There are a lot of ways to describe it: soft, hard, brown, green, runny, and certainly stinky. It’s a messy topic often discussed behind closed doors, but let’s break down the scoop on poop — what parents need to know, from its color, consistency and frequency to what to do when a child is “backed up.”
According to Mollie Grow, M.D., a pediatrician at Seattle Children’s and the University of Washington, it can be challenging for some families to have frank conversations about the body’s natural process of elimination. In other words, it can be hard to talk about poop.
“As pediatricians, we get really comfortable talking about poop,” says Grow. “We try to normalize the conversation with patients and families.”
This excerpted post was originally published on the Seattle Children’s On the Pulse blog.
Breaking it down
According to Grow, normal, healthy poop can range in color. This is especially true for babies. Since parents are more aware of changes in their baby’s poop day to day, Grow says to think about the colors of fall when evaluating if there is cause for concern.
“Green, brown and yellow can all be normal,” says Grow. “But if the colors are more like [shades of] Mickey Mouse — black, white and red — then you should call your child’s doctor. These colors are abnormal and can indicate something might be wrong.”
If a child’s poop is black, it can be a sign of internal bleeding. If there is red, or blood, in the stool, a child may have a cut around their bottom or in their intestine. White poop occurs when there is a lack of bile, which may indicate an underlying problem, but according to Grow, this is very rare.
It’s also important to note that diet can play a role in the color of a child’s poop. For example, eating a lot of iron could cause poop to look darker and eating beets could make a child’s poop look red.
When it comes to frequency, Grow says children should poop every one to two days, and the consistency should be soft and formed, much like soft-serve ice cream. If a child’s poop is hard or dry, resembles pellets, or if a child has to strain to poop, they may be constipated.
According to Grow, constipation is one of the most common complaints she sees during clinic visits, and one-quarter of referrals to gastroenterologists are related to constipation.
“One of the most common symptoms is abdominal pain,” says Grow. “If a child has tummy pain, the first question you should ask is, ‘When was the last time you pooped?’”
All backed up
According to Grow, there are a number of risk factors related to constipation.
“Low intake of fiber and fluids can cause constipation,” says Grow. “It’s important to make sure kids are drinking water between meals and eating enough whole fruits and vegetables. Pitted fruits, such as apricots or plums and also pears, tend to be really good sources of fiber. Don’t overdo it on bananas, which can be constipating. Also, avoid too much dairy and offer primarily whole grains. Many kids suffer from constipation due to high intake of fast foods and processed foods, which tend to have very little fiber. Admittedly, it is a challenge for families that are always on the go. Looking for ways to add whole foods and food cooked at home is helpful.”
Grow also recommends regular exercise to keep constipation at bay.
“Our digestive system works better when we’re active,” says Grow. “Preschoolers need lots of active playtime. They should get two hours each day. Older children should get at least 60 minutes of daily activity. A great way to stay active is by encouraging outdoor time and physical play. A sedentary lifestyle can increase your risk for constipation.”
If a child is constipated, it’s key to seek early intervention.
According to Grow, the biggest concern in not treating the problem, it’s that constipation can lead to a child’s inability to feel when it’s time to go to the bathroom. If a child is constipated and has a large collection of stool in their rectum, they can leak poop, a condition called encopresis. If a child holds their poop, they can also lose tone in their rectum.
“It’s a really big problem,” says Grow. “Kids can’t control the leaking poop, and it can be a big source of embarrassment. What we’re trying to avoid is the retention of poop.”
Another sign a child could be constipated is if they have a sudden increase in bedwetting. When a child holds in their poop, the collection of feces can push on their bladder. With early intervention, the issue can be managed.
“The combination of what we can do from a feeding standpoint and activity standpoint work hand in hand,” says Grow. “Constipation is a common cause of distress in families. The earlier we can intervene, the better. Often, diet changes can help manage it, but if they don’t, there are good medicines that can help.”
Talking about poop, just like going to the bathroom, doesn’t need to be a straining experience. Talk to children about poop and make the experience enjoyable.
“We want kids to not have a fear of poop, especially when they are learning to toilet-train,” says Grow.
Grow also recommends talking to children about their poop as they get older. Parents will be less in tune with their child’s toilet habits as they grow older, and so being able to talk about poop will help parents identify if something needs to be addressed with their doctor.
So, the next time a child says, “My tummy hurts,” it’s helpful to ask, “When was the last time you pooped?”