Urinating and bowel movements

New parents often wonder what's normal when it comes to their baby's urination and bowel movements. By the time a baby is three or four days old, he or she should have at least six wet diapers a day. As your baby gets older, he or she may have wet diapers with every feeding. However, if the baby is ill or feverish or if the weather is very hot, the usual output of urine may drop by half and still be normal.

If urine output decreases when a baby is sick, especially if the baby is vomiting or feeding poorly, it could indicate dehydration. In older children, the presence of tears would suggest adequate hydration, but in young infants, tears don't serve as a reliable guide. So if you're worried about dehydration in the baby, have the baby examined by his or her health care provider.

In a healthy infant, urine is light to dark yellow in color. Sometimes, highly concentrated urine dries on the diaper to a pinkish color, which may be mistaken for blood. Actual blood in the urine or a bloody spot on the diaper is cause for concern, however.

As for stools, the range of normal is quite broad and varies from one baby to another. Babies may have a bowel movement as frequently as after every feeding, as infrequently as once a week, or in no consistent pattern. By 3 to 6 weeks of age, some breast-fed babies may have only one bowel movement a week because breast milk leaves little solid waste to be eliminated from the digestive system. If a baby is being fed formula, he or she will likely have at least one bowel movement a day.

If you're breast-feeding, your baby's stools will resemble light mustard with seed-like particles. They'll be soft and even slightly runny. The stools of a formula-fed infant are usually tan or yellow and firmer than those of a breast-fed baby, but no firmer than peanut butter. Occasional variations in color and consistency are normal. Different colors may indicate how fast the stools moved through the digestive tract or what the baby ate. The stool may be green, yellow, orange or brown.

Mild diarrhea is common in newborns. The stools may be watery, frequent and mixed with mucus. Constipation is not usually a problem for infants. Babies may strain, grunt and turn red during a bowel movement, but this doesn't mean they're constipated. A baby is constipated when bowel movements are infrequent, hard and perhaps even ball-shaped.

Check with your baby's health care provider about urination and stools if:

• You notice any signs of distress when your infant is urinating

• Your baby is wetting fewer than four diapers a day

• The baby's urine is unusually dark or strong smelling

• You see blood in the urine or a bloody spot on the diaper

• Your baby seems to have ongoing difficulty with bowel movements

• Your baby has hard or only ball-shaped stools

• Your baby is formula-fed and has fewer than one bowel movement a day

• You notice a drastic change in the baby's stool patterns

• You see blood, mucus or water are in the stool

• Diarrhea is severe or persistent and the diaper area looks red and sore Your baby's reflexes

Newborns are just learning to enjoy the freedom of movement outside the cramped quarters of the uterus. In their first few days, they may seem a bit reluctant to experiment with their new mobility, preferring to be wrapped and held snugly. Over time, however, they will begin to explore a range of movements.

Babies are born with a number of reflexes (automatic, involuntary movements). Some of these movements — such as turning the head to avoid suffocating — seem to be protective responses. Some may be preparing babies for voluntary movements. Most reflexes diminish after a few weeks or months and then disappear completely as they're replaced with new, learned skills.

In the meantime, watch for some of these reflexes:

• Rooting. This reflex prompts babies to turn in the direction of the food source, whether it's a breast or bottle. If you gently stroke a newborn's cheek, he or she will turn in that direction, with his or her mouth open, ready to suck.

• Sucking. When a breast, bottle nipple or pacifier is placed in a