How to prepare your baby for the perfect poo

An excerpt from Looking Out for Number Two: A Slightly Irreverent Guide to Poo, Gas, and Other Things That Come Out of Your Baby.

Early bowel patterns | What’s normal

As we learned, the poo patterns of new babies don’t settle in until a week or two after birth.

And beyond the evolution of the early poo trifecta, you’ll likely find that poo is slow to get going if you are breast-feeding your baby. As you will figure out, your breast milk doesn’t just magically appear. It takes a few days for your breasts (and tired brain) to come around to the idea that they need to be making and releasing milk. And during that time period, when production hasn’t met demand, things may be slow from down below.

Remember that if there isn’t much going in, there won’t be much coming out the other end.

The rule of fours and the first month or two of life

As a general rule, a breast-feeding baby of a mother making milk will be on the poo bus by around three or four days. If that isn’t the case, it may make sense to talk to an expert about what you’re producing or how your baby is feeding.

If everything manages to go according to plan from there, your baby will follow the rule of fours. The rule of four suggests that after four days of life a baby should have at least four poos a day for the first four weeks. In fact, I’d expect more like one poo with every feed, but the rule of fours is an easy rule to live by and a great way to help young stool-gazing parents keep track of the absolute minimum. So as we’ve suggested, things are slow to get moving, but once they do you can expect a lot of dirty diapers.

Bowel actions

If you speak with a British accent and do poo research, you’re likely to refer to taking a dump as a bowel action. While I’ve never fully understood the need for such a formal term, it nonetheless remains de rigueur terminology for those who think about poo and have high-pressure anal sphincters.

What happens when we poo? The basics of the human poo process

To understand the process of how your baby “makes a diaper,” it might be helpful to understand what actually happens when we eliminate. While this may seem like TMI, it isn’t for a book about all things poo. And this basic understanding of elimination ultimately becomes important for potty training and the speed bumps you might hit later on.

What we do when we poo

Here’s how it goes down (or comes out) for the average pooer:

1. Poo arrives in the rectum. Through the normal process of intestinal motility or squeezing, fecal matter makes the turn through the sigmoid colon and into the final stretch of the rectum, where it hangs waiting to be expelled.

2. We sense something’s there. We feel pressure, or fullness, in the rectum and on the pelvic floor.

3. We hold on until the time is right. When that fullness sensation goes to our brain, we make the social calculation that the frozen food section where we’re standing may not be a good place to do what needs to be done. So we intentionally hold on using our external anal sphincter and some of our pelvic floor muscles to keep things in place.

4. We sit and let it out. Actually, it’s more involved than that. We sit with our hips flexed. Then we relax our bottom and push with our abdominal muscles to create a little pressure. And there you go.

When all is said and done, we sense that our bottom is empty. We clean up and go on our way. This is the normal, nonbaby cycle of continence and elimination.

How your baby is different

The poo process for babies is different in a lot of ways. Babies are not cognitively connected to what’s going on, or to what’s coming out. They can’t directly associate rectal fullness with the need to do something else. And despite our upcoming conversation about “potty training” babies, they certainly can’t make judgments about when and where to let go.

Babies do learn and understand that the generation of pressure plus the relaxation of the pelvic floor results in a relief of pressure. Beyond this primitive reflexive ability to push, the high amplitude contractions of the colon as well as the gastrocolic reflex (see sidebar on page 00) play a significant role in moving things along and out.

Positioning for the perfect poo

Have you ever tried to poo standing up? Okay, that was a weird question, but it brings up an important point: positioning is important. And as it turns out, for stool to make its final passage into the light of day (or the darkness of a diaper), things have to be aligned just right.

There’s a sharp turn between the rectum and anal canal, or the final segment before the anus. When you’re out and about, walking and running, this angle plus the job done by the external sphincter muscles helps to keep things in where they belong.

Squatting, flexing the hips (pulling them up), or pulling the legs up straightens out the angle between the rectum and the anal canal, making it easier for the poo to pass. Babies, like dogs, instinctively know this. Or at least they figure it out pretty quickly.

And as you may find out in a couple of years, toddlers who don’t want to poop learn that stiffening the legs and arching their bodies and backs is a good way to avoid dealing with number two.

Just remember: Poo flows best with knees to chest. And you can’t poo standing up.

What is a code brown?

If you really want to call yourself a parent, you have to first participate in a code brown. A code brown is a situation where a baby creates a dangerously large mess as the result of a megabowel action. For the purpose of this book, a code brown is typically:

  • Initiated by the passage of a large amount of poo.
  • Occurs in a situation in which you’re unprepared.
  • Requires an uncountable number of wipes.
  • Involves cursing.

A good example would be a supraphysiologic blowout through the onesie at twenty thousand feet while traveling alone with your baby. Cabin pressure change on the colon can be a bitch.

While understanding the potential for a code brown at any point might be reassuring, keep in mind that it’s not a code brown unless you’re thoroughly unprepared.

Bryan Vartabedian is a pediatric gastroenteriologist who blogs at 33 Charts.  He is the author of Looking Out for Number Two: A Slightly Irreverent Guide to Poo, Gas, and Other Things That Come Out of Your Baby.

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