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DIAPERS: WHAT TO EXPECT, PT. 1

January 04, 2018

DIAPERS: WHAT TO EXPECT, PT. 1

Changing a baby’s diaper is a right of passage for new parents but deciphering what’s normal and what warrants a call to the doctor can be challenging even for seasoned parents. Babies are complicated little bundles of joy and the plethora of things a new parent may tackle just with a single diaper change can be overwhelming.

Fear not! Nurse Melissa is here to lay out the good, the bad, and the ugly so parents can have an easy reference for all sorts of diaper chaos. When you know what to look for, your baby’s pee and poop can be a clear roadmap for their health - when they are feeling well vs. when you should call the doctor. Read on to become a diaper pro!

Starting Easy - Wet Diapers

Within 24 hours of birth, newborn babies should have their first pee. On average, during the first few days of life, a baby should have at least 1 wet diaper by day 1, 2 wet diapers by day 2, 3 wet diapers by day 3, 4 by day 4, and 5 or more for day 5 and every day thereafter.

Sometimes it can be tricky to tell if baby has peed because it might be a very small amount or be hidden by a poop. If that happens, save yourself the hassle and grief and use the line on the outside of the diaper as your guide. Almost all disposable diapers have a small yellow line visible on the outside of the diaper that turns blue when the diaper is wet! This is an easy way to know if you need to change baby’s diaper without actually looking inside the diaper, plus it’s a sure-fire way of keeping track of baby’s wet diapers daily!

For the most part, the urine you see in baby’s diaper should be light yellow or yellow. Darker yellow or an orange tinge can indicate dehydration which would call for an intervention. If baby’s urine is dark or has fewer than normal wet diapers, dehydration is likely which could simply resolve with an increase in feeding frequency or feeding volumes or a call to the pediatrician could be in order.

Note that breastfed babies within their first week, when mom’s milk still isn’t in yet, are at higher risk of having darker yellow or even orange tinged pee. In some cases, uric acid crystals may appear in the diaper as small red “rust” stains. All of this should be communicated to the pediatrician but isn’t necessarily cause for major concern, just increased monitoring and communication with baby’s doctor.

Boys vs. Girls

While we are on the subject of wet diapers, we’d be remiss not to mention some major differences in the plumbing structure between boys and girls and how that relates to newborn diaper expectations and care.

For parents of boys, it’s worth mentioning that some little boys have a reflex where they start peeing the minute their penis is exposed to the air even if they’ve just peed into their diaper! This means you go to change a wet diaper and just as the old dirty diaper is off, you get sprayed in the face with urine! Eeek! At the very least to prevent getting a face full of pee, you should never be positioned at baby’s feet during a diaper change. To prevent any pee ending up on you or your house, you can always put a washcloth over baby’s penis while you clean him up and change the diaper or you can keep the old dirty diaper up over the penis and work from back to front to get him cleaned up and the clean diaper applied. There is also a specialized “Pee Pee TeePee” you can buy to do the job of the washcloth/diaper during baby boy diaper changes.

Also worth noting with boys, if baby is getting circumcised, there will be special diaper related considerations and post-circumcision care that parents should be familiar with! Please see our recent Facebook live broadcast and blog post that covers the topic in more detail: https://www.tranquilomat.com/blogs/news/newborn-care-101

If you opt against getting baby circumcised, just be sure to keep his penis clean, especially from any poop that might migrate into the area, during diaper changes. Every few days during his bath, a good thorough but gentle scrubbing of the penis with warm soapy water will keep good hygiene and prevent any foreskin infections or issues.

One thing to note with uncircumcised boys is that you should never try to push the foreskin back to expose the penis. Most baby boys have some skin adhesions in this area when first born that resolve naturally over their first few months and years of life. Any forced tugging or pulling on the foreskin of uncircumcised boys can cause unnecessary pain and/or bleeding if these adhesions are disturbed. In a worst-case scenario, foreskin that’s been forced out of place can swell which might prevent it from returning to its natural positioning which could cause pain and blood flow issues that might damage the penis permanently.

For baby girls, their anatomy warrants different pointers for parents. First, it is worth noting that during the first few days after birth some baby girls experience a small amount of menstrual bleeding like a little mini-period. This is due to the change in hormones they experienced in utero thanks to mom vs. their own lack of these adult hormones! There is no need to panic or do anything special - e.g., no baby tampons or pads - but just ensure the blood flow and discharge is minimal. As with boys post-circumcision, there should never be more than a quarter size blood stain on a diaper during this mini-menstruation. If there is, contact your pediatrician ASAP.

Also important to note when changing a baby girl’s diaper - always wipe front to back. If you aren’t careful and wipe from back to front or in an unorganized fashion, you might get poop residue and bacteria near her urethra (where pee comes out) which can cause a urinary tract infection (UTI), bladder infection, or even kidney infection. In more rare cases the unwelcomed fecal bacteria can also cause issues with yeast infections or vaginal infections. Uck! Many moms might already know this “wipe front to back rule” or have experienced UTI related issues themselves for similar reasons but this is likely to be new information for most dads!

