I bet you didn’t think this blog was going to go below the belt! I’m here, in your baby’s diaper, to talk a little about red tushies and green poop.
I know a bit about this because when my first December baby was born, her red tushie and green poop fit in with the Christmas décor, but didn’t seem … right. She was exclusively breastfed, and at her two-week well-baby check, our pediatrician told me my breasts were so big, I was making too much milk, and I was overfeeding her. He suggested I put my baby girl on a strict feeding schedule. I laughed. He had no idea how much she loved to nurse, and how impossible putting her on a schedule would actually be!
He told me her diaper rash was “normal,” even though we were changing her diaper frequently (sometimes as often as every two hours, an definitely immediately after she pooped), not using harsh detergents on her cloth diapers, she wasn’t allergic or sensitive to the absorbent materials in disposable diapers, and the diapers fit her well — no friction or other reason for discomfort. We definitely didn’t have yeast. A yeast rash looks … angry. It is red, raised, and covers most of the immediate area of genitalia, as well as “satellite” lesions that extend to the baby’s cheeks. A yeast rash does not improve with diaper rash creams, and requires an antifungal agent to resolve. Talk to your doctor about probiotic supplements for your baby, especially after antibiotics or if you have/had thrush. If your baby has a yeast diaper rash, it is likely that he has systemic yeast (candida) and you need to check for yeast in his mouth, as well as on/in your breast. (Find more about thrush at this Thrush FAQ.)
Our little girl’s rash was a bright red ring around her anus. Far from being normal, that red ring was a red flag! We began to notice that, after a particularly fussy or gassy period of time (pretty much every evening), that red ring became more pronounced and caused her pain. Diaper rash cream may have been protective, but it stung her and made her cry (and broke our hearts).
My instincts didn’t agree with my pediatrician’s assessment that my little girl’s rash was normal and her green poop should be controlled by a feeding schedule. I knew that breastfeeding was her comfort and something wasn’t right. It was only 2002, but thankfully, a Google search of “bloody infant stools” came up hot for exactly what I needed: published research about protein sensitivity in breastfed babies. I was surprised; I had no idea that half-gallon of milk I was consuming every two days (to wash down my mother-in-law’s incredible fruitcake, which provided my total subsistence during that bleary-eyed postpartum time) could pass into my milk and hurt my baby as if I was feeding her cow’s milk directly. Under normal circumstances, this doesn’t happen, but many mothers (apparently, I was one of them) have stressed or damaged digestive tracts. Rather than breaking down and absorbing the nutrients we consume, our bodies instead allow these “invaders” to pass through our guts, to our bloodstream, and into our milk. The most common food irritants are dairy (from any animal but cow’s milk seems to cause more problems than others), soy, eggs, and wheat.
While there is a wide range of normal in color for a baby’s bowel movements, a persistent mossy color can indicate something is up. The green may also be tinged with blood (usually dark in color). Consult your doctor immediately if you see blood in your baby’s diaper. While bright-red blood typically indicates a fissure or other lesion near the opening to your baby’s anus, darker blood comes from further up and can indicate allergic/sensitive irritation or something more complex. With or without the presence of blood, you may also notice that your baby’s bowel movements are frothy, foamy, or mucousy. While this is fairly common, it is not normal and should be investigated. This article from the Academy of Breastfeeding Medicine addresses allergic proctocolitis in the exclusively breastfed baby – feel free to print it out and bring it to your pediatrician for reference.
If your baby is older and eating solids, common allergens may be the culprit of colorful diapers. Check out the Food Allergy and Anaphylaxis Network for more information.
Many reliable sources consider food sensitivities and red/green diapers related, and I have extensive elimination-dieting and diaper-watching experience as a mother of three breastfed diaper-fillers that confirms this. In my practice, I have seen too many mothers and babies to count with this obstacle, and in nearly every case I’ve worked with, identifying and eliminating the offending food(s) resulted in a complete or near-complete resolution of the red ring AND the green poops, and reduced fussiness in the baby.
Another cause of green poop is oversupply/overproduction of milk, which can be related to an endocrine/hormone issue like postpartum thyroiditis. If you have oversupply, it might be worth it to have your hormones checked, since it’s fairly common for things to get a little wonky in the postpartum period. In my experience, oversupply and a food sensitivity tend to happen together, so if you resolve an issue of oversupply and your baby’s diapers are still more colorful than seems normal, consider an elimination diet.
If the prospect of an elimination diet seems overwhelming for you, see this post and keep a few things in mind: first, it is temporary. Most likely, you will be able to slowly re-introduce the problem foods into your diet after a few months. Second, if you choose the alternative of weaning your baby to artificial baby milk, remember that those are made from the very allergens you are trying to avoid! There are special preparations for very sensitive babies, but these are very, very expensive and rather than a few months of adjustment, you’re facing a financial investment through the end of your baby’s first year. Third, many of us have been through this, and there are lots of resources and great products out there if you need to cut dairy, soy, gluten, eggs, or any other food from your diet. You will survive and you might even find some new, healthier favorite options. You may be very pleasantly surprised to recognize that you feel better than ever after eliminating one or more of these foods, as well.