Your baby may have a bowel movement after every feed or as infrequently as every 3 days and still be normal. However, it is desirable for your infant to have at least one bowel movement every day so as to expel fermenting fecal byproducts, thereby minimizing such problems as gas and spitting up. The consistency of infants’ stools is very different from older children or adults. Usually, the bowel movements of bottle-fed infants look like scrambled eggs, and those of breast-fed infants are “soupy”, and yellow or brown. Sometimes, infants. stools are green, and this does not mean anything terrible. The color of the stool in part reflects the transit time through the bowel. Green bile pigments are introduced high up in the bowel. With rapid transit time through the bowel, as is common in a newborn, or as with insults to the bowel such as diarrhea, bowel movements may remain green. With slower transit, the color of the bowel movement changes to yellow and then to brown.

A constipated infant will have infrequent, hard stools which may be in the form of small “pellets”. Insertion of a lubricated thermometer or 1/2 of an infant glycerin suppository into the rectum will be helpful in the event of a difficult stool. Infant glycerin suppositories are available without a prescription. Sometimes, constipation problems necessitate a change in formula. In particular, sometimes iron-enriched formulas may result in constipation, and may need to be changed. One to four teaspoons of prune juice or 1 teaspoon of dark karo syrup per four ounces of formula, or 2-4 ounces of apple-prune juice may be very effective in treating constipation. There are also medications for treatment of constipation which are sold over the counter, such as maltsupex and senokot. Please call our office if your infant is having a problem with constipation. I may need to check your infant to rule-out the very uncommon anatomic causes of constipation such as anal stenosis or Hirschsprung’s disease, and to recommend a plan of treatment.

Constipation is a common problem in infants. First, infants are like bedridden adults in that their mobility is low. Moving around stimulates bowel activity. Secondly, infant diets do not contain roughage. The Academy of Pediatrics recommends the introduction of solid foods at 4-6 months. Certain foods or dietary supplements may cause changes in the bowel movements, including changes in consistency, frequency, or color. For example, rice cereal, bananas, applesauce and iron tend to cause constipation, whereas prunes, plums, and green vegetables tend to have the opposite effect.

Occasionally after the passage of hard stools, bright red streaks of blood may be seen. This is generally due to slight rectal tearing and can be seen at the anal opening. Treatment involves “sitz baths” with baking soda, then gently applying A and D ointment to the anal area, as well as treating the underlying constipation problem. I would like to check your infant if this occurs, both to be sure that a fissure is indeed the source of the blood, and to reassure parents, since this is generally a frightening experience for most parents.

Diarrhea is more than loose stools; it is watery movements with little or no solid matter, and an increase in frequency. The danger of diarrhea, particularly in a tiny infant, is dehydration. Some signs or symptoms of dehydration are a sunken fontanel (“soft spot”), decreased urination, decreased skin turgor, weight loss, and listlessness. Please consult me if your infant has diarrhea since this may require attention.