Poop jokes are not my favorite kind of jokes. But they are a solid number two!!

Joking aside, constipation can be a major pain in the behind. I just can’t stop myself!

Let’s get down to business. Constipation is NOT HOW OFTEN you go, but what it looks like WHEN you go. I have infant patients who only poop every 8-10 days, and what comes out when they finally poop is a volcanic explosion of the normal newborn yellow, seedy stools. Children can have vastly different pooping patterns, some poop three times a day, others poop once a week, and that is their own normal pattern. However, hard to pass, rabbit pellet or large hard balls of stool are never normal. “Normal” stools are Type 3 and Type 4 on the Bristol stool scale.

That’s right, enjoy the pictures of poop while you’re perusing this article during your lunch break; the things we do for our kids is special, right?!

Constipation is usually diet-related due to picky eaters. Favorite foods of toddlers and children that can worsen constipation include: bananas, sweet potatoes, milk, cheese, crackers, bread, pasta, and cookies. You can add a few things into your child’s diet to help relieve the hard stools: yogurt, probiotic, fiber gummies, flax and chia seeds, plenty of water (six or more cups per day for elementary age and older) and eating high fiber fruits and vegetables (think celery, spinach, apples with skin, berries). Also, a sedentary body will be more prone to constipation, so get up and get at least 1 hour of strenuous physical activity daily.

After making dietary changes, the treatment of constipation depends on the age of your child.

For infants who are solely on breastmilk and/or formula and truly are constipated, you can help facilitate a stool by checking his or her rectal temperature, or massaging the tummy in a clockwise motion.

For infants older than 6 months who have started pureed foods, remember the “p” foods help you poop: pears, peaches, prunes. So offer “p” fruit jars and a variety of green vegetables. You can also give 2-4 ounces of an electrolyte solution, such as Pedialyte, per day to add more fluids into the gut.

For toddlers, elementary age and beyond, discuss with your doctor if medication can be helpful. Over-the-counter stool softeners, such as Miralax, used short term can add fiber bulking to the stool and start allowing it to pass more comfortably. Give this a few days to work, it is not a magic quick fix as it is not a laxative. Your doctor may consider prescribing a laxative medication (I sometimes prescribe lactulose for my patients) if his or her symptoms warrant its use.

There are several medical reasons why your child may be constipated, so a problematic pooper is precisely a proper purpose to pop it to your pediatrician.

I am reminded of a very festive party I had for my kid a year or two ago. I served cupcakes with blue frosting. What followed was a week of worried messages from friends. “Something’s wrong with his poop”. “I don’t know if he ate anything different recently, it’s so bright green!” Ha. I brought that one on myself.

So what colors of poop make a pediatrician worry? Well, mostly – black, white and red. I’ll explain. Let’s dive into the different colors. So to speak. 

GREEN – super common with food dyes that are green and blue (like…. blue cupcakes). Also very common when breastfeeding infants drink a lot of foremilk (rather than a mix of foremilk and hindmilk), or kids drink formula. Taking antibiotics. Eating grass. Eating a lot of dark leafy green veggies like kale and spinach. Having a tummy bug (gastroenteritis, which causes vomiting and diarrhea sometimes).

BLUE – mostly food dyes. Blueberries.

ANY SHADE OF BROWN – Normal. Yes, tan is okay. Light brown. Greenish brown. All fine.

RED – Sometimes cause for concern. Could mean bleeding in the lower half of the intestinal tract. Could be Cow Milk Protein Intolerance. However, I’ve seen red stools with certain foods like beets and cranberries, too. The antibiotic Cefdinir (and other meds) can make stools red or orange. Your doctor can test a red stool to see if it’s actually blood or something different.

ORANGE – usually normal with foods like carrots and sweet potatoes. Medications like Cefdinir can cause orange stools too.

BLACK – Sometimes worrisome, sometimes not. Newborn babies have dark black tarry stools at birth and for a few days following. Pepto Bismol, licorice, and iron supplements can cause black stools. Can be due to blood from higher part of intestinal tract. If persistent and your kiddo isn’t taking meds, would see your doc.

YELLOW – totally normal in breastfed babies. Can sometimes happen with diarrheal illnesses in kids.

WHITE/PALE – I think this is okay if it’s an isolated 1 day event. I see it sometimes with diarrhea illnesses. However if it persists past 1 or 2 poops, time to talk to your doctor about possible liver disease.

This list is in reference to kids only. Adults have different-colored poops for similar, but not always the same, reasons.

Call your doc if you feel like your kiddo’s stools are any of the concerning colors above.

If you missed the first story, please check it out here. Now for some constipation and Miralax AMA responses:

1.Is short term use of MiraLax for a colonoscopy OK?

