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Preemie Poop Talk

By Heather Cresswell, NP


If you are a parent, there is a good chance you spend a lot of time talking about poop. Changes in bowel patterns are normal as babies grow and are common after babies go home from the NICU. But what is normal, and when should you be concerned? Let’s talk about all things baby poop!

There are many different words for poop. The proper medical words for poop are feces or stool. The act of passing poop is called a bowel movement. This blog will use poop to refer to feces or stool.


Key takeaways

  • Babies may go hours or days between bowel movements.

  • Your baby is probably not constipated as long as poop remains soft and feeding is going well.

  • Grunting and straining are normal for babies while they learn to coordinate their muscles during bowel movements.

  • Normal poop can be many different colours, but black poop (after the first few days of life), red, pale, or white poop might be a sign of a medical problem needing medical attention.


If your baby has a history of problems with their intestines, colon, or anus, especially if they needed an operation, some of this information may not apply. Talk to your baby’s NICU or surgical team about what normal poop and warning signs would look like for your baby.


Frequency: how often should babies poop?


A very common concern from parents of premature babies is how often they poop. After all, when they were small and in the NICU, nurses reported down to the hour when the babies last had a bowel movement, sometimes even helping with a suppository if needed.


Some babies will poop with every feed. Other babies may go days in between. As long the poop is soft, the baby’s belly is not bloated, and the baby is feeding well, this is all very normal.


It is not how often a baby poops that tells us if a baby might have constipation or diarrhea.


Consistency (texture) and how to know if a baby has constipation or diarrhea.


The texture of baby poop can be different from baby to baby and diaper to diaper. Normal newborn poop can be mushy, paste-like, runny, or seedy in texture. None of these are cause for concern.


Diarrhea

Because normal baby poop can be runny or mushy, parents sometimes worry it might be diarrhea. One way to tell the difference between normal runny poop and abnormal watery diarrhea is that diarrhea will usually soak right into the diaper. If the poop is absorbed into the diaper like urine, with no solid matter on the surface, this could be diarrhea. A doctor or healthcare professional should check out any newborn with diarrhea, especially if it happens in the first few months of life (or the first few months after the due date for a premature baby).


Constipation

Some babies may go days between bowel movements. A baby may be constipated if the stool appears formed, hard, or looks like pebbles. In this case, talk to your baby’s doctor or nurse practitioner. As long as the poop remains soft and the baby continues to feed well, letting nature take its course and being patient is often the best course.


Why do babies grunt so much?


It is normal for babies to make grunting sounds, especially when they have a bowel movement. Premature babies grunt a lot. They grunt before, during, and between bowel movements. So pretty much, all the time. This is normal, and it does not mean a baby is constipated.


So why do babies grunt so much? To have a bowel movement, two things need to happen. The anus (bum hole) and the pelvic muscles (the muscles along the bottom of the pelvis, just above the bum) must relax to let the poop pass through. At the same time, the stomach muscles need to tighten to increase the pressure in the belly to squeeze the poop out.


Babies grunt and strain when their muscles have not learned to work together to have a bowel movement. They are trying to push poop out with their stomach muscles while, at the same time, their pelvic muscles and anus are holding it in.


The fancy medical name for this is infant dyschezia. Sometimes it's called grunting baby syndrome. This is a stage that babies outgrow, and it does not need treatment. Term babies outgrow this within a few weeks, but this may take longer in premature babies.


Colour: What colours are normal for baby poop?


In the first days of life, babies pass thick black, sticky poop called meconium. After a day or two, this changes to regular baby poop. Babies who are fed breastmilk milk often have mustard-

yellow coloured poop, while formula-fed babies tend to have poop that is more brown or tan in colour. Green colour is also normal.


Babies who have poop that is red or black (after the initial meconium stage) may have blood in their poop and should be seen by a healthcare professional. Mucous and blood in the poop could be a sign of food intolerance, allergy, or other medical problems. Small streaks of blood sometimes also happen due to an anal fissure (a break in the skin around the anus). Anal fissures are not serious and heal on their own.


Pale or white poop can be caused by some medications but can also be a sign of medical problems. Seek medical care if your baby has pale or white poop.


Poop colours that are not normal (have your baby checked out by a doctor or nurse practitioner):


Summary


Overall, what is considered normal for baby poop can vary widely. Remember, every baby is unique; what is normal for one may not be normal for another. Always talk to your baby’s doctor or nurse practitioner about your baby’s unique needs and if you have concerns or questions.


Additional Resources


Alberta Health Services. Constipation in Babies and Children.

American Academy of Pediatrics. The Many Colors of Baby Poop.

About Kids GI. Infant Dyschezia.


Heather Cresswell is a Neonatal Nurse Practitioner and health writer. As a nursing student in 1995, Heather discovered the NICU during a clinical placement and never looked back. She has spent her entire nursing career (more than 25 years and counting) caring for NICU patients (premature babies are her favourite!). When not caring for her tiny patients, Heather is also a health writer and is happy to contribute to the Canadian Premature Babies Foundation.

Heather lives with her family in Burlington, Ontario, and is a proud mom to one son.


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