Babies can be mysterious creatures. They have few needs but the variations on those needs can be endless. So any clues into their wellbeing are helpful. One big source of information is your baby’s diaper – your baby’s poop can help you understand what is happening inside his or her body.
First let’s follow the path of normal digestion.
Food goes in the mouth and digestion actually begins here! Enzymes in our saliva start to break down the starches in cereal and bread (enzymes are chemicals that break our food down into smaller, more digestible parts).
Amazingly, your breast milk has the same enzyme, called amylase. Mixing breast milk with your first cereal feedings are a great way to help introduce a new food while using the enzymes in your milk in new ways.
Next stop is the stomach where strong acids continue the process of breaking down your milk into small pieces your baby can use. A cup of your milk contains about 2.5 grams of protein and 11 grams of fat (a study of 24 hour milk collection showed fat content was highest in mid-day and evening, lowest in the morning and late night feedings. These numbers can vary quite a bit.) Your first milk contains about 90% whey and 10% casein protein since whey is much easier for your baby to digest by an immature gut. As your baby gets grows, the type of proteins even out to about equal quantities.
As your milk exits the stomach for the small intestine and the real work of absorbing nutrients happens here. Some parts of your milk leave a protective coat on your baby’s intestines to keep illness causing germs out of the blood and moving down the digestive tract, leaving the body unharmed. Other parts of your milk are changed into glucose and absorbed into the blood, where insulin lets it in the cells to be used for energy and building new structures.
After the body has extracted all the possible nutrients from your milk, it moves to the large intestine where more water is re-absorbed and bacteria continues to break down the milk into smaller molecules that can consumed by the bacteria that live there. The food starts to look like poop by now. If your baby is exclusively breastfeed, their waste doesn’t spend much time here. Since breast milk is highly digestible, there isn’t much for the bacteria to work on and it moves to the rectum to accumulate into a bowel movement.
So what can go wrong?
Constipation – this occurs when the poop stays in the large intestine too long. If food moves too slowly, the large intestine continues to absorb more water from the poop, it gets harder, drier and more difficult to pass out of the body.
Food intolerance – if we don’t have the right enzymes, digestion can’t happen in the stomach and small intestine. Instead the bacteria in the large intestine get the job. These bacteria aren’t equipped to do the job efficiently and produce gas as a byproduct. Some gas is normal, but too much can be a sign of tummy trouble.
Spit up – there is a muscle at the top of the stomach called the cardiac sphincter (it’s near the heart, hence the name). Normally food enters the stomach and the muscle closes like a drawstring… so you can lie down and all your food doesn’t come back out. In some babies, this muscle doesn’t close completely and milk comes back up. Sometimes the milk has a sour smell due to the acidic environment of the stomach curdling your milk.
Diarrhea – when material moves too quickly through the large intestine, water and salt don’t get reabsorbed as usual. It just moves out too quickly. The body loses water and electrolytes it needs, if diarrhea is severe and goes on for more than 1-2 days, for an infant it could be fatal.
GERD – an acronym for gastroesophageal reflux disease or heartburn. Also related to a loose cardiac sphincter. The strong acid from the stomach leaks up into the esophagus and throat causing pain from the acid actually eating away to the tissue. The stomach is protected by a tough mucus coating, but no other parts of the digestive tract have this protective cover. Anytime the acid from the stomach leaks out, it can cause injury and pain to the tissue it touches.
Red blood – if you spot blood in your baby’s poop it can mean the intestines are inflamed somewhere, a small crack in the skin around the anus or an allergy to something they ate. If your baby has 1-2 bloody poops, mention it to the doctor at your next appointment. If your baby is having 1-2 bloody poops an hour, acting tired and painful, page your doctor for advice.
Black poop – black or tar-like poop is a sign of digested blood. If your nipples are bleeding or you notice pink milk or “strawberry milk” when you pump, you might notice darker poop. Supplementing your baby with extra iron can also cause darker poop. If you have ruled out the common causes and you notice consistent dark poop, talk to your baby’s doctor.
Green frothy poop – the usual cause is too much foremilk. If your baby falls asleep at the breast before emptying it or fills up before getting to the hind milk later in the feed – try to keep your baby on one breast until it’s is empty, then switch to the second breast. Green poop can also be a sign of iron supplementation so consider this as well.
If you ever have any questions or concerns, collect a sample to bring to the doctor’s office. Your baby’s poop may not be your favorite surprise (especially an outfit wrecking blowout!) but it provides a valuable look into the workings of their little body.