Quite a few studies have looked at short-term use of MiraLax for bowel regimens for colonoscopy, which showed MiraLax to be safe and effective (and much more tolerable than more “aggressive” regimens).

2.What are the diet modifications for treating constipation?

Foods that are high in fiber should be offered to children who are experiencing constipation. Some examples would be high-fiber cereal (more than 5 grams per serving), fruits (pears, strawberries, apple with skin, dried fruits) and vegetables (beans, sweet potato, lentils). Children should also be encouraged to drink 32-64 ounces of water per day. One common cause of constipation is ingestions of more than 32 ounces of cow’s milk.

3.What are the treatment alternatives for MiraLax?

Of course, diet and fluid intake are the primary means of treatment and should be for all children. There are other medication alternatives to MiraLax. Some work like MiraLax and are osmotic (draw fluids into the bowels) but others are stimulating (they cause the intestines to contract). Each has its own side effect profile so I would recommend discussing with your pediatrician.

4.Is there tolerance or dependence on MiraLax over time?

According to the available information about MiraLax, there should be no reason to believe that a tolerance to MiraLax could develop. Kids should be transitioned to a high-fiber diet and weaned off MiraLax as soon as possible.

5.Are probiotics an option for treating constipation?

A few small studies looked at the use of certain probiotics for constipation, but nothing I can find on a large scale study or a firm suggestion of which bacterial strains and dosage should be included.

6.Is MiraLax absorbed into the bloodstream?

Based on the available information, there is no reason to believe that MiraLax is absorbed into the bloodstream. A current study in Philadelphia is intended to better address this question by assessing if small amounts of the substance or bi-products are present in the child’s blood.

7.Would you give your child MiraLax?

Given the available information, if my children had problems with constipation that couldn’t be relieved with diet modifications, I would feel comfortable giving MiraLax to them. Should further information from the Philadelphia study surface, I would definitely want to take that into consideration.

It’s not the most common I see but it might be #number2.

And, no, I’m not advocating for an Instagram stream of abnormal poop pictures; but, we should all know that all of our kids will have some kind of weird poop this year. Here are the most common types:

1.Hard balls - In babies, little hard boo-boos are how I define constipation. It’s not about the frequency of poop or how hard a baby strains because all babies turn into purple Troll dolls when they are pooping. I like to say they are just learning which muscles to poop with …

2.White - White stools in babies mean that the gall bladder is not working the way it should and can point toward a serious liver condition. This should be evaluated and the child’s bilirubin should be checked.

3.Hard stools/stools that are hard to push out - This is how I define constipation in older kids. If a kid feels like they need to go but can’t, it’s probably constipation. Other common symptoms are vague belly pain but when you ask them … Guess what? The kid hasn’t pooped for days.

4.Large - Some kids just make humongous BMs. I don’t know why. If there are no other symptoms and they can go regularly without pain, it’s probably just fine.

5.Bloody - Bright red blood, particularly if on the outside of the feces or that comes off on the toilet paper is likely the result of a small tear in the rectum (the area right before the poop comes up). This is really common in children who have constipation and can lead to very painful attempts to poop. If there is a lot of blood, or it doesn’t go away, the child may need to be checked for rectal polyps.

6.Red - The most common cause I’ve seen for this lately: Hot Cheetos. Just because it’s red, doesn’t mean it’s blood. Think about what the child has been eating. Particularly if you parent the one child in the world who likes beets.

7.Black - Dark, black stool are one of the most concerning stools but not always. It can be an indication that there’s bleeding somewhere higher in the stomach or intestines. If the child has other symptoms, they should be seen fairly quickly. Other possible causes include: ingesting blueberries, taking iron supplements or Pepto-Bismol (which we don’t recommend but can also cause dark green stool).

8.Looseish - Not really diarrhea but not normal either. This can be the norm for some kids. Think about places where your child might be ingesting some extra sugar (especially juice).

9.Runny - The most common cause of diarrhea is a stomach bug. Usually these children have vomiting as well (but not always). It generally last a few days to a week and the child should not appear particularly sick. Children who have diarrhea that lasts longer than a week or that has blood or mucous should be seen by a doctor as it could point towards a different kind of infection.

10.Snotty - Small amounts of stringy mucous in poop can be normal, especially for a very short period but if the child has blood or belly pain along with it, it could point toward an inflammatory bowel problem like Crohn’s or ulcerative colitis.

11.Nutty/Corny - Yep. It happens. You all know it does. In fact, it’s one way to know how fast everything is passing through …

Next time you’re wondering if your child’s poop is normal, I hope this takes a load off your mind. Sorry. Couldn’t resist.

About the Author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

There, I said it.

Those of you who insist that every child can do so, comment away.

Those of you who tried and started a knock-down-drag-out weekend of fighting in your house, only to quit and come back to it later with a different strategy that was much more successful, you may stand up and applaud.

