Blood in Baby’s Stool? A discussion on gastrointestinal health, formula supplementation and questioning
Seeing blood in a baby’s stool can be shocking and frightening for a parent. Is there internal bleeding? Is something causing damage to your baby’s esophagus or stomach or intestines? Did baby swallow mom’s blood? Is baby having an illness or allergy? It can be quite concerning until a proper diagnosis is determined!
*This blog post is about finding small amounts of blood in diaper or potty and NOT about other more extreme bleeding or emergencies. If you see copious amounts of blood, your baby is crying in acute PAIN or your baby stops eating, I would consider this an emergency situation and not part of the following discussion. *
I am not a medical doctor and I want to make it clear to encourage a good working dialog with your physician (because I truly feel just like myself with the families I volunteer for, doctors do care about their patients). There are some truly informed and breastfeeding-knowledgeable health care workers and there are others who either don’t know or don’t care about the differences between human breastmilk and artificial formula. When a family collaborates with their physician, many physicians will consider the common concerns and dig deeper depending on the range of symptoms. Sadly, a common theme I hear is that some physicians suggest babies switch from breastfeeding or human breastmilk to formula rather than considering other causes or recommendations first.
First, it is important to know what typical infant stool characteristics are. This is a wonderful resource from the authors of the book The Breastfeeding Atlas titled “Diapers of the Breastfed Baby”. Notice that the baby’s first stools are sticky and dark… it includes amniotic fluid and blood. Human colostrums is a wonderful laxative which flushes the infant’s body of the meconium and starts to line the baby’s gut. It is a true first food and vaccine all in one. I am sure there are yet to be discovered values to human colostrum for the human infant.
The early stools will gradually change from the sticky, dark stools to a greenish and then yellowish coloring. By day 4 or 5, an exclusively breastfed (only breastmilk) baby will stool somewhere between 2 to 5 times in a 24 hour period. http://www.kathydettwyler.org/detwho.html
Babies are meant to eat and grow quickly and that will also mean pooping or stooling. There is a range of variation but the important word here is volume. Some find a couple of really large stools while others see several small ones 24 hour period. For the stool to count it should be about the size of a U.S. quarter (2 ½ cm) or the size of an OK sign on your hand. The poop will be yellow and may sometimes look seedy. http://www.llli.org/faq/enough.html
Using the WHO terminology linked above, there may be some slight variation if you are predominantly breastfeeding or human milk feeding. I make this emphasis because color or consistency will most likely change slightly if you are using some vitamins or supplements. For example, if you are also using complementary feeding (non-human milk) your baby’s stool will more than likely be darker in color and thicker in consistency than exclusively human breastfed or breastmilk fed stools. Around the 6-week mark, a noticeable change in stool pattern often happens. http://www.lalecheleague.org/faq/bm.html
Blood in the diaper (or potty for those that are diaper-free) is typically a signal of one of three things… an allergy, an illness or an injury of some type. There are always so many sites on the Internet so I find the most valuable tools to be specifically medical institutions. In other words, when working with my children’s’ physician, I look to first their own American Academy of Pediatrics to see if they are following their own guidelines. There are multiple reasons that might cause blood in stool in children. Seattle Children’s Hospital website lists many reasons. http://www.seattlechildrens.org/medical-conditions/symptom-index/stools-blood/
The list includes anal fissures (blood but not diarrhea), strep skin infection (blood streaks), diarrhea from other infections (Shigella, Salmonella, etc), food allergies, red dye in foods, antibiotics causing either bleeding or red colored stools. This information tells me that families and physicians first should discuss they type of blood they see and what else they see… using their eyes, nose and senses for further detail. It doesn’t seem that it is enough to state that you see blood but to discuss the full range of symptoms going on. Are you seeing copious, mucousy stools? Is the baby using a new vitamin or have either of you been on antibiotics? Are you seeing large clots (an emergency signal)? Is there a diaper rash? Is the baby upset by this or content in other ways? How are weight and length checks?
A wonderful and trusted resource is KellyMom. KellyMom lists multiple potential causes of blood in stool. They include anal tears, food allergies, mom’s own nipple damage and blood, oversupply, reactions to other supplements, medications or vitamins, bacterial infections and more.
http://kellymom.com/health/baby-health/bloodystool/ Read her full post for more information. Some reasons for blood in stool are limited and short lived while others will require specific attention.
