Wednesday, June 24, 2009

How often should a baby poo?

Whilst trying to find out about green poo, one question that was being consistently asked by the medical profession was: 'how often should a child poo?'

The lastest research from Archives of Disease in Childhood 2009;94:231-233
suggests that a healthy child at 4 weeks gives a stool on average 3 times a day.
When the child gets to 42 months the average healthy child gives a stool 1.3 times a day.

In terms of colour (see previous post), the colour tends to be yellow/mustard at 4 weeks and changes to brown at 6 months (the age of weaning onto solids).

DID YOU KNOW?: that according to Archives of Disease in Childhood 1993;68:317-320; the bowel habit of an infant is pretty much determined at 25 weeks of gestation. (Determined by maternal nutrition (no milk feeds), in pre-term infants).

The La Leche Legue has a great page on how often at what age...

Regular stool pattern in a breast-fed child is:

up to 6 weeks:
2-5 stools in 24 hours

6 weeks onwards: between 5 stools in 24 hours to 1 every few days (up to a week). (This is because the colostrum in the mothers milk diminishes and no longer provides such a laxative effect).

Regular stool pattern in a formula fed child is:

Anything from 2-5 times a day up to 1 every 3/4 days.

In both groups (breastfed and formula fed), by the time they reached 16 weeks, the average no of stool per day was 2.
Ref:Journal of Pediatric Gastroenterology & Nutrition. 7(4):568-571, July/August 1988.
Weaver, Lawrence T.; Ewing, Gail; Taylor, Linda C. *

In pre-term infants the first meconium poo (black) could arrive from first day through to past the second day, with inverse relationship according to gestational age.
Thereafter it seems that per every 50ml/kg increase in milk intake, the further production of one poo a day ensued.
Ref: Archives of Disease in Childhood 1993;68:317-320

As a general rule: breast fed babies produced a greater number of poos and of softer consistency, than cows milk formula fed babies.

SO what if you are worrying about your child being consitpated/fewer and harder stools when transitioning to formula? The answer is to go with a formula that is cow milk-based formula with a whey:casein ratio of 48:52 (i.e more whey than casein) and a fat blend of 42% high-oleic safflower, 30% coconut, and 28% soy oils. In the study PEDIATRICS Vol. 103 No. 1 January 1999, p. e7 this formula was named as 'Similac' with iron powder. The study found proposed that a formula with palm olein fat, that created the formula more acidic like breastmilk, made stools significantly harder. This may have been due to the creation of insoluble soaps from palmitic acids combining with calcium.

Tuesday, June 23, 2009

Green stools in infancy

During a consultation it is becoming increasingly common to hear of 'green' stools in the infants that present. What I wanted to find out was what on earth - if anything- does it mean for a child to have green poo?

Apparently it is not abnormal for the child to have green stools occasionally, like once in a few days, but if it becomes a common occurence then this is when it can be signalling something else is going on.
  • Breastfeeding and green stools..
Reading up on my ever favourite la leche league international website, they relate the child to having green stools due to a imbalance between foremilk and hindmilk. If the child is 'snacking' on the breast, poor latching, or improper feeding by the mother (i.e, not staying on the one breast long enough) then child will be getting more foremilk and less hindmilk. Of course, as stated in my previous blogs, if there is too much foremilk and not enough hindmilk, the child will be more hungry, gassy and irritable, and may have green stools.

  • Formula fed babes and green stools..
From the information databases it seems that green stools are more common in formulas that have 12mg/L of iron than 1mg/L iron.
Ref: Pediatrics. 1995 Jan;95(1):50-4.

In general:
It seems as though green stools come about from the faster passage through the digestive system. If the time of passage is slower, the poo is more mustard colour. This way it allows time for the movement of nutrients in and out of the intestine.

In pre-term infants, one study found that the colour and consistency of stool vaired according to the different pre-term formulas given.
Turk J Pediatr. 2000 Apr-Jun;42(2):138-44.