For something that everyone does, there’s still so much mystery around poop – especially when it comes to kids.
In this ultimate guide to kids’ poop, a CHOC pediatric expert offers advice for parents on the full spectrum of poop, including color, frequency, diarrhea and constipation.
Poop is the last step of digestion for the body, says Dr. Monica Molina, a pediatrician in the CHOC Primary Care Network. After swallowing food, it heads to the stomach, then the small intestine, and then to the large intestine, or bowels. Throughout this process, the body soaks up water and nutrients from the food.
What’s left is poop. And after reaching the bowels, it comes out through the rectum and anus.
Poop is normally any shade of brown, tan, yellow or green. White, black or red poop, however, may be a sign of disease, but Dr. Molina cautions that these colors may also be attributed to a child’s diet or other factors.
White poop in kids or light gray poop can be a sign of liver disease, says Dr. Molina. Blocked bile ducts in babies can lead to light gray or pale yellow stool. An all-milk diet, however, may also lead to white stool, as can certain medicines.
Black poop might be a sign of stomach bleeding because stomach acid might turn blood into a dark tar-like color, Dr. Molina says. Additionally, black stool can be caused by cigarette ashes or charcoal. It might also though be caused by foods like licorice or grape juice.
Red poop in a child can also be a sign of blood, though the vast majority of red stools in children are not caused by blood, Dr. Molina says. Red stool may also be the result of certain medications or foods, such as red frosting, paprika or tomato sauce.
Green poop in kids is normal but sometimes may look black under poor lighting, says Dr. Molina. Green stools are typically caused by bile, certain foods and medicines. Green poop is common in diarrhea and is more typical in formula-fed babies than babies who are breastfed.
Dr. Molina says a parent should call the pediatrician if light gray stool or white poop occurs two or more times, or if poop continues to be a strange color (besides green) for more than 24 hours without a suspected cause. A parent should also call if the poop continues to be a strange color 48 hours after the suspected food or medicine was stopped.
How often everyone poops varies, but ideally a child should have a soft bowel movement each day, says Dr. Molina.
Initially, breastfed babies tend to poop more often than formula-fed babies because breast milk is more easily digested. However, at around ages 3 to 6 weeks, breastfed babies may start having fewer bowel movements, sometimes only one or two a week. Formula-fed babies usually continue to have daily bowel movements.
It’s normal for infants to strain when they’re pooping. Pooping is more of a challenge for them because they are lying flat and don’t have gravity to help.
This chart was developed to help doctors to talk about the shape and type of poop, or stools.
Ideally, a child’s bowel movement resembles type nos. 3 or 4 and passes easily without being too watery, says Dr. Molina.
Stool that looks like types 5, 6 or 7 are likely signs of diarrhea.
Poop that looks like type 1 or 2 is likely a sign of constipation.
A stool’s hardness is determined by how much water the body absorbs during digestion. Normally, as food moves through the large intestine, the colon absorbs water while forming poop. Muscle contractions then push the stool toward the rectum. By the time the stool reaches the rectum, most of the water has been absorbed, making the stool solid.
When the colon’s muscle contractions are slow or sluggish, the stool moves through the colon too slowly, resulting in too much water being absorbed.
Additionally, if a child is dehydrated, more water will be taken from the colon to provide water to the vital organs, resulting in harder stool.
It’s important to wipe from front to back. Wiping from back to front increases the risk of spreading bacteria from poop to the urethra, which can cause urinary tract infections.
For children and teens, regular toilet paper should do the trick. It’s normal for toddlers just learning to poop in the toilet and some smaller children to need help wiping.
For babies with delicate skin, a parent may use a wet washcloth, cotton balls or baby wipes to clean up after a bowel movement. Be sure to lift the baby’s legs by the ankles to get underneath, and don’t forget the creases in the thighs and buttocks.
Diarrhea is frequent soft or loose poop. Most kids have diarrhea from time to time. It usually doesn’t last long and often gets better on its own.
Diarrhea is usually caused by an infection in the intestines.
Several types of viruses can cause diarrhea.
Viral gastroenteritis – often called the “stomach flu,” though unrelated to influenza – is a common illness in children. It causes diarrhea and, often, nausea and vomiting. The symptoms usually last a few days, but kids (especially babies) who can’t take enough liquids may become dehydrated.