This discussion underscores the importance of taking a good medical history rather than just downplaying the important role that breastmilk plays in gut health. Taking away human milk from a human infant who is showing signs of distress in their gastrointestinal tract is, in my opinion, not only poor logic but unethical practice to suggest before looking into other causes. If there is one thing that the medical community has known for decades, it is the value of human milk on infant gut health and the important role human milk plays in infant gut development.
It is also well known that babies fed formula can develop allergic colitis from cow’s milk. http://childrenshospital.org/az/Site2959/mainpageS2959P1.html
So the very idea of switching to formula when a baby has bloody stools seems to defy logic itself. Exclusive breastfeeding has been associated with less inflammatory bowel issues… less Chrohns, less Celiacs, some studies even suggest less Inflammatory Bowel Disease.
A much healthier course for discussion would be for the mother to be informed about what types of challenges may cause blood in an otherwise healthy infant stools. She and the physician can discuss the idea of oversupply or meeting with a lactation consultant for more support as well. There may be dietary changes suggested while continuing to breastfeeding as the most common offending foods are eliminated.
Breastfeeding Benefits; Human Breast Milk Ingredient Adjust to Optimize for Beneficial Gut Bacteria Over Time
The Academy of Breastfeeding Medicine has this protocol on the allergic baby and management of breastfeeding.
The Academy of Breastfeeding Medicine’s protocol guidelines for doctors from doctors, explains not only dietary changes for the mother but the use of enzymes, making a proper evaluation and recommendations for the family as well as testing to be done by the physician. Nowhere in this protocol is it suggested that human breastmilk be suspended as the food for human babies, rather it is suggested that delaying or avoiding exposure to the allergens is advised. This would be a wonderful resource to take to your pediatrician or other family physician for discussion and dialog. It would not only help you but help to educate your health care for the next family.
The truth is, there is not enough known on why some babies have blood in their stools. There are truly more questions than answers for parents. It is often considered a self-limiting condition that resolves itself as stated here from Children’s Hospital of Colorado:
“How do I treat this baby? There are several options. If the baby is happy and thriving and not overly fussy with stooling, in most circumstances nothing need be done. The problem will resolve without treatment by 6-9 months of age as the baby’s immune system changes to the adult pattern. These infants may need supplementation with iron. If the baby is breast fed, having the mother observe a strict milk protein free diet may make the blood streaks disappear. Maternal diet restriction is not 100% effective. Do not tell the mother to further restrict her diet beyond milk and soy. It will not be likely to help and will be very hard on the breast feeding mom. In the bottle fed baby, or in the breast fed baby who fails the first step, hypoallergenic (not a soy) formula can be helpful and results in prompt resolution of the blood. If the gross blood disappears, the occult blood in stool will remain positive in the majority of babies. This rarely results in iron deficiency or anemia. Occasionally I use probiotics with good effect.”
I use this quote as an example of the type of message families hear. Even if it doesn’t include the idea to switch to formula it is one that doesn’t tell or ask for the whole story. There seems to be a group that will suspend logic and blame breastfeeding or simplify the issue rather than digging deeper. As I have explained in this post, there may be underlying causes or allergies other than dairy or soy and each situation may be different. Please know that I am not trying to create the feeling of judgment against formula or claim that families are naïve when following medical advice. Rather, I am critical of some in the health care field, who are simply not being supportive of human milk for human babies. My hope is that information on typical stooling and gut health may further the path to healing, perhaps favorably for both baby and mother.
References and further reading:
Allergies and the Breastfeeding Family
Breastfeeding Saved My Child’s Life
Common Sense Breastfeeding: Gaining, Gulping and Grimacing
Normal, Like Breathing: Red tushies and green poop
Holistic IBCLC: The Gut, Microbes and Poop
Normal, Like Breathing: So, what CAN I eat?
Dr. Jen 4 Kids: Pediatric Myths; Formula Recommendations
Pediatrics: Breastfeeding and the Use of Human Milk
Breastfeeding and risk of inflammatory bowel disease: a systematic review with meta-anaylysis
Best for Babes: Your A Team.
Cronobacter Illness and Infant Formula
Effect of Infant Formula on Stool Characteristics of Young Infants
Diapers of the Breastfed Baby: Barbara Wilson-Clay, Kay Hoover
Jay Gordon, MD: Color of the Day: Solving Bowel Movement Mysteries http://drjaygordon.com/pediatricks/general/poop.html
Listen to this short podcast on HMO’s (fatty acids) in milk which support good bacterial growth in the infant’s gi tract or gut.