The three-day potty training method has several different flavors but all of them involve some of the following ingredients:

• Draw a hard line in the sand - no more diapers.
• Let the child go naked for the weekend (or longer).
• Give the child lots of fluids and salty snacks (I’ve seen some recommend soda. I mean, just … NO!)
• Put the child on the potty frequently.
• Celebrate successful pees and poops.

I know that these methods work some of the time, with some kids. The posts about the strategy wouldn’t be so popular if they didn’t. Problem is, I don’t hear much about it when it works. But, I do hear about it when it becomes a disaster. I hear about it when everyone is in tears and tensions are through the roof.

Any of you with more than one child can confirm that kids are different. They do things on their own time and in their own way. Potty training is the same way. To assume that every child can potty train by age 3 and in three days is unfair. Each child may need a different strategy.

Here is my potty training guide:

Readiness

I usually give two signs for potty training readiness:

1.Knowledge of wet and dirty. If a child doesn’t understand what pee and poop is, good luck.

2.Ability to sit still on the toilet. Unless you want to be forcing your child to sit down on the seat every time, they have to be patient enough to wait for the action to happen.

But guess who ultimately decides when your child (and you) are ready to potty train? You and your child! Not grandma, nor your judgy friend or the blog post they shared. So, take your time if you want or go ahead, it’s up to you.

Method

I only have one rule when it comes to your method for potty training. Be patient!

Be patient with your child. Some kids have legitimate fear about the part of their body that they are flushing down the drain. It can be the same to them as flushing an arm. Some kids will get it right away, some won’t. Give them the chance to fail without punishment.

Also, be patient with yourself. You will get frustrated at some point during the process. Pick some fun things to do with your child and alone to recharge. It’s OK if it doesn’t go perfectly.

Pick a method that you think fits well with your child and stick with it for a bit. Don’t change after one day. But, it’s also ok to step back and make a change after a bit if things are going well. It’s even ok to decide that you tried to early and wait to start again in a few months.

Potty training is a necessary step in development. It might not be as fun as the first word or first step but it is just as monumental. So maybe it’s not always a “happy” time but at least it can lead to joy. Don’t let unreasonable expectations steal that.

Constipation is the cause of alllllll the things. Just joking.

No, but really – it’s one of the most common things I see in my office at Willow Park, and it causes strange problems sometimes. Parents often don't believe me when I tell them it's constipation causing the problem. 

What is constipation? It doesn't necessarily mean your child isn't stooling daily. A kiddo can be constipated and poop many times a day. Constipation means hard, dry stools. They’re often painful to push out. And yes, most kids with constipation will go a few days between stools.

I really feel that constipation has become more prevalent over the years because of how our kids' diets have changed. In general, kids are eating less fresh fruits and veggies and depending more on packaged goods for snacks and meals. 

There are lots of medical causes for constipation as well. Did you know that hard poops can cause:

1. Stomach pain
2. Withholding of stool
3. Vomiting
4. Refusal to eat
5. New urinary accidents
6. Wetting the bed
7. Diarrhea
8. Poop accidents 
9. Blood in stools, blood in diaper
10. Fever (yes it can cause fever! mostly lowgrade)

Here's the deal - and let's get down and dirty about it. The things your kids eat affect the quality of their poop. If they eat and drink things that don't have much fiber (think cheese, yogurt, pastas, cookies, white bread, bananas, milk, goldfish crackers), their stools will be harder. 

Also, did you know our bodies absorb water out of our stools if we need it? So if your kiddo isn't drinking enough water, his body will just take it out of the poop, and it will become hard. 

The poop gathers at the “end of the tube” in a child’s body – the rectum and descending colon – and stretches everything out a lot. See the pic. This chronic distension leads to problems with the “valves” inside the rectum. Sometimes, this leads to leaking – soft stools can leak out without the child being able to control it. 

These big bulky stools can also push on neighboring organs, like the bladder, and even push urine out sometimes. And children with chronic constipation tend to develop poor control of their pelvic muscles and can lose control over their bladder, leading to leaking. One study showed that after being treated for constipation, 89% of 250 kids had complete resolution of their daytime wetting problems.

When the stools become hard, they hurt to push out. So kids don’t want to poop. So they hold it in. And the body slowly takes water out of it. And the stools get harder. And more difficult and painful to push out. Thus starts the painful cycle. 

Kids can get constipated anytime, but I find it’s most common 1) when babies start solid foods, 2) when kids start potty training, and 3) when kids start school.

