Before becoming a parent, nappies -and their contents!- most likely couldn’t be further from your mind, for obvious reasons! But once baby arrives, her nappies can be an important clue as to how she is developing, particularly in the early days and weeks, so you may find yourself wondering how to interpret them, what to expect and when to look for help. Here is a whistle stop tour of what you might find at changing time. Don’t forget that all babies are different and if you have any concerns about your baby, even if she seems to be following the usual pattern, seek advice from your doctor or midwife.
In the first six days, it is easy to remember how many wet and dirty nappies to expect your baby to have. They are about equal to your baby’s age in days. So over the first 24 hours of life, when your baby is one day old- you can expect her to have at least one wet nappy and one black meconium dirty nappy.
At two days old you can expect at least two wet nappies and two dirty nappies which are likely to still be black. At three and four days old you can expect three and four wet and dirty nappies. As your milk transitions to mature milk you will see baby’s poo changing from black to green and then green-yellow.
On day five you should see at least five wet nappies and at least four dirty nappies with yellow poos. From day six and for the first six weeks you should see six or more heavy wet nappies with clear or light yellow urine and at least three but often more than eight dirty nappies which are runny and seedy or with soft curds.
After the first six weeks and for the first six months baby’s poos are usually soft and yellow but as your milk composition changes in line with baby’s changing needs you may see the poo thickening slightly. You can still expect to see anything from three to five dirty nappies daily but after six weeks baby may start to skip a day when it comes to dirty nappies. She should always have plenty of heavy wet nappies every day.
After six months as you introduce family foods the colour, texture and odour of baby’s dirty nappies will change.
How To Tell If A Nappy Is Wet?
Another question that you never think of until the situation arises. But with modern nappies being so absorbent it can sometimes be difficult to tell if they are wet, especially when you haven’t changed a baby’s nappy before. When your baby is five full days old and copious milk production is happening, then baby’s wet nappies should feel heavy. But how heavy is heavy? If you try taking a dry nappy and pouring 45 mL or three tablespoons of water into it, when you pick it up that is how heavy you can expect baby’s nappies to be from 5 days old onwards.
But what if baby has dirtied her nappy too? In the very first days when only a small number of wet nappies may be produced, it can be hard to tell if a nappy is wet and dirty or just wet. A lot of modern nappies have a coloured line along the front which changes colour when wet which can be helpful but not always fully reliable when the nappy is dirty too. If you are awaiting a wet nappy in the first days and want to avoid this situation you can try placing a small cotton pad in the fresh nappy over baby’s penis or vulva before you close the nappy after changing. When you open the nappy you will see the urine on the cotton pad which will stop it from mixing with the poo if they have urinated as well.
What Do Different Colours Mean?
Baby’s first poos are called meconium. They are dark, sticky and tar like and have been in the bowel in the build up to birth. Over the first few days following birth baby’s poo will transition from dark meconium to green to yellow. Once meconium has transitioned in the first three days of life you should not see it again. Black, tarry poos after this stage can be a sign of bleeding and needs urgent investigation by your baby’s doctor.
Somewhere between the second and fourth day of life your baby’s poo should transition from black to a khaki green colour. This is a normal transitional stool and is a sign that baby is digesting her milk well.
Large green, frothy stools can be a sign of lactose malabsorbtion caused by overabundant milk supply. This is a common issue and can be corrected by measures such as block feeding, speak to your doctor, midwife or lactation consultant if you have concerns.
As your baby grows, if she eats a lot of green foods such as broccoli or cabbage, you may see these in her nappies.
Sometimes babies may have green poos for a short time after having a viral infection such as a cold, or after immunisations. Sometimes green stools can indicate a cow’s milk protein allergy, but there are usually other signs such as blood and mucous in the stool along with other symptoms such as rash and growth problems. If you see any of these signs in your baby or are worried about your baby for any reason, speak to your doctor straight away.
After the fourth day of life, a breastfed baby’s poo should transition to a pale or mustard yellow colour. This is a sign that baby is digesting mature milk well. The casein protein in breastmilk is very easily digested and can cause soft curds, like cottage cheese, to appear in the poos, this is nothing to worry about.
After six months when you begin to introduce family foods to baby’s diet you may notice a change in her poos. When you first introduce the foods baby is not used to digesting anything other than breastmilk so you may see food coming out in the nappy looking very similar to when it went in. As your baby matures and becomes accustomed to solid foods you may notice the stools changing from liquid yellow stools to soft, more solid brown stools. They will also smell more strongly. At this stage you probably won’t see undigested food except in the case of particular foods which can be difficult to digest fully like cabbage or grapes. If you notice undigested food persistently in your baby’s nappy, or if your baby has constipation or diarrhoea, or you are worried, check in with your doctor.
Babies who are formula fed tend to have stools that are more brown in colour but they can vary from tan brown, green brown or yellow brown. They are thicker in consistency, usually similar to smooth peanut butter, and tend to smell more like adult stools.
It can be frightening to see blood in your baby’s nappy. There are many causes for this. In the first few days of life baby girls can have a false menstruation or period due to hormonal changes around the time of birth. This is a very small amount of blood which comes from her vagina and is quick to settle.
Sometimes if your baby is constipated, passing a hard poo can irritate the skin around her bottom and cause some bleeding. Or when breastfeeding, baby could ingest a small amount of blood from cracked nipples which could appear in the nappy.
Blood in the stool can also be a sign of bleeding anywhere in the intestine or other conditions such as cows milk protein allergy, other allergies or infections. Poos that look like redcurrant jelly are a sign of a serious condition called intussusception and needs urgent medical attention.
Even though blood in your baby’s nappy does not always mean there is a serious problem, it is always best to keep safe and get it checked out so if you do notice any blood in baby’s nappy contact your doctor straight away.
If you notice baby’s nappy is stringy, shiny or slimy it is likely there is mucous in it. Sometimes after a cold or other virus, baby may swallow mucous which can appear in her nappy. This doesn’t last long. Mucous in the nappy can have other causes, such as allergies, so this is another one which is important to contact your doctor about.
Although your baby’s nappy is gives a good insight into the inner workings of your baby and your milk production, it is also important to know when to take a step back from it. There are many variations of normal and the above is a guide but it is not an exhaustive list of what you may see in your baby’s nappy. Once your baby is feeding well and growing and her nappies have developed a consistent pattern that you are happy with you can take a step back from focusing so closely on the nappies and focus on enjoying your baby and your journey together. If you notice any worrying changes or have any concerns at any time contact your doctor or midwife.