As long as this does not affect the baby’s ability to develop normally, you need not worry about interfering in the process. Regular checkups and probiotics will help your child grow in a healthy manner, as there are no medications yet that completely eliminate dysbiosis, nor are there any that are better for your child than natural mother’s milk. However, one route to take to care for prolonged symptoms of dysbiosis is to have your breast milk tested for bacterial inoculation, in order to make sure that it does not contain any harmful pathogens. If any are found, it is necessary to determine their sensitivity to antibiotics before any treatment is carried out (which is the most effective method for this case). While this treatment is being administered, breastfeeding is usually stopped.
If all is not well in the baby’s state of health, (for example, he suffers intestinal cramps, allergic skin reactions are observed or he is not gaining weight and growing), then it is necessary to undergo some tests—namely a coprogram. A coprogram, or a general analysis of feces, shows how the process of digestion and the rate of food passage through the gastrointestinal tract. It can confirm the presence of mucosal inflammation as well as revealing diseases of the stomach, small and large intestines, liver, pancreas, gallbladder and other parasitic diseases. Attention is especially placed on the analysis of the flora and the presence of pathogens and “unfriendly” microbes that should not normally appear in the gut or intestines. The detection of pathogenic (disease-causing) microbes will help in finding the right medication for your child. In some cases, antibiotics or probiotics can also be appointed, taking into account the sensitivity of the pathogenic bacteria to them. The medication prescribed in the end will contribute to the restoration of normal microflora. A coprogram is used not only for diagnosis, but also for monitoring the development and progress of disease.
The white lumps in the stool
Sometimes you’ll notice a few white lumps in your baby’s feces, that look not unlike granular curds. If you notice these lumps in the stool of your child who is otherwise healthy and physically developing in a normal manner (i.e. eating well, gaining weight and growing), then it could be an indication of overeating. When the body receives more nutrients than are necessary in order to satisfy real needs (like offering breastfeeding as a solution not only to satisfy hunger, but also as a form of sedation), it means that your child is overeating—but there is absolutely nothing wrong with that, as the body of a baby is adapted to taking in such a “surplus.” The white lumps are merely a result of undigested, excess food. This feature in the stool of healthy children has become more commonplace in the present day due to pediatricians’ advice to feed “at the first cry.”
However, if this symptom is accompanied by a shortage in weight and growth, especially if this lag is exacerbated, it is most likely because the fermentative deficiency of digestive glands has taken place, which does not allow the child to properly digest incoming nutrients. In this case, a pediatrician or gastroenterologist may prescribe replacement therapy by fermental preparations.
Often, a baby’s stool is thin, watery and even foamy. Along with these features it can also have a sharper, sour smell and, in some cases, it even changes to a green or mustard color. This type of stool, in conjunction with the cotton fabric of diapers, often leads to diaper rash. The stool takes on this form when there is a disturbance in the digestion of lactose, like if the amount of lactose from breast milk exceeds the amount of the enzyme lactase needed for digestion in the baby’s intestines. The extra lactose in the milk could be because of a genetic predisposition or because of an excess of fresh milk or dairy products in her diet. It could also be from the decreased production of lactase in the digestive glands of the baby. Since undigested carbohydrates “pull together” a large amount of water into the intestines, this causes the feces to have a liquefied, watery consistency.
Lactase deficiency is often accompanied by intestinal dysbiosis: when there are not enough of the proper flora in the gut, the ability to digest carbohydrates is reduced. If a lactase deficiency does not interfere with the development of the baby (as previously mentioned, its symptoms are normal growth in height and weight, lack of intestinal colic and persistent diaper rashes), this condition is quite possible to leave be without treatment. In the vast majority of cases—lactase deficiency is a transient problem and disappears without trace with age (by 9 – 12 months the activity of digestive glands increases so that the baby can begin to easily cope not only with fermented milk products, but also with fresh milk).
Severe and life-long interruptions in the production of lactase is almost always caused genetically. Take some time to research whether or not your family has a history of this hereditary malfunction, that way you can predetermine if your next of kin will also suffer from this lactase deficiency. For a concrete diagnosis, a feces analysis on carbohydrates must be carried out. If there is a confirmed lactase deficiency, a mother should first adjust her diet—mostly by eliminating fresh milk and dairy products (with the exception of cheese, which contains practically no milk sugar). If this measure is not successful, your doctor may prescribe a lactase substitution treatment.
Constipation is the lack of an independent stool for more than one day (except in cases of the complete assimilation of milk), as well as cases when bowel movements are difficult and are accompanied by a considerable amount of discomfort.
Constipation seldom occurs when a baby is being breastfed, but it is not completely uncommon. There are two main causes for constipation in newborns: improper maternal nutrition and intestinal motility disorders—including spasms of the anal sphincter.
Improper maternal nutrition occurs when there is an expressed penchant for foods rich in protein and easily digestible carbohydrates, but a lack of dietary fiber, in the diet of the mother. This can manifest itself in the form of constipation in the child. To correct this imbalance, the mother must first normalize her diet by adding in more cereals (especially those containing buckwheat, brown rice, and oatmeal), whole wheat bread and boiled vegetables. Additionally, some foods like peaches, apricots, prunes, dried apricots, figs, boiled beets and fresh yogurt posses laxative properties. In many cases, these foods will normalize not only the mother’s own stool, but the stool of her baby as well.
If this change in the mother’s diet does not resolve the issue of constipation in the baby, then the cause is most likely a violation of the intestinal motility (for example, hypotension) and/or a spasm of the anal sphincter has taken place. If there is a spasm of the sphincter, the discharge of gas from the intestines is also difficult, so constipation is often accompanied by marked intestinal colic. Unfortunately, it is practically impossible to deal with this issue with just household care or natural remedies. Since these spasms are often the result of malfunctions of the in the nervous regulation of smooth muscle tone, they are most likely the consequences of birth trauma or an adverse course of pregnancy. If the spasms are accompanied by other symptoms like irritability, sleep disorders, dormancy, meteodependence (a severe mental and physical reaction to a change in weather), disorders of muscle tone, etc., then it may be necessary to visit a neurologist, who will prescribe a treatment that will help understand and correct any imbalances in the central nervous system as well as aid in the elimination or improvement of constipation. If the absence of stool is accompanied by pain and/ or swelling in the abdomen of the baby, a gas outlet tube can be administered to gently stimulate the anus. Constipation is more common in newborns that are formula-fed, as it is more difficult to digest milk formula. This can be treated by replacing half of the daily diet of a baby with a sour milk mixture (sour mixture can be gradually introduced after 3 weeks of life). After 4-6 months of life, broth and mashed prunes can be introduced into the diet of the child, as they also help to cope with constipation.
If the above measures do not help to normalize the situation (for children who are both breastfed and formula-fed), the pediatrician may prescribe some medications: Glycerin (glycerol) suppositories (in the first 6 months of life, a single dose is ¼-½ of one suppository) Duphalac (a prebiotic laxative for bowel obstruction) or “Microlax” (a sodium citrate enema), just to name a few.
These are just a few of the “secrets” that are contained within your baby’s diaper. We hope that now you have gained a better understanding of what’s both normal and abnormal when it comes to your child’s bowel movements. These tips can help aid in the health and wellbeing of your infant, but we want to once again remind you: any diagnostic analysis and especially the appointment of treatments must be done ONLY by your pediatrician.