Green Poop: When Should You Worry?

Baby poop is high on many new parents’ worry list. How often should baby poop? Does baby’s poop provide clues to how breastfeeding is going? What do color and consistency mean? When should you worry?

GreenPoop2.jpg

Normal Color and Consistency

Baby’s first stools are the black and tarry meconium that was in her gut at birth. When breastfeeding is going well, by about the third day, baby’s poop changes to “transitional stools,” which have a dark greenish color. By the fifth day or so, the poop’s color changes again to yellow. Its consistency now (and until baby begins consuming anything other than your milk) may look like split pea soup, liquid with seedy bits in it. But if your baby’s poop is all liquid and no seeds, this is also normal.

Baby’s yellow poop is made mostly from the fat in your milk. During the first six weeks, babies gaining weight well usually poop at least 3 to 4 times a day with stools at least the diameter of a US quarter (22 mm) or larger. There is no such thing as too many poops. (Lots of pooping just means your baby is getting lots of milk, which is great.) But too few poops mean it’s time for a weight check.

If your baby is younger than 6 weeks old, is pooping fewer than 3 to 4 times per day, or her stools haven’t turned yellow by the fifth day, a weight check will tell you if this is just a normal variation or a cause for concern. It’s not until after 6 weeks that some healthy breastfed babies poop much less often, sometimes even once a week. Check baby’s weight at a health-provider’s office. A bathroom scale just won’t do. A weight gain of about 1 oz. (30 g) or more per day indicates that all is well. No matter what your baby’s age, as long as she is gaining weight well, don’t worry if she has fewer stools than expected.

Causes of Green Poop

Despite what you may have heard (see the next section), green and brown are in the normal range of poop colors. They are not a reason to worry if baby seems well and is gaining weight.What can cause green poop?

  • A tummy bug. When your baby is ill, this can cause a change in poop color that may last for weeks. Keep breastfeeding! It’s the best way to help baby recover.
  • Oversupply. If you produce so much milk that your baby receives mostly high-sugar/low-fat milk, it may overwhelm baby’s gut and cause watery or green stools. (Click HERE more details and tips for adjusting milk production downward when needed.)
  • Ineffective breastfeeding. If on the fifth day, baby’s stools turn green instead of yellow, as in the case of oversupply, this may be a sign that baby can't drain the breast well enough to get past the low-fat/high sugar foremilk. In this case, though, a health or anatomy issue (like tongue tie) may be the cause. Unlike oversupply, baby’s weight gain may or may not be below average. Now is the time to see an IBCLC.
  • Sensitivity to a food or drug. When a sensitive or allergic baby reacts to a drug you’re taking, something in your diet, or something baby consumes directly, this may turn her poops green or mucusy. You may even see bits of blood in it, which is not considered serious. (Click HERE for info you can share with your health-care provider.)

Food sensitivity occurs most often in families with a history of allergy. When this is the cause, expect to also see other physical symptoms, such as skin problems (eczema, rashes, dry patches), tummy upsets (vomiting, diarrhea), or breathing issues (congestion, runny nose, wheezing, coughing).

What about Foremilk-Hindmilk Imbalance?

Many new parents read online that “foremilk-hindmilk imbalance” is the most likely cause of green poop. This term was coined in a 1988 journal article that reported the experiences of a few mothers who breastfed by the clock, switching breasts after 10 minutes even though baby hadn’t finished on that side. Its results have never been duplicated, and newer findings call into question this article’s conclusions. Many now wonder if foremilk-hindmilk imbalance even exists. To learn more, click HERE.

Setting Worries to Rest

In most cases, green poop is nothing to be concerned about. But it helps to know what’s normal, possible causes, and some of the common myths about this experience. If your breastfeeding baby is healthy and thriving, that’s the most important thing you need to know.

Worries About Foremilk and Hindmilk

A little knowledge can be a dangerous thing.  This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding.  The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and premature weaning. 

The 2003 edition of The Breastfeeding Answer Book defines these terms this way:

“The milk the baby receives when he begins breastfeeding is called the ‘foremilk,’ which is high in volume but low in fat.  As the feeding progresses, the fat content of the milk rises steadily as the volume decreases. The milk near the end of the feeding is low in volume but high in fat and is called the ‘hindmilk’” (Mohrbacher and Stock, p. 34).

