Number 2: The Scoop on Poop
This blog comes after a long hiatus. The flu season seems to be grinding to a close so let’s talk poop.
Poop in the toddler can have quite a large variation. I would say that earth tones are all normal, greens, oranges, yellows, and browns are all within range of normal. The color of stool depends on what has been eaten, the presence or absence of bilirubin, and the normal gut flora that are working on it.
Poop that is white, maroon or black is generally not normal and needs to be assessed. White poop could be a sign of the liver not properly secreting bilirubin into the gut. In the infant this might be a sign of biliary atresia which is a medical emergency, and in the older child could be seen in acquired blockages of the gall bladder and several chronic medical conditions. These stools are almost always pale and clay-like. More often I see white stools in the context of a child with a “stomach flu” who for 2 or 3 days develops white colored stools. This resolves and the child never develops yellow skin or eyes. The child with white stools and yellow eyes needs to be assessed promptly. Maroon stools are a sign of bleeding from the gut and need to be assessed. Occasionally we see maroon stools in the child that has been eating beets. Black stools, especially those with coffee ground appearing stools, are also a sign of bleeding in the gut, and arise from bleeding from the stomach. We frequently see black stools in patients who have been given Pepto-Bismol.
Some colors of stool are not possible to see without something dyeing the stool. Blue stools are always due to some food coloring in the diet. The antibiotic Cefdinir can cause stools to be fire-engine red. Fiberous foods may pass through the gut without being broken down and may change the color and consistency.
More commonly the issue with toddlers and young children is constipation. The most common cause of recurrent belly pain in this age group is constipation. This age group may be potty training, becoming more shy, or starting school. These issues all lead to withholding poop which leads to constipation. Young children always respond that their poop is normal when asked, and they may poop every day. This doesn’t mean they might not be constipated, constipation is more of a function of the size shape and consistency of the stool. I refer parents to the Bristol Stool Chart which is easily googled. Type 1-3 stools are all considered constipated stools and require treatment. Dietary changes are the best first step, increasing fresh fruits and vegetables as well as increasing the juice to milk ratio are easy first steps. My next step is adding some Miralax, 1 cap full in six ounces of fluid once a day for 3 to 12 weeks.
A prolonged course is required to allow the over stretched colon to return to normal caliber. Rarely there is need to clear the child out from the bottom with fleets enemas. I should be involved by this time but I am always happy to talk poop. Call the office and we will shoot the poop.
Coming Soon- The Scoop On Poop 3: The Loaded Teen.