Rotavirus affects babies and young kids and can bring on watery diarrhea. Outbreaks are more common in the winter and early spring months, especially in childcare centers. The rotavirus vaccine can protect children from this illness.
Enteroviruses, like coxsackievirus, also can cause diarrhea in kids, especially during the summer months.
Many different types of bacteria can cause diarrhea, including E. coli, Salmonella, Campylobacter, and Shigella. These bacteria are often responsible for cases of “food poisoning,” which can cause diarrhea and vomiting within a few hours after someone is infected.
Parasitic infections that can cause diarrhea in children include giardiasis and cryptosporidiosis.
Beyond bacteria, viruses and parasites, diarrhea can be caused by a few other things:
Kids often get crampy belly pain first, followed by diarrhea that can last three to five days. Other symptoms may include:
Parents of babies who have diarrhea and are younger than 6 months should call the pediatrician right away, Dr. Molina says.
Parents of older children should call the doctor if the child is experiencing these symptoms:
Call the doctor right away if your child seems dehydrated. Signs include:
To determine the source of a child’s diarrhea, the pediatrician will do a few things, Dr. Molina says.
First, they will ask questions about the child’s recent diet, when symptoms first arose, and how often the diarrhea is happening.
They will also ask specific questions about the bowel movements’ texture and consistency, and whether any blood is present.
They will perform a physical exam, and sometimes they may send a stool sample to the lab for further analysis. This helps determine what germ caused the illness.
While viral diarrhea goes away on its own, most children with bacterial diarrhea will need treatment with an antibiotic. Diarrhea caused by parasites will always need treatment with anti-parasitic medicines.
Children who aren’t vomiting or becoming dehydrated can continue eating and drinking or breastfeeding as usual. Continuing a regular diet may even shorten the diarrhea episode. Dr. Molina suggests though that parents serve smaller portions of food until the diarrhea ends.
Parents shouldn’t give a child an over-the-counter anti-diarrhea medicine unless their doctor recommends it, cautions Dr. Molina.
Water alone is not sufficient to rehydrate children because it doesn’t contain the correct mix of sodium, potassium and other important minerals and nutrients.
To replace body fluids, kids with signs of mild dehydration should have oral rehydration solutions, which are available in most grocery stores and drug stores without prescriptions, says Dr. Molina. The child’s doctor will know what type to give, how much and for how long.
For children with severe diarrhea and dehydration, they might need fluids administered intravenously for a few hours at the hospital.
Diarrhea is a near inevitability for most children at some point, but there are a few things parents can do to make it less likely, Dr. Molina says:
Constipation is a decrease in the number of times a child poops usually. While how often a child poops varies, generally a child is considered constipated when they pass only small amounts of hard, dry stool, usually fewer than three times a week.
Constipation is pretty common and different things can cause it, says Dr. Molina:
While constipation can be experienced differently in each child’s body, Dr. Molina says, the child may experience these symptoms:
A baby who cries when pooping or has hard or pebble-like poop might be constipated, says Dr. Molina.
Parents should always speak to the pediatrician before giving a child or baby any medicine or treatments to ease constipation. Fortunately, there is much that parents can do to help relieve constipation says Dr. Molina:
Parents of constipated babies should speak with their pediatrician about adding 100% fruit juice to soften their poop.
Constipation can be painful usually painful and causes the child great discomfort. If your child suffers from chronic constipation, it’s time to take him to the doctor when:
Call the pediatrician if a baby’s constipation symptoms don’t improve. Call the doctor right away if the baby has one has these symptoms:
In most cases, constipation won’t require special treatment. A pediatrician might recommend a diet change or a medication. It’s also possible that the doctor might order an X-ray or other types of tests to examine the child’s digestive system more closely.
In cases of chronic, long-term constipation, the pediatrician may refer the child for treatment with a gastroenterologist, a doctor that specializes in the gastrointestinal tract and liver. The treatment for chronic constipation is typically threefold:
To prevent constipation, parents should use the same tactics for treating it, says Dr. Molina. Drink lots of water and eat plenty of fiber. Use healthy oils in cooking and encourage regular exercise.
We are excited to offer the Pfizer BioNTech pediatric COVID-19 vaccine for children and teens. To receive a vaccine, contact your CHOC primary care pediatrician to make an appointment.