It goes on to explain that by simply letting the baby “finish the first breast first”—switching breasts when the baby comes off the breast on his own rather than after a set time—the mother can be sure her baby receives the “proper balance of fluid and fat.”  Since this book was published, research has expanded our understanding of foremilk and hindmilk and answered many of the common questions mothers have about these concepts.

What worries?  Confusion about foremilk and hindmilk has led to all sorts of uncertainty. Are there two distinctly different types of milk?  Does the baby need to breastfeed for a specific number of minutes before foremilk suddenly turns to hindmilk?  Can a baby miss out on hindmilk altogether if he breastfeeds for too short a time?  If this happens often, will his weight gain suffer?  Sometimes healthcare providers get into the act, telling breastfeeding mothers they should watch the clock to make sure their baby breastfeeds “long enough to get the hindmilk,” with the number of minutes recommended varying by adviserWhat do we really need to know about foremilk and hindmilk? And is there any reason to worry?

The truth about foremilk and hindmilk.  Research has found this concept is not as simple as it sounds.  It is true that fat sticks to the milk ducts in the breast and the percentage of fat in the milk increases during a breastfeeding as the fat is released from the ducts during milk ejections.  But the reality of this seemingly simple dynamic is not always as it seems. 

  • There are not “two kinds of milk.”Despite this common belief, there is no “magic moment” when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully. 
  • The total milk consumed daily—not the hindmilk—determines baby’s weight gain.  Whether babies breastfeed often for shorter periods or go for hours between feedings and feed longer, the total daily fat consumption does not actually vary.
  • Foremilk is not always low-fat.  The reason for this is that at the fat content of the foremilk varies greatly, depending on the daily breastfeeding pattern.  If the baby breastfeeds again soon after the last feeding, the foremilk at that feeding may be higher in fat than the hindmilk consumed at other feedings. 

How does this work?  Interestingly, foremilk and hindmilk are concepts that really only make sense when longer intervals such as two to three hours or more occur between feedings.  The longer the time gap between feedings and the fuller a mother’s breasts become, the greater the difference in fat content between her foremilk and hindmilk.  These differences in fat content can vary greatly over the course of a day even among individual mothers.  For example, when a long breastfeeding gap occurs during the night, at the next feeding a mother’s foremilk will be lower in fat than during the evening when her baby breastfeeds more often. 

What really matters.  Research indicates that there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer.  As long as a baby is breastfeeding effectively and the mother does not cut feedings short, baby will receive about the same amount of milk fat over the course of a day no matter what the breastfeeding pattern (Kent, 2007).  This is because the baby who breastfeeds more often consumes foremilk higher in fat than the baby who breastfeeds less often.  So in the end it all evens out.

What’s most important to a baby’s weight gain and growth is the total volume of milk consumed every 24 hours.  On average, babies consume about 750 mL of milk per day (Kent et al., 2006).  As far as growth is concerned, it doesn’t matter if a baby takes 30 mL every hour or 95 mL every three hours, as long as he receives enough milk overall (Mohrbacher, 2010).  In fact, researchers have found that whether babies practice the frequent feedings of traditional cultures or the longer intervals common in the West, they take about the same amount of milk each day (Hartmann, 2007) and get about the same amount of milk fat.  Let’s simplify breastfeeding for the mothers we help and once and for all cross foremilk and hindmilk off our “worry lists.”

References

Hartmann, P.E.  (2007). Mammary gland: Past, present, and future. in eds. Hale, T.W. & Hartmann, P.E. Hale & Hartmann's Textbook of Human Lactation. Amarillo, TX: Hale Publishing, pp. 3-16.

Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

Mohrbacher, N.  Breastfeeding Answers Made Simple: A Guide for Helping Mothers.  Amarillo, TX: Hale Publishing, 2010.

Mohrbacher, N. and Stock, J.  The Breastfeeding Answer Book, 3rd edition.  Schaumburg, IL: La Leche League International, 2003.