Chances are, you never gave much thought to stooling or urination before you had your first baby. Now, it's probably all you can think about. As parents, we tend to become a bit obsessed by how much and what is coming out of our baby. You may be keeping an excellent log of this information, but what should you really expect? Here's what to look for.
What should normal stool look like? How can I tell if something is abnormal?
The first few stools will be very dark and will look like tar. This is meconium. Meconium is usually passed within the first 24 hours after birth. This indicates that the baby is getting enough colostrum and it lowers the risk of jaundice. In addition to indicating potential inadequate milk intake, delayed passage of meconium can suggest a problem with the large intestine and may need additional evaluation.
From Day 3 to 5, you will notice that stools will become lighter in color and turn a greenish brown, sometimes closer to a yellow, mustardy color. The baby should pass these stools quite often and they will be loose, sometimes watery. Other times, you may notice they appear curd-like. This is good news, as it indicates that your milk has come in. You should expect at least 3 to 4 soiled diapers a day in a baby under six weeks old.
As far as amount is concerned, some feeds may produce only a stain in the diaper and then a later, more substantial, stool. This is not a problem if the majority of stools are large; the stain may serve as a precursor of things to come! Some will be small, some will be big, and this is quite normal. However, keep in mind that it is almost impossible to have a constipated breastfed baby. So, if your infant does not stool in a 24-hour period, or if every stool is small (for reference, let's say the size of a quarter), a visit to the pediatrician will be necessary. He will check the baby's weight and if the weight gain is fine, despite the stooling issue, this may be reassuring to know that feedings are going well. If there is a problem with weight gain, a lactation consultant should be seen immediately to assess your breastfeeding situation.
Most breastfed babies stool every time they feed. Many new mothers are worried that their baby has diarrhea. Have no fear. Diarrhea is usually much more obvious: The baby may have a fever and be lethargic; the stool will smell rancid; there may even be blood in the stool. If this is the case, a visit to the pediatrician is in order. Keep in mind, though, that some babies stool seemingly infrequently (compared to those who do after every feeding). However, if, when they do finally go, the stool is loose and not pebbly or formed, this is normal.
You may also want to keep in mind that certain vitamins, vegetables and fruit drinks may stain breast milk, which will cause a discoloration (albeit temporary) of stools and urine. This is nothing to worry about.
How much should my baby be urinating?
How much your baby urinates is a tell-tale sign of how well hydrated she is. Your baby should have at least six wet diapers each day by one week of age. Here's the glitch, though: These days, disposable diapers are made to be super-absorbent, which can hinder your observation. Here are some tips to ease the stress of figuring out whether or not your baby has urinated:
- Put some toilet paper into the diaper to have a better sense of when she is wet
- Put 3 tablespoons of water into a diaper and compare the weight to a dry diaper. When your baby urinates, you'll have a good sense of how much to expect.
- Use cloth diapers in place of disposable.
What is Brick Dust Urine?
This may be seen in some babies in the first few days after birth. Quite often, parents see this in their baby's diaper and think it's blood, concerned even more that it is abnormal. It is not during those initial days. Brick dust urine is simply uric acid crystals. The more you nurse, the more the baby will start urinating. At the same time, if your milk production is delayed for any reason, or if the baby is having trouble breastfeeding, these crystals can be a sign of dehydration. If the baby is hydrated well, the urine should be clear. When the urine is very dark, that may indicate that the baby is receiving an insufficient amount of milk.
I see blood in my baby's stool. What could this be?
There may be a few reasons for this. Examples include:
- Small anal fissures
- Intolerance or sensitivity to something in the mother's diet
- A reaction to a food or medication the baby is having
- Internal bleeding
If you do notice blood in your baby's stool, it is critical that you make an appointment with a doctor for a full evaluation. The most common reason for bright red blood (not mixed with the stool, but simply coating it) is bleeding in the anorectal area. If the blood is dark or mixed well with the stool, it is most probably coming from an area higher in the GI tract.
Why does my baby have vaginal discharge?
Many baby girls have bloody vaginal discharge in the first few days after birth. This stems from maternal hormones leaving the baby's body after delivery and it should disappear quickly. However, it may not be bloody -- you may notice a white discharge. This is common. If the discharge does not subside or if it smells foul, call your pediatrician. Sometimes vaginal infections are associated with extensive diaper rashes that won't go away regardless of airing out, changing frequently and using creams.
Source: Wilson-Clay B, Hoover K. The Breastfeeding Atlas. Austin, TX.
Wilson-Clay B, Hoover K. The Breastfeeding Atlas. Austin, TX.