At Tiny Health, we often get parents who are concerned about their baby’s poop. An unexpected color, a weird consistency, or not pooping very often are some of the things parents get worried about. In short, what does healthy and normal baby poop look like?
And it’s okay to get worried.
Poopy diapers can tell a lot about a baby’s gut health. And so it’s a good idea to be dialed in to common red flags.
And also - certain things that may have you worried can actually be common for babies. How can you tell? Here are two things you should look for when evaluating baby poop as a pro:
- Color
- Consistency
Let’s tackle each one separately.
Baby poop color
Baby poop comes in many colors and shades. The baby poop chart we use in Tiny Health is based on the Brussels Infant and Toddler Stool Scale (BITSS). There are six colors for parents to choose from:
- Yellow
- Orange
- Green
- Brown
- Grey
- Black
Different shades of yellow, orange, green, and brown may indicate normal baby poop.
And going from one to another shouldn’t be a concern. A change of color can occur due to a variety of reasons. For example changing from breastmilk to formula, changing to a formula with a different composition, or adding new solid foods to the diet.
If you spot gray baby poop or black baby poop, this is something that you may want to ask your provider about.
For example, gray baby poop can indicate bile deficiency and/or a liver disorder that leads to undigested food or milk [1], [2].
Whereas black poop is only normal for your baby’s first poop or meconium. After that, it may indicate the presence of blood that comes from higher up in the gut.
What about blood in stool?
In addition to your baby’s poop color, sometimes you may notice there’s blood in it. Blood may appear as bright red to very dark red, and this has to do with where the blood came from.
Bright red blood likely came from the colon or from anal fissures, which are caused when a baby strains to poop [3].
But it may also indicate a food allergy or intolerance.
Dark red blood often comes from higher in the gut, and it can also indicate food allergy or intolerance [4]. This can make the stool look blackish. It may also come from mom’s nipples if there are cracks or fissures that bleed when feeding the baby.
Baby poop consistency
Baby poop can range from watery to hard. Breastfed babies often have more loose, runnier poop that doesn’t smell very much. Formula-fed babies instead tend to have more firmer, darker brown, and smellier poop.
It’s normal for consistency to change when you go from breastfeeding to formula-feeding. Or when starting solid foods.
1. Watery poop versus diarrhea
Breastfed babies have looser poop than formula-fed babies. And having an occasional watery poop is normal. So, how can you distinguish between normal and diarrhea?
Signs of diarrhea include:
- Watery poops that last more than one day
- More poop than usual
- Baby seems unwell, or may even be vomiting
- Baby refuses to be fed
Diarrhea can be caused by:
- A viral or bacterial infection
- Food allergies
- Food intolerances
Because diarrhea can rapidly cause dehydration in babies, it’s important to contact your provider if you find your little one is having more watery poop than usual.
2. Hard poop and constipation
Very hard and dry poop may mean that your baby is constipated [5]. At Tiny Health, constipation in little ones is a pretty common concern for parents. Many times this is described as their baby not pooping for several days.
But for babies, constipation is more about consistency than frequency.
How often should a baby poop? It varies.
For some babies, especially those who are fully breastfed, pooping once a week can be okay, as long as they look well and happy. In these cases, your baby isn’t constipated if their poop is soft, even if they haven’t passed one for a few days.
The main signs of constipation are hard, dry poops. Plus some of the following:
- Signs of straining when trying to poop
- Baby may be eating less or feeding less than usual
- Baby may be fussy or unsettled
- A fissure or tear may appear in the skin around the anus, which sometimes can bleed
- Your baby’s stomach may appear larger than usual, sometimes you can feel hard, solid lumps if you press softly in their stomach
For a small percentage of babies, constipation may be a symptom of cow’s milk protein allergy (CMPA) [6], [7], or another food allergy or intolerance. This may be especially the case if your baby suffers from persistent constipation and hasn’t responded well to medications.
If your baby hasn’t been diagnosed with CMPA or with another food allergy, consider talking with your provider about going on an elimination diet to see if constipation improves after removing possible food triggers. This includes triggers in a mom’s diet, if breastfeeding. And in a baby’s diet, if on formula or already eating solids. It’s worth noting that it can take up to 72 hours for a mom’s breastmilk to become free of milk protein.
While it makes a lot of sense that the baby gut microbiome would play a role in baby constipation, there’s currently not a lot of research on this topic.
The studies that have looked for associations between gut bacteria and constipation are in kids ages 4 and older [8]–[10].
In these studies, some researchers have found lower levels of Prevotella and higher levels of Blautia, Ruminococcus and Faecalibacterium in kids with constipation. That said, we don’t know if these bacteria are the cause or the result of constipation. And more importantly, the gut microbiome of a 4-year old kid is (ideally) very different from that of a baby.
3. Soft stool
AKA the perfect stool.
For some babies this can be the usual. For others it may not be. And that’s fine. Stool consistency can come and go from watery to soft, and from soft to hard without this being an issue.
4. Mucus in stool
In addition to watery, hard, or soft stool, we often get parents that are concerned about baby poop with mucus.
The good news is that some mucus is normal: One study found that for most breastfed babies, poop is either filled with strings of mucus or watery [11]. However, this study didn’t account for things such as food allergy or a mom’s diet, so we can’t say for sure that mucus wasn’t linked to these. We just know mucus in poop seems to be pretty common among babies.
On the other hand, higher amounts of mucus are thought to be linked to food allergies and intolerances. It’s a good idea to pay attention to other symptoms such as skin rashes and colic, and correlate all these with specific foods in your baby’s diet.
5. Poop with food pieces in it
As babies start eating solid food, you may encounter pieces of undigested food in the poop. And this is completely normal, as your baby’s microbiome may be just starting to grow the bacterial species needed to digest a certain food.
