Your baby may urinate as often as every one to three hours or as infrequently as four to six times a day. If she’s ill or feverish, or when the weather is extremely hot, her usual output of urine may drop by half and still be normal. Urination should never be painful. If you notice any signs of distress while your infant is urinating, notify your pediatrician, as this could be a sign of infection or some other problem in the urinary tract.
In a healthy child, urine is light to dark yellow in color. (The darker the color, the more concentrated the urine; the urine will be more concentrated when your child is not drinking a lot of liquid.) Sometimes you’ll see a pink stain on the diaper that you may mistake for blood. In fact, this stain is usually a sign of highly concentrated urine, which has a pinkish color. As long as the baby is wetting at least four diapers a day, there probably is no cause for concern, but if the pinkish staining persists, consult your pediatrician.
The presence of actual blood in the urine or a bloody spot on the diaper is never normal, and your pediatrician should be notified. It may be due to nothing more serious than a small sore caused by diaper rash, but it also could be a sign of a more serious problem. If this bleeding is accompanied by other symptoms, such as abdominal pain or bleeding in other areas, seek medical attention for your baby immediately.
Beginning with the first day of life and lasting for a few days, your baby will have her first bowel movements, which are often referred to as meconium. This thick black or dark-green substance filled her intestines before birth, and once the meconium is passed, the stools will turn yellow-green.
If your baby is breastfed, her stools soon should resemble light mustard with seedlike particles. Until she starts to eat solid foods, the consistency of the stools may range from very soft to loose and runny. If she’s formula-fed, her stools usually will be tan or yellow in color. They will be firmer than in a baby who is breastfed, but no firmer than peanut butter.
Whether your baby is breastfed or bottle-fed, hard or very dry stools may be a sign that she is not getting enough fluid or that she is losing too much fluid due to illness, fever, or heat. Once she has started solids, hard stools might indicate that she’s eating too many constipating foods, such as cereal or cow’s milk, before her system can handle them. (Whole cow’s milk is not recommended for babies under twelve months.)
Here are some other important points to keep in mind about bowel movements:
- Occasional variations in color and consistency of the stools are normal. For example, if the digestive process slows down because the baby has had a particularly large amount of cereal that day or foods requiring more effort to digest, the stools may become green; or if the baby is given supplemental iron, the stools may turn dark brown. If there is a minor irritation of the anus, streaks of blood may appear on the outside of the stools. However, if there are large amounts of blood, mucus, or water in the stool, call your pediatrician immediately. These symptoms may indicate an intestinal condition that warrants attention from your doctor.
- Because an infant’s stools are normally soft and a little runny, it’s not always easy to tell when a young baby has mild diarrhea. The telltale signs are a sudden increase in frequency (to more than one bowel movement per feeding) and unusually high liquid content in the stool. Diarrhea may be a sign of intestinal infection, or it may be caused by a change in the baby’s diet. If the baby is breastfeeding, she can even develop diarrhea because of a change in the mother’s diet.
- The main concern with diarrhea is the possibility that dehydration can develop. If fever is also present and your infant is less than two months old, call your pediatrician. If your baby is over two months and the fever lasts more than a day, check her urine output and rectal temperature; then report your findings to your doctor so he can determine what needs to be done. Make sure your baby continues to feed frequently. As much as anything else, if she simply looks sick, let your doctor know.
The frequency of bowel movements varies widely from one baby to another. Many pass a stool soon after each feeding. This is a result of the gastrocolic reflex, which causes the digestive system to become active whenever the stomach is filled with food.
By three to six weeks of age, some breastfed babies have only one bowel movement a week and still are normal. This happens because breastmilk leaves very little solid waste to be eliminated from the child’s digestive system. Thus, infrequent stools are not a sign of constipation and should not be considered a problem as long as the stools are soft (no firmer than peanut butter), and your infant is otherwise normal, gaining weight steadily, and nursing regularly.
If your baby is formula-fed, she should have at least one bowel movement a day. If she has fewer than this and appears to be straining because of hard stools, she may be constipated. Check with your pediatrician for advice on how to handle this problem.