The Scoop on Poop

Okay, admit it.


Before you became a parent, you never really gave much thought to poop.


Now you are captivated and can even discuss it over meal time: your child’s poop with its changing colors and consistency. Your vocabulary for poop has likely also changed as you are now parents. Before your baby’s birth, you probably used some grown-up word like “bowel movement” or “stool” or perhaps some “R” rated term not appropriate to this pediatric site. But now, all that has changed.


As a pediatrician I have many conversations with new parents, and some not-so-new parents, about poop. Mostly this topic is of real interest to parents with newborns, but poop issues come out at other milestones in a child’s life, namely starting solid foods and potty training. So I present to you the scoop on poop.


Poop comes in three basic colors that are all equal signs of normal health: brown, yellow, and green. Newborn poop, while typically yellow and mustard like, can occasionally come out in the two other colors, even if what goes in, namely breast milk or formula, stays the same. The color change is more a reflection of how long the milk takes to pass through the intestines and how much bile acid gets mixed in with the developing poop.


Bad colors of poop are: red (blood), white (complete absence of color), and tarry black. Only the first poop that babies pass on the first day of life, called meconium, is always tarry black and is normal. At any other time of life, black tarry stools are abnormal and are a sign of potential internal bleeding and should always be discussed with your child’s health care provider, as should blood in poop (also not normal) and white poop (which could indicate a liver problem).


Normal pooping behavior for a newborn can be grunting, turning red, crying, and generally appearing as if an explosion is about to occur. As long as what comes out after all this effort is a soft poop (and normal poop should always be soft), then this behavior is normal. Other babies poop effortlessly and this, too, is normal.


Besides its color, another topic of intense fascination to many parents is the frequency and consistency of poop. This aspect is often tied in with questions about diarrhea and constipation. Here is the scoop:


It is normal for newborns to poop during or after every feeding, although not all babies poop this often. This means that if your baby feeds 8-12 times a day, then she can have 8-12 poops a day. One reason that newborns are seen every few weeks in the pediatric office is to check that they are gaining weight normally: that calories taken in are enough for growth and are not just being pooped out. While normal poop can be very soft and mushy, diarrhea is watery and prevents normal weight gain.


After the first few weeks of life, a change in pooping frequency can occur. Some formula fed babies will continue their frequent pooping while others decrease to once a day or even once every 2-3 days. Some breastfed babies actually decrease their poop frequency to once a week! It turns out that breast milk can be very efficiently digested with little waste product. Again, as long as these babies are feeding well, not vomiting, acting well, have soft bellies rather than hard, distended bellies, and are growing normally, then you as parents can enjoy the less frequent diaper changes. Urine frequency should remain the same (at least 6 wet diapers every 24 hours, on average) and is a sign that your baby is adequately hydrated. Again, as long as what comes out in the end is soft, then your baby is not “constipated” but rather has “decreased poop frequency.”


True constipation is poop that is hard and comes out as either small hard pellets or a large hard poop mass. These poops are often painful to pass and can even cause small tears in the anus. You should discuss true constipation with your child’s health care provider. A typical remedy, assuming that everything else about your baby is normal, is adding a bit of prune or apple juice, generally ½ to 1 ounce, to the formula bottle once or twice daily. True constipation in general is more common in formula fed babies than breastfed babies.


Adding solid foods generally causes poop to become more firm or formed, but not always. It DOES always cause more odor and can also add color to poop. I still remember my husband’s and my surprise over our eldest’s first “sweet potato poop” as we asked each other, “Will you look at that? Isn’t this exactly how it looked when it went IN?” If constipation, again meaning hard poop that is painful to pass, occurs during solid food introductions, you can usually help by giving more prunes and oatmeal and less rice and bananas to help poop become softer and easier to pass.


Potty training can trigger constipation resulting from poop withholding. This poop withholding can result in backup of poop in the intestines which leads to pain and poor eating. Children withhold poop for one of three main reasons:


1.       They are afraid of the toilet or potty seat.


2.       They had one painful poop and they resolve never to repeat the experience by trying to never poop again.


3.       They are locked into a control issue with their parents. Recall the truism “You can lead a horse to water but you can’t make him drink.” This applies to potty training as well.