So how do you fix the problem? Well, that depends on the severity of the problem and the age of the kiddo. But some general rules:

1. WATER. LOTS OF IT. Children and teens should drink at least 6 to 8 cups of water a day. 
2. Fresh fruits and veggies! I encourage kids to eat green veggies, prunes and other fruits (but not bananas), bran, whole grain bread. Sometimes those puree pouches with the kale, spinach, and broccoli are a good start for the picky kids.
3. Certain fruit juices – ok, we pediatricians are NOT big fans of juice. But I’ll make an exception in this case – go with prune, or pear.
4. Fiber supplements – flax seeds are great. Fiber gummies and cookies are good, too.
5. Behavioral and schedule changes – encourage a routine for “potty time”. 20-30 min after meals, have your kiddo sit on the toilet for 5 minutes. Encourage your child to listen to his body and stop playing when he feels the urge to “go” (and not hold it in). 
6. Do not punish your child, or get mad, if he has an accident (urine or stool) – remember, this isn’t under his control!
7. Avoid those foods I mentioned before for a few days – bananas, cheese, crackers, milk (if over age 1), breads, pastas.

If there is anything I can’t express enough to parents – it’s BE PATIENT! It takes many months for the intestines to stretch out and constipation to form in toddlers and children, and it takes many months (sometimes even years) to treat it. Sometimes we use safe laxatives or glycerin suppositories to help during the really rough patches – call or come visit us to talk more about that if you think its necessary. 

Hugs,Dr. Poop (er, Diane)

• You will be awake during hours of the night you didn’t even know existed.
• You will begin to interpret everything as a smile.
• You will allow words like spit up and poop become normal dinner conversation.

As you talk about poop, you will uncover something you will be concerned about or at least something that gets your attention. So, here are some weird things you might find in a baby’s diapers:

1. No poop - Babies need to poop in the first day or two after birth to prove that they can. After that, skipping a day or two shouldn’t concern you.
2. Lots of poop - Infrequent stools can be normal but so can pooping all day long every day. It’s also not uncommon for babies to poop every meal with a few stuck in the middle. So much poop, you literally can’t even.
3. All the colors - Pretty much any color stool can be normal. Yellow, green and brown are the most common. In the first few days, it will be black. But there is one color that should get your attention…
4. White or clay-colored poop – This is the one poop color that should prompt an immediate visit to the doctor. Do not pass Go, do not collect $200. It can point toward a rare, but serious liver condition and the baby needs to be seen.
5. Seeds in poop – These little flecks are common in breastfed babies and won’t grow breast milk trees if planted although that would be cool.
6. Blood or mucous poop – This could be a sign that your child is allergic to the protein in their milk. Call your doctor.
7. Red specks in pee – These little red crystals are not blood but are actually urate crystals. They are common and normal.
8. Swollen scrotum – If your little boy has one sided scrotum swelling or both sides are increasing in size, it could be a hernia. This is much more of an emergency if the baby seems to be in pain or there is redness of the skin.
9. Diaper rashes – Most of these are just general irritation from stool. For those, large amounts of thick cream, keep stool off the skin and allow it to heal (you probably aren’t using enough).
10. Bloody or clear/white vaginal discharge – This discharge is very common and is the result of hormonal changes that occur after birth and nothing to worry about.

There are plenty of other weird things your baby will show you, even some more in the diaper area. Some of these are more severe abnormalities that should have been picked up by the doctor before you left the hospital. Hopefully by reading this, you can avoid having to talk about if your baby’s poop is normal tonight. Have a great dinner!

Watch the video below for five key facts about diarrhea that every parent needs to know in only a minute. 

In today's video, Doc Smitty explains:

1. What are the common causes?
2. How long can it last?
3. When are the symptoms more than a stomach bug?
4. When do you call your pediatrician?
5. What are the biggest risks?

Learn the answers to these questions. It only takes a minute.

So, you have a new baby. That means your automatic, "I worry about poop" button is switched into active mode. It seems that you can't have a new baby and not worry about their stool. Suddenly, it's the main topic of conversation at the dinner table, in bed before you go to sleep at night -- anywhere, anytime is the appropriate time to discuss pooping habits. (Just remember, your child might be discussing your pooping habits and diaper changes around a dinner table in the future.)

So, what is normal poop?

We generally state that babies should be having wet and dirty diapers about six to eight times per day in the first week. However, there can be a lot of variability in this. Babies can poop every time they feed or just once a week and still be normal. You should worry if the baby is having hard stools or has a lot of swelling of their belly.

Normal stool color and consistency also varies. The color can be all over the place.

Also, straining and turning red and pushing with all their strength is normal. They're learning what muscles to push with to get the stool out. Imagine if you didn't know and were just guessing how to poop. It wouldn't go so well.

There are many varieties of normal stool but if you are concerned about your newborn’s poop, call your pediatrician.

Newborn U

Having a new baby in the house is an exciting, and generally, very happy time. It can also be a time of worry and fear. Learn more at Dr. Smith's Newborn University.