What goes in, must come out. Read on to learn about meconium, constipation, what's normal and more.

Bowel movements

The first bowel movement of a newborn is called meconium. This is a sticky, greenish-black substance that forms in the intestines during fetal development. Some babies, particularly if distressed during labor and delivery, may pass meconium in utero or as they are being born. The baby may have several meconium bowel movements before this substance is completely gone from the baby’s system. The next bowel movements are seedy-looking and are greenish yellow. Bowel movements in the first few days may also contain mucus. Occasionally, there may also be blood present, usually as a result of the baby swallowing some of the mother’s blood during birth. Save any diapers containing bloody stools to show your midwife or doctor, to eliminate any other causes. If your newborn baby has not had any bowel movements, your doctor should check to make sure the anal opening is okay.

It may take a couple of weeks for all traces of meconium to pass from your baby’s system and for him to settle into producing ‘normal’ stools. Some babies will have bowel movements as frequently as one with each feeding, while others may have one stool every two to three days. Some babies have even gone a week or more without having a stool and not be in any discomfort. This can be distressing for a new mother, so if you are not sure what is normal, see your health professional.

Once the bowels have settled, breastfed infants usually have looser and more frequent stools than bottle-fed infants. Formula-fed babies have thicker, more formed bowel movements that are more beige in color.

All babies will pass gas, a normal process due to swallowed air passing through the intestines. There should be no concern unless the baby seems very uncomfortable. Burping the baby diligently and feeding him in an upright position may decrease the amount of intestinal gas.

If you are interested in seeing what meconuim, transitional or other newborn stools look like, The Stanford School of Medicine have photos and descriptions - click here if you dare!

Constipation

Occasionally, babies become constipated. A baby is considered to be constipated if the bowel movements are hard and/or associated with signs of abdominal pain or discomfort, such as crying while passing a stool. Here are some things to watch for and ideas for dealing with constipation:

• No bowel movement for 48 hours or more along with the following factors: 
• Straining as if to have a bowel movement but with no results.    
• Hard, dry stool.   
• Bloody streaks in the bowel movement due to hard dry stools.    
• Distended abdomen with excess gas.    
• Crying when having a bowel movement.

Treatment for constipation includes:

• Increasing fluid intake by either encouraging more nursing or giving a supplement of water.  No more than two or three ounces a day until the baby is over six months old.  
• Never give your child laxatives or enemas unless your pediatrician says it’s okay. Laxatives can be dangerous for babies.    
• As long as there is no evident discomfort or distention, and the baby is otherwise well and feeding normally, nothing really needs to be done. A bowel movement will happen in time!

Call your baby’s doctor if:

• Your new baby has never had a bowel motion.    
• Blood is noted in the stool.    
• Large, hard, and dry stools occur.    
• Your baby cries excessively when having a bowel movement.   

Diarrhea

Diarrhea is described as loose, frequent, often liquid stools. Very runny or watery bowel movements, especially if there is distinct change, may mean the baby has diarrhea. You should contact your baby’s doctor if this occurs. Diarrhea is sometimes a sign of other problems such as infection, allergy, or food intolerance. Unlike normal bowel movements, diarrhea often has a particularly offensive or unusual odor.

Call your baby’s doctor if:

• Your baby has severe or persistent abdominal discomfort along with diarrhea, or has blood in the stool.
• Diarrhea is accompanied by other symptoms, such as fever, crying, or abdominal pain.The diarrhea lasts longer than 48 hours, or comes and goes over one or two weeks.
• Your newborn has vomiting associated with diarrhea that lasts for more than 24 hours.

Diarrhea in an infant needs to be monitored carefully because it can lead to dehydration. Dehydration is a dangerous condition in which excessive loss of body fluids results in a potentially life-threatening imbalance of water and essential body salts. Signs of dehydration include decreased urination, dry mouth, lethargy, lack of tears, and sunken eyes. If you suspect your baby may be dehydrated, get medical attention immediately.

Treatment:

• We recommend consulting your physician if your newborn has persistent diarrhea.
• If your baby is formula-fed, sometimes a change in formula can improve symptoms of diarrhea.
• To prevent dehydration, your doctor may recommend oral electrolyte formulas, such as Pedialyte or Ricelyte.

Discuss any concerns about your baby’s bowel movements and their frequency and appearance with your baby’s doctor.

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