Newborn’s 1st Poops - Meconium through Transition

When babies are first born, their first poops are a sticky, dark black, tar-like substance called meconium. Meconium is the byproduct of baby’s time in the womb where they aren’t eating or pooping for 9+ months! Suspended in amniotic fluid, babies do practice swallowing and sometimes take in amniotic fluid but that’s not the sustenance they’d normally get from breastmilk or formula so their gut is basically on vacation until they’re born. If baby does poop in utero, it is usually only due to the stress of labor not because they should poop in utero!

Instead, in utero, baby gets all of his nutrients (including oxygen) from mom’s bloodstream which is processed at the placenta and passed into baby’s bloodstream which is carried back to baby via the umbilical cord. Since baby isn’t pooping in the womb either, anything they need to digest sits in the bowels like some kind of weird gift for mom and dad during their first diaper changes.

This first meconium poop is so black and sticky because it’s got a lot of dead red blood cells in it that have been building up for the last 9 months! Red blood cells, just like any cell in the body, have a limited lifespan and are constantly dying and being remade. When red blood cells die, they are processed by the liver into bilirubin and then excreted into poop. In fact, bilirubin is what gives most adult poop its brown color! But now imagine you’ve gone 9 months without a poop - talk about feeling constipated! - so that when this first poop does finally emerge it’s super concentrated with bilirubin and thus takes on the unique black, sticky quality.

This sticky meconium poop can take a few days for the baby to pass out as their digestive tract gets working. The more baby eats, the more they will poop and the more they poop, the faster these meconium poops will transition!

Transition stools start as less sticky, still dark black or green colored and eventually move into a more “army green” color, sometimes with little seed-like pieces in it, especially in breastfed babies. These “seeds” are actually just the semi-digested milk curds baby gets in breast milk. Just as its name suggests, this poop is simply a transition and soon you’ll notice it getting lighter and lighter until it becomes the more traditional breastfed or bottle fed stools! We will dive more into the intricacies of breast and bottle fed poop in Part 2 but for now, we’ll just summarize.

Breastfed baby’s poop is usually a loose, almost watery stool that is like mustard in both color and consistency often with seeds (aka curds) intermixed. Formula-fed poop is better formed than breastfed poop but will still be soft. Formula fed poop can have a large range of colors - anywhere from light yellow to yellowish brown or even a light brown or greenish brown.

So how often should baby poop during these early days? As a general guideline, just like with wet diapers, baby should have one poop for every day old they are. So for example, they should have 1 meconium poop within 24 hours from birth (i.e., day 1), 2 poops by day 2, 3 by day 3, 4 on day 4, and 5 or more on and after day 5. This is especially true of breastfed babies but a formula fed baby may poop less often, maybe even only once per day or once every other day! You’ll have to see what your baby’s “normal” is once the meconium and transition stools make way for their regular poop!

Baby poop can be varied, especially for babies who’ve started eating solids, but there are a few consistency issues to keep an eye on and call the pediatrician for - diarrhea and constipation. Even though baby poop might be quite watery, there should always be some solid parts, especially in the form of small seeds or curds. If, however, it looks like you took a poop colored liquid and poured it right into baby’s diaper without any solid parts at all - that is diarrhea! One or two diarrhea diapers is not a problem and might resolve on their own. If they don’t or baby has other signs of dehydration like fewer wet diapers or dark yellow urine or rust colored stains of uric acid crystals, it’s time to call the doctor! Dehydration can also manifest as lethargy or excessive sleepiness and difficulty drinking either from the breast or a bottle - so if you spot any of these, call the pediatrician sooner rather than later.

Similarly, if baby has hard, firm, rabbit-like poop or seems in noticeable pain when pooping, they are likely constipated and it’s time to call the doctor. Remember, all in all, with babies it is all about the “big picture!” If you’ve got one weird diaper and a happy, giggling baby, no worries! If on the other hand, you have several abnormal diapers and a baby who’s not themselves, it’s best to call the doctor. And of course, when in doubt, always err on the side of caution and call the doctor. She’s the expert and an important team member to ensure your baby is happy and healthy.

For more information on breast vs. formula fed baby’s poop, as well as a full rundown of all kinds of poop colors and what they could mean, stay tuned for our next Facebook broadcast and blog from Nurse Melissa. She’ll also be sure to tackle diaper rash - how to prevent it and treat it!

We hope this information has been helpful and gives even the most seasoned parent some more information about the strange and wonderful world inside baby’s diaper! We’d love to know what you learned from our post by commenting below. Sharing your favorite baby related diaper story is also a surefire way to let us know you enjoyed Nurse Melissa’s tips! Of course, if you have questions about anything, please let us know in the comments so we can answer them. Chances are if you have questions, other parents do too, so ask us anything.

Watch Nurse Melissa's Facebook live broadcast on "Diapers: What to Expect, Pt 1"


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