Q: I have a newborn baby and the nurses asked me to look out for changes in the stool color? Why is that?
A: Yes, your discharging nurse was correct in giving you that advice.
Stool color is an important marker for various conditions, so we need to be aware of the changes and what they mean. This is true not only for babies, but also children and adults.
The obvious one, which almost everyone would be familiar with, will be the presence of blood in the stool. Blood in the stool, as you can guess, is always abnormal. Hence the key is to know why there is blood? What is the source of the blood? Blood in the stool is often mistaken for many food agents that we consume; more so in younger children. A child who consumes pink or red colored drinks may have a “blood-” or “red-“colored stool. Similar appearance can happen when you consume beetroot. Certain antibiotics can rarely do the same. But, it would be important to ensure that it is truly not blood.
The most common reason for blood in a child’s stool is constipation. But, no matter, if there is blood present, it is important to check with your doctor. Other causes of blood include polyps, hemorrhoids, ulcers, inflammation or infection (the latter two are often associated with diarrhea), and malignancy, especially in middle-aged and older individuals. And these are some of the conditions your doctor would be thinking about when you present to them with a history of blood, or possible blood, in the stool. I would also suggest taking pictures of stool that appear abnormal. After all, a picture is worth a thousand words.
Black stools can be caused by certain medications, including iron and bismuth, but it can also denote bleeding in the upper part of the intestines. Please do not ignore black stools. It could be an important marker of an illness that needs urgent attention.
In a baby, we are concerned with the stools becoming lighter or pale. This suggests that bile is not coming through into the intestines. After all, the baby drinks milk and poops mustard-yellow or green, or a combination. This is due to the bile coming down from the liver and meeting the white milk, and helping in absorption of the nutrients followed by coloring the remnants. We worry about less bile reaching the intestines as it denotes some liver disorder or blockage in the tubes that carry the bile into the intestines from the liver where it is made and the gallbladder where it is stored. These conditions often need a quick workup and specific treatments. Delay results in worsening of the liver condition.
Light or pale stools, or clay-colored stools as we often call them, can also be due to an infection with some parasites or hepatitis. Hepatitis is a common term used for any inflammation in the liver and could be due to a virus or drug or other causes. As I mentioned above, this affects the bile going out into the intestines. As the inflammation improves, the pigment comes back.
Dark green stools can result from bile flowing too fast through the intestines, or if the child has diarrhea. This is usually self-limiting in most situations. It may also denote a good intake of green foods or green fluids, as you may see orange poop with a lot of carrots or squash in a baby.
Malabsorption stools can lead to foul-smelling stools that appear pale and fatty, and denote a problem in either the pancreas or intestinal lining.
In today’s vignette, doctors and nurses all over the world are stressing the need of watching the color of a baby’s stool to detect early blockages of the tubes that allow bile to reach the gut. There are many stool color charts available online to help the parent decide if it appears normal or light-colored.
Light-colored stools in a baby demands urgent evaluation with a blood test for the liver. In some countries, new parents are sent home with stool color charts and, if the stool does not match the color in the normal panel, they need to call the doctor.
So should you if you see that happening.
Full marks to your newborn team!
Pankaj Vohra is a Pediatric Gastroenterologist at UNM. Please send your questions to pvohra@salud.unm.edu.
