Newborn poop and nappies: colours, frequency and warning signs

Blood in the nappy, and the colours that need a doctor

Blood in the stool needs medical assessment. Do not wait to see if it happens again. Take a photograph, or take the nappy with you.

It has causes that are minor — a small anal fissure from a hard stool, or swallowed maternal blood from a cracked nipple, which is common and harmless — and causes that are not, including infection, cows' milk protein allergy, and in an unwell baby, intussusception. Only a doctor can tell those apart.

Go to hospital immediately if blood in the nappy comes with: severe intermittent crying with the legs drawn up, a stool that looks like redcurrant jelly, vomiting that is green, a swollen or tender abdomen, floppiness or a baby who is unwell. This is an emergency.

Pale, white, chalky or clay-coloured stool needs a doctor the same day. It can indicate a problem with the liver or bile ducts, and early diagnosis changes the outcome substantially, particularly for biliary atresia. This is the least-known important sign in this whole article.

Black tarry stool after the first few days of life, in a baby not on iron, needs same-day assessment.

Brick-dust or orange-pink staining in the first days is usually urate crystals and is common — and if it continues past the first week, or the baby is feeding poorly, get it checked.

Call 108 or go to the nearest hospital immediately if your baby: is breathing fast, grunting, or drawing in beneath the ribs; has blue or grey lips, tongue or face; is floppy, unresponsive or very difficult to wake; has a fit; has a temperature of 38C or above at under three months; is not feeding at all; or has a rash that does not fade when pressed with a glass.

What is normal

Meconium in the first two days: sticky, dark green-black, hard to wipe off. Passing it in the first 24 hours is expected.

Days three to five: changing stool, greenish-brown and looser.

From about day five, breastfed: mustard yellow, seedy, soft to runny, often with each feed. Several a day is typical.

Formula-fed: paler, tan to yellow-brown, thicker and more paste-like, and usually less frequent and stronger-smelling.

Frequency: a breastfed newborn may pass several a day. After about six weeks some breastfed babies go several days between stools, which can be normal if the stool is soft when it comes and the baby is well. In the first weeks, though, infrequent stool usually means insufficient milk and needs checking.

Explosive, loud and dramatic is normal. So is straining, going red and grunting while producing a soft stool — a newborn has to learn to coordinate this, and effort is not constipation.

Green stool: common, and usually nothing. It can accompany a fast transit, a cold, or foremilk-heavy feeds. Green alone in a thriving baby is not a problem.

Wet nappies: at least six heavy ones a day from about day five, with pale urine.

Gas, straining and constipation

Gas is normal and every newborn has it. Winding partway through feeds as well as at the end, a good latch or the right teat flow, and holding upright afterwards all help.

True constipation in a newborn means hard, dry, pellet-like stools passed with pain — not straining, and not infrequency alone.

It is uncommon in exclusively breastfed babies. In a formula-fed baby, check that the formula is being made up exactly to the instructions — too much powder for the water is a common and important cause.

Do not use: gripe water, ghutti, honey, castor oil, soap sticks, rectal thermometers used to stimulate, or any adult laxative. All are used in Indian households, none are safe for a newborn, and some are dangerous.

Gentle leg cycling and a warm bath are harmless. Anything inserted is not.

Constipation in a newborn is a reason to see a doctor rather than to manage at home, particularly if the baby has never passed stool easily.

When to see a doctor

Same day: any blood in the nappy; pale, white or chalky stool; black tarry stool after the first days; no stool at all in the first 48 hours of life; fewer than six wet nappies a day after day five; dark strong-smelling urine; hard painful stools; or diarrhoea in a newborn, which dehydrates quickly.

Immediately, calling 108 if travel is difficult: green vomiting, redcurrant-jelly stool, severe intermittent crying with legs drawn up, a swollen tender abdomen, or a baby who is floppy or unresponsive.

Also for a rash in the nappy area that is not improving, is bright red with satellite spots, or has broken skin.

This article is general information, not medical advice, and has not been reviewed by a paediatrician. It is no substitute for personal medical advice.

Frequently asked questions

Q: My baby has not passed stool for three days. — In a thriving breastfed baby over six weeks this can be normal if the stool is soft when it comes. In a newborn in the first weeks it needs checking.

Q: There is a streak of blood on the nappy. — See a doctor. Do not wait for a second occurrence, and take a photograph.

Q: Is green poop a problem? — Usually not, in a baby who is feeding and gaining well.

Q: My baby strains and cries before passing a soft stool. — Normal. Newborns have to learn to coordinate this. Hard pellet stools are different.