Dr. Grace Eberly
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Pediatrician
Caughman Health Center & Carey Medical Center
Everyone poops. Despite this universal truth, monitoring your child’s toileting habits can be very stressful. Parents often express concerns about their children’s bowel movements and whether or not they are “normal.” In actuality, what is normal in terms of form, color, and frequency will vary greatly depending on the age of the child and the type of foods they are eating.
A newborn’s first bowel movements consist of a dark, tarry substance called meconium which gradually lightens in color over the course of several days. Newborns who are exclusively breastfed tend to have loose, yellow stools that are “seedy” in texture. Breastfed babies tend to have bowel movements more frequently (as often as every feed) while it is not uncommon for formula-fed babies to go several days between.
Keep in mind that almost all babies appear to strain with bowel movements initially because they are still learning to coordinate the muscles involved. If you are concerned that your baby is uncomfortable, it may be helpful to “bicycle” their legs, massage their tummy, or give them a warm bath.
While uncommon, you should notify your child’s doctor immediately if there is blood in the diaper or if they have a bowel movement that is white or light gray in color, as this can rarely be a sign of a serious problem with the liver.
Around the age of 6 months, the color, consistency, and frequency of an infant’s bowel movements may change due to the introduction of baby foods. Furthermore, some children develop constipation when they transition to whole cow’s milk at age 12 months (be sure to limit to no more than 16-24 oz/day – this also helps prevent iron deficiency) while others may have looser, more frequent stools. This phenomenon is commonly referred to as “toddler’s diarrhea” and can be exacerbated by excessive consumption of fruits, juices and artificial sweeteners.
School-aged children and adolescents should aim for at least one soft bowel movement daily or every other day at most.
While constipation can be distressing, it is very common in children and, in the vast majority of cases, is not due to an underlying disease or structural abnormality. Often, children with constipation are stuck in a vicious cycle: a child who fears they may have pain with a bowel movement will subconsciously “hold it in” and avoid using the bathroom until the stool is so large or backed up that it has no choice but to come out; this is often traumatic for the child and reinforces the initial withholding behavior. Your child’s pediatrician can help develop a tailored treatment plan that both relieves acute symptoms and prevents recurrence.
In the meantime, it is essential to work on healthy habits such as staying well-hydrated, eating plenty of fruits and vegetables, and having your child sit on the toilet for 5-10 minutes once or twice a day, even if they do not feel like they have to go (after a meal is best – reward charts are great for this purpose). Happy flushing!
