Years ago, during elementary school, my second grade teacher asked us what we wanted to be when we grew up. Many of the kids answered with the usual responses: a doctor, a lawyer, a firefighter or a police officer. But one student responded that he wanted to study "Poopology." We all laughed, even the teacher, and then we moved on to other things. I think that boy wound up selling insurance, but ironically, now I'm the one who is actually a bonafide "poopologist."
I get many questions about stool and bowel movements from worried parents, so here are some things you may want to know about the many aspects of poop in infants and small children.
A little known fact is that almost all babies hold their first bowel movement until after they are born. Why? Because the stool is full of bad chemicals that might damage a baby's lungs if he should get them into his lungs while still in the womb. Sometimes the baby can't "hold it," so that creates meconium in the amniotic fluid. Meconium is what we call the first few baby bowel movements. It's made from dead cells and bile (I hope you're not eating lunch while reading this article!). When a baby has meconium in the amniotic fluid during the birthing process, the situation has to be monitored closely. Once the baby is born, his mouth, stomach and trachea need to be thoroughly suctioned before he can take his first breath; otherwise the meconium will seriously burn his lungs.
For most, meconinum is a sticky situation - quite literally. It is black or dark green and very thick and pasty. I jokingly tell my parents that they will need a putty knife to clean it off. Over the first few days, it will transition into a green sludge and then a yellow, loose substance resembling mustard with rice in it. The frequency of the bowel movements can vary, depending on whether the baby is breast-feeding, bottle-feeding, or a combination of both. Breast-feeders typically have more bowel movements that tend to be looser. Babies who feed from bottles have fewer bowel movements; the consistency may be thicker and the color can vary from yellow to green to brown. v
Things to Watch For
Newborns have an interesting reflex called the gastro-colic reflex. This means that every time they eat, they poop. In the first few months, that means you will burn through a heck of a lot of diapers. They can also shoot out several rounds of explosive poops in staggered increments. My wife found out the hard way when she tried to change our daughter's diaper for the first time. She opened the diaper, cleaned the child, and when she reached for a fresh diaper, our little Princess let loose with the "second barrel." The resulting scream made us think my wife dropped the child, but when my mother-in-law and I arrived to the scene of the massacre, we found my wife covered in yellow poo. After suppressing the laughs, we sent her to get cleaned up and finished up the diapering process ourselves.
Another issue parents may encounter in the diaper is blood. There are two possible sources: mom or the baby. Sometimes babies swallow blood during the birthing process; this is mom's blood, and it passes quickly through the baby. In the hospital, there's a way to test it to see whose blood it is. This type of bleeding is harmless and resolves on its own.
Sometimes babies develop rectal tears and can have streaks of blood in their stool; your pediatrician can examine the rectal area and determine if this is what's happening. Rectal tears sound awful, but I like to describe them as "chapped lips of the butt"-a little uncomfortable, but nothing too bad. They are generally harmless and will get better on their own.
Occasionally, babies will have bleeding in their guts, which can cause blood in the stool, or black stools. There can be several causes for this, and your pediatrician will need to examine the baby and run tests if necessary. The causes can be formula/milk intolerance, infection or obstruction. Formula/milk intolerance can be fixed by changing the formula or the foods that breastfeeding moms eat. The other two problems are more serious and require hospitalization.
Babies can also produce a substance called uric acid, which can be mistaken for blood. It has a pale pink color and usually is found in the front of the diaper. Once again, this is a harmless condition and resolves in time.
As children grow, their bowel movements become more regular and predictable. But just when you think you've figured it out, they get constipation. By constipation, I mean bowel movements that not only slow down but are hard to pass. The infant will usually get cranky and gassy, and may not feed very well. Sometimes a simple tummy rub or bicycling the legs will help. If not, I suggest using either 1 to 2 teaspoons of dark karo syrup twice a day until the stools become normal, or a mixture of 1 to 1 ratio of Pedialyte and prune juice. Sometimes you may need to do both. It seems that almost every child will develop constipation in the first year. Severe constipation can lead to rectal tears, so be on the lookout for bleeding. If the constipation is severe, see your pediatrician-your baby may require stronger medicines or a suppository.
When we start babies on solids, this affects their bowel movements. Typically, rice cereal will slow bowel movements, and barley and oatmeal will speed them up. When you start vegetables and fruits, be prepared for some "special" surprises in the diapers. When meats are introduced, the poops can get quite foul, and no diaper pail in the world will be able to contain the powerful, odiferous emanations. I recommend taking these diapers directly to the outside trash can, where they serve as great raccoon repellants. I affectionately call these toxic diapers "Chernobyl poops." Something to note is that food allergies may present as blood in the stool.
Toddlers develop a special ability when it comes to having bowel movements: they can choose to hold it for longer if they want. This is good, since now they can control when they poop, but it's also bad since some kids decide that they don't want to poop... ever! This will lead to a cycle where they hold their poops, then have a painful poop because they held it too long, and then try even harder to hold longer to avoid the pain. In this situation, we need to break the association with pain and bowel movements. I usually recommend that parents use a combination of a high-fiber diet and either apple/prune juice or Miralax for several weeks.
By this time, normal stools take on the familiar brown color and consistency that adults have. Cleaning the diaper/pull-up can be challenging, since many times you will have to catch the child first and wrestle her to the proper position to change the diaper.
It All Comes Out in the End
Maintaining healthy bowel habits can be difficult for younger children. Sometimes they try to ignore their body's signals because they're too busy playing or watching their favorite TV show. They also are picky at times with their eating habits. This can lead to constipation, or the occasional "accident." Do your best to offer a healthy diet with plenty of water (not juice or sugary drinks), and encourage your child to use the bathroom when she feels her body telling her that it needs to go.
The next time you open up a diaper and it looks like something out of a horror movie, don't panic! Your pediatrician is a trained "poopologist" who can handle the situation!
William "Dr. Bill" Incatasciato is a pediatrician at Capital Area Pediatrics in the Countryside Shopping Center in Sterling. For more information about Dr. Bill and/or his practice, visit www.capitalareapediatrics.com.