First time parents, pediatricians and old folk love discussing poop. When, what and not usually how, thankfully. As I go about my day in the office, it is inevitable that I will talk about poop at least a few times. While at home, I clean it up a few times and hour. Parents often have legitimate questions about what is normal, when to be worried and when to just “go with the flow.”

I was thinking about adding photos and graphics to these blogs, but I’ll spare you the visual details.

Let’s review normal and abnormal stools by age.

Newborns:

The first 2-3 days, a newborn’s stool will be sticky, dark green/black/dark brown - “meconium”.Next 2 days, it will be “transition” poop - lighter in color, tan, less sticky.Then you will likely see brown, pasty stool if “formula fed” and yellow/light green, seedy, liquid-like poop if “breastfed”.

meconium resembles motor oil.

transition stools are mushy and tan.

breastfed stools resemble runny, dijon mustard.

formula fed stools resemble pasty, peanut butter.

If a baby’s stools are lime green, frothy and they are breastfed, they are likely getting too much foremilk (at beginning of feed) and not enough hindmilk (later into feeding). So one needs to breastfeed longer on each side. If a baby’s stools are white, chalky or clay-colored we are concerned about a potential issue with the liver. Always tell your pediatrician. Bring a sample in or take a photo if you can. Like I said, we ALMOST enjoy discussing poop. If you see bright red blood in the diaper, it could be from mom’s hormones passing to baby - in which case it is coming from the baby’s vagina. This is normal and can last a few days. If it is mixed in with stool or seems to come from the rectum, let us know right away. This could be a sign of a milk allergy, a tear in the mucousa of the rectum or a more serious issue like a bowel obstruction. Particularly, if you see dark, red, jellylike stool and your baby is in pain or vomiting - call us immediately! This is true even for older children.

Infants:

Breastfed babies can poop once every 7 days or 7 times in 1 day. As long as it is soft, it is not considered constipation. If you do find that your infant’s stool is pebblelike, you can try giving 2 ounces of pear or prune juice with 2 ounces of water. It’s one of the few times we say juice is OK. Breastfed babies eat more often because breastmilk is more easily digested compared to formula. Breastmilk has enzymes that help the baby break it down into useful nutrients. Babies usually strain when they have a bowel movement. You would too if you tried to poop lying down. A little tummy massage in a warm bath can help. The babies not you:) When babies start eating solids, a few things can change. The stools become smellier, are usually dark brown, mushy and may contain pieces of undigested foods. The color can vary quite a bit depending on intake. The baby may stool less often, especially if they are breastfed.

True colors:

red/pink poop - can be blood from a milk allergy or an infection, can be a side effect of the antibiotic Cefdinir

red “jelly like” - a bowel blockage where the intestine telescopes into itself (intussusception)

dark green poop - from iron supplementation or dark green veggies

lime green - a foremilk/hindmilk imbalance or an infection

black - can indicate old blood from higher up in the gastrointestinal tract

white/gray - can indicate a liver problem

School-aged Children:

I’d say that the most common poop issue for school aged children (and toddlers) would have to be constipation. Constipation is having fewer than 3 stools per week or having hard, large, painful poops ( could be daily). Stool consistency is determined by the amount of water absorbed by the colon. As the poop passes through from mouth to rectum, it loses more and more water. If transit is slower the colon absorbs more water and the stool becomes dry. It can a vicious cycle, as the pain causes withholding of stool and that in turn can dilate the rectum. A loss of sensation can occur and this explains why lots of kids have accidents and don’t feel it. This can also cause issues with incontinence of urine as the large, bulky stool can press on the bladder. Kids always giggle when I ask them about their pooping. I encourage them to know their bodies and what comes out of them. They giggle some more. We, as parents certainly aren’t keeping track once our kids are independently toileting. The only reason why I know my 5 year old’s usual pooping schedule is because the need to go always occurs that “one time” I take her in the car without shoes. I’ll tell you I was traumatized the day I had to go into the Dunkin Donuts bathroom with her for her “emergency”. She only had socks on. I had to hold a carseat with my infant and my toddler (who also didn’t have on shoes) in my arms. It was terrible. Someone was crying (not me) and she didn’t even poop. Not. fair. Another issue that frequently comes up in this age group is bloody stools. While alarming for any parent or child, you can be reassured that it is unlikely to be from a serious condition. Usually, it is from an anal fissure (tear), a hemorrhoid, an infection or a polyp in the colon. Occasionally, it can be a sign of a concerning condition such as inflammatory bowel disease, a bowel obstruction, or a congenital abnormality. Bloody stool can also be a symptom of an infection called C. Difficile - related to antibiotic use. Googling can be a dangerous habit, so if your child is experiencing any of the above, just schedule an appointment with us and we will check them out.You can also send us a message through the patient portal. It’s quick, easy and we receive it right in our email inbox!

Stay tuned for my next “belated” blog on vaccines.

Dr. S

It’s been proven that getting a flu shot is the best prevention of contracting flu. Flu shots are recommended for all children 6 months and older, every year. Flu vaccinations are only available seasonally. You can expect flu vaccines to be available between September and June depending on availability of flu shot supply.

Please call to get on our Flu Shot Clinic list and we will call you to schedule.
The 2016 A.C.I.P. does not recommend flu mist be given to any patient. Please feel free to ask your physician about this new recommendation.

Immunization and Flu Shot Links

Vaccine Information Statements
ACIP 2016 Flu Recommendation
Immunization Action Coalition (a non-governmental advocacy site)

One of the most prestigious honors available to primary care practices such as ours is becoming certified by an independent quality agency as a “Patient-Centered Medical Home (P.C.M.H.).

Hendersonville Pediatrics is a certified Patient-Centered Medical Home.
We proudly boast this news because P.C.M.H. certification ensures you, our patients, that we deliver the most up-to-date, compassionate care available. Obtaining this certification is not easy. We must not only demonstrate that Hendersonville Pediatrics doctors and staff have excellent clinical expertise and skill but also that they deliver care in a caring and sensitive manner.

You share responsibility for helping us maintain P.C.M.H. certification in the following ways:

1) Obtain care and clinical advice from us whenever possible before seeking care and advice from other sources. Know how to reach us during regular hours and after hours. Always seek care immediately through the nearest emergency room should your child be experiencing a medical emergency that can threaten their life and wellbeing. For non-emergency situations, you can count on us doing everything possible to work in your sick or injured child in a convenient, safe manner. Always schedule your child’s well visits such as annual physicals, sports physicals, and camp physicals with us. This is the best way of ensuring your child will be checked out top to bottom by someone who knows your child.

2) Comply with all medication and specialty referral orders initiated by your pediatrician.

3) Inform our office right away should you seek specialty care through self-referral. This way we can update your child’s records and help coordinate care as needed among your child’s multiple care providers.

4) Talk to your pediatrician about a behavioral health referral to one of our practitioners should your child start to experience difficult or troubling behavior patterns.

5) Should you need information about obtaining health insurance coverage for your children contact our office. We will do our best to offer you helpful information and assistance.

Hendersonville Pediatrics has re-opened it’s patient portal with new and improved services and reliability. If you’ve not already registered for your individual Followmyhealth account please contact our office immediately to get started. Once you create your portal login using a unique username and password you will enjoy many benefits including accessing your child’s health records, communicating with your child’s doctor, requesting prescription refills, requesting appointments, and receiving email reminders. Don’t wait to set up this valuable service. It’s safe, convenient and secure.

Simply click here to get started.  Portal