Nappies: what to expect

Parents often ask what to expect when changing the nappies of a breastfed baby. How many wet and dirty nappies are normal? What should they look like?

As what goes in must come out, your baby’s nappies will give you a good measure of how much milk they are getting. 

The First Week   

In the first and second days of life, it is typical for babies to wet only one or two nappies per day since they are drinking small amounts of the colostrum. As the milk volume increases, their urine output increases markedly. Urine gets lighter in color and their nappy feels heavier when being changed.

Occasionally, you might notice orange-red stains in the nappy in the first week of life. This is referred to as “brick-dust urine”, highly concentrated urine that contains urate crystals. Such stains may be mistaken for bleeding after a baby boy’s circumcision or a baby girl’s normal vaginal bleeding under the influence of her mother’s pregnancy hormones. This brick-dust urine is very normal for breastfed babies on the third day right before the milk volume increases and the transition from colostrum to mature milk occurs. It disappears as the milk volume increases. However, if you continue to see these deposits after the fifth day, especially if your baby is having fewer than three poos a day, contact your midwife or doctor and get in touch with an LLL Leader here.

In the first few days after birth, newborns pass dark, tarry poo called meconium, a sticky black substance that has been stored since before birth. As your baby feeds, early milk acts as a laxative, clearing the meconium from the intestinal tract. Within a few days, your baby’s poo will become softer and much lighter in color. These poos are normally yellow, yellow-green, tan or occasionally green. After meconium has passed, poo should not be white, black or look bloody, and if you see this you should seek urgent medical review for your baby. The smell should be mild and not particularly unpleasant. The consistency may be described as being similar to scrambled eggs, custard, pea soup, or even prepared mustard. There are often small, seedy-looking solid particles in the stool. Occasionally seeing mucous in the stool can also be normal.

If your baby is not having as many poos as expected, this can be a sign they are not getting enough milk. You can read more about this here. They should be reviewed by a health professional and you may need additional breastfeeding support. 

The First Six Weeks

Most babies, after the first week, have at least three to five soft mild-smelling poos every 24 hours, until they are about five to six weeks old. The poos should be at least the size of the “okay” circle you make with your thumb and forefinger or a 50p coin. Some babies have more frequent poos, sometimes after every feed. Having many (even 10 or more) watery mustard-colored stools a day between weeks two to four can be normal; it is usually an indication that breastfeeding is going well and is not diarrhoea. Occasionally well-looking breastfed babies are mistakenly admitted to hospital and investigated for diarrhoea in this age group.

In the first four to six weeks of life, the stool count is a more reliable indicator of adequate milk intake than wet nappies. During weeks five and six, poo nappies may reduce to one to two stools per day. This is normal and not because your milk production has reduced.

After Six Weeks

After weeks five to six, dirty nappies generally reduce to one to two poos per day and can change consistency, becoming more like peanut butter. This is due to a normal change in milk composition as your baby gets older. 

Occasionally, some healthy babies will have only one bowel movement every few days. When bowel movements are less frequent, they should be soft, yellow, easy to pass, and large in volume. IBCLC Carol Smyth says: “Babies who are pooing infrequently tend to have a massive ‘poosplosion’ when they do finally poo, or they may fill several nappies in succession.” As long as the baby is gaining according to their own growth curve, wetting sufficiently, and is happy and content there is no cause to be alarmed by infrequent bowel movements. This pattern is not constipation. Constipation is defined as passing hard, dry, pebbly infrequent bowel movements that are painful for the baby. It is not necessary to give the baby a laxative, fruit juice, syrups or any other “helpers.” In fact, attempting to force bowel movements can have harmful consequences to your baby. Constipation is very rare in an exclusively breastfed baby and should be explored by your healthcare provider.

If a baby develops a consistent pattern of infrequent stooling, it is important to ensure that the baby is having enough opportunities to breastfeed. Using a dummy can reduce the amount of time at the breast, and therefore the amount of milk your baby takes. Typically babies between the ages of three to five months are very interested in their surroundings and easily distractible during the day. Bedsharing often allow babies to take in bigger volumes of milk during night time breastfeeds. Read more about how to safely bedshare here.

After about six weeks of age, your baby may wet only five to six nappies per day.  These nappies should be much wetter and heavier than those of a younger baby. Urine should be light yellow to clear in color. As your baby’s bladder grows, it will hold more urine. If at any time you have concerns about whether or not your baby is gaining and growing well, consult your healthcare provider.

After Solid Foods – Get Ready!

Once solid foods are introduced to your breastfed baby around six months of age, there will be many changes in their nappy patterns. The stools will have a stronger odour and different colour and consistency. It is normal to find bits of vegetables in the nappy, as even cooked vegetables are harder to digest than many other foods. After the introduction of solids, it is indeed possible for your baby to experience constipation or diarrhoea. These can be clues that they are not tolerating a new food. Some foods with iron added, such as rice cereal or infant formula, can cause constipation in some babies. Be sure to breastfeed before offering solids, to make sure the more nutritious milk is their main source of food. Consider attending your local LLL meetings as well for support from other nursing mothers, parents, and accredited LLL Leaders.

Take Home Messages

Under six weeks, poo matters more than wees. Many poos are a good indication that breastfeeding is on track. Under six weeks, if your baby is passing fewer than two or three big poos a day, please consult an LLL Leader, Lactation Consultant, or healthcare worker in person as your baby may not be getting enough milk.

Over six weeks, one or two stools and five or six heavy wet nappies over a 24 hour period is expected. If your baby is consistently passing less than this, please seek medical help.

You can find more detail about nappies, milk supply and other breastfeeding information in our book, “The Art of Breastfeeding”. You can buy this here, and some of the money you spend will help us support other families like yours. 

Adapted from La Leche League International article: “pee and poop in the exclusively breastfed baby”