Bowel Movements and Urinating
During the first day of two of life, your baby will have thick greenish-black, tarlike stools, called meconium. As your baby begins to nurse or bottle-feed, these stools will change first to a greenish-colored stool and then to yellowish colored stool.
Your breastfed baby will not become constipated as long as breast milk is the only food. Formula fed infants are more likely to become constipated. A constipated stool is hard, painful to pass, and may resemble pebbles. It is very common for infants to make a great deal of grunting, groaning an even crying when they have normal soft bowel movements. See the section on formula feeding for management of hard, formed, painful stools.
Occasionally normal breast milk stools are thought to be diarrhea because of their frequency and loose consistency. They vary from liquid with suspended curds to a thick toothpaste type consistency. In the first weeks of breastfeeding, there may be as many as one to two movements per feeding; as the baby gets older you may see the other extreme with one large, soft loose “breastfed” stool as infrequently as once every three to four days! In some instances, stools are as infrequent as once/week! The babies are not distended, continue to eat well and are not in unusual distress. The breastfeeding stools are typically bright yellow and may range from “Army” green to “University of Texas” orange in color. This whole range of frequency, color and texture are normal in breastfed infants. Formula fed infants tend to have less frequent soft yellow stool initially and trend toward 1-2 brown and more odorous stools/ day over the next few months. Many formula-fed babies will have 2-3 day intervals between stools as they get older. This is of no significance as long as the stool is fairly soft and easily passed. It is very unusual for a breast-fed baby to have diarrhea if he is fed only breast milk.
Regardless of feeding method, we want you to contact our office if there is a sudden and significant increase in watery stools that soak into the diaper. Also, any blood in the stool is reason to call us.
A baby’s urine is normally clear and light yellow in color. Occasionally, a baby may have some brick-colored flecks where the urine soaks into the diaper. This is often mistaken for blood, but really is the normal excretion of urate crystals and is normal during the first few weeks of life. As a general rule of thumb, a baby getting adequate feedings has one wet diaper per day of age up to 6-8/day for the next several months. The newer super absorbent diapers can sometimes make it difficult to tell if a child has urinated if the urine volume is small and the child is being changed frequently; one solution is to weigh a fresh diaper on a scale accurate to the ounce and again after the change The increase in weight should reflect stool/ urine. Another alternative is to put some Kleenex if the anterior part of the diaper to detect the presence of urine.