Treatment for this stool withholding is to QUIT potty training for at least a few weeks and to ADD as much stool softening foods and drinks as possible. Good-for-poop drinks and foods include prune juice, apple juice, pear juice, water, fiber-rich breads and cereals, beans, fresh fruits and vegetables. Sometimes, under the guidance of your child’s health care provider, medical stool softeners are needed until your child overcomes his fear of pooping and resolves his control issue. For more information about potty training I refer you to our podcast on this subject.


My goal with this blog post was to highlight some frequently asked-about poop topics and to reassure that most things come out okay in the end. And that’s the real scoop.


Julie Kardos, MD with Naline Lai, MD


©2009 Two Peds in a Pod®

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13 comments

  1. my son is three weeks old and seems like he has a very hard time pooping. I have been feeding him good start protect plus. but at the hosptial they were feeding him good start gentle plus an he was fine. now he is constantly screaming when we put him to bed. what can i do?

  2. Congratulations on the birth of your son! We hope this article provided some general information about infant pooping behavior that can help you.  However, in order to best individualize his care, we recommend that you discuss your question with your son’s health care provider.

    Julie Kardos, MD and Naline Lai, MD

  3. I can see that you are an expert in this field! I am launching a website soon, and this information is very useful for me. Thanks for all your help and wishing you all the success in your business.

  4. I like your style, the fact that your site is a little bit different makes it so interesting, I get fed up of seeing same-old-same-old all of the time. I’ve just stumbled this page for you 😀

  5. I remember that in the movie “The Last Emperor” the toddler emperor’s attending servants huddled over the boy’s feces (caught in a gilded porcelain bowl) and examined it carefully. Now I understand more thoroughly what they were looking for—any sign of unhealthy color or consistency. Thanks for the “how to”—the “scoop on poop.” My daughter thanks you, too.
    G’pa Jack

  6. Hi, my daughter is 3 months old and since I stopped breastfeeding 2 months ago she seems to be having a difficult time. She grunts and groans quite a bit and can get obviously uncomfortable (screams, throws her body back etc…) when it is time to poop. Nothing comes out and she stays this way for something 2-3 days. It doens’t come out hard and is blackish green. The dr said just to give her pear juice which worked for a few days and then seemed to stop. He mentioned she may be formula intolerant but not to switch formula since that can be tough on the system. We are sorta at a lost on what to do.

  7. We suggest that you take your daughter back to her pediatrician so that she can be reassessed. Your daughter should be checked to see if she is growing normally, and she needs a physical exam. When doctors give recommendations that do not work, they need to see the patient again to re-think the problem and to offer other solutions. Thanks for writing. We hope this helps.
    Drs. Kardos and Lai

  8. As a pediatrician, I do have many conversations with new parents, and some not-so-new parents about this poop. Anyways many thanks for posting this in this site as it is really informative. I am eagerly waiting for more post from your side.

  9. Hi,
    My daughter is 15 months old and has had a great difficulty pooping since she turned one. She was put on Zyrtec and Zantac dailyfor her Urticaria Pigmentosa diagnosis and it seems to coincide with when the constipation issues started. At her well visits, the doctors have recommended Miralax daily but she still seems to have such difficulty passing stool. It’s not a daily issue but definitely comes about a few times a week where she is in quite a bit of pain. For instance, she has not gone for 3 days now and her stomach does seem to be distended, her appetite has decreased (although she also seems to be teething). I’m just not sure when the right time to call the office would be. When should I be concerned enough to call and what else can I do in the meantime to ease her discomfort. Any help would be greatly appreciated!
    Thank you!

  10. Hi- Sounds like it’s time for your daughter to visit her doctor to obtain specific medical advice. Pain is never good, especially going into potty training. Even if it’s off-hours, start by placing a call into her doctor. Nearly all doctors, have a way to give you guidance even if the office is not open. Here are some red flags with any type of belly pain to look for-  http://twopedsinapod.org/2014/03/26/stomach-pain-in-children.aspx  

    Ultimately, trust your gut instinct, if you will be up at night worrying whether you need to head to the emergency room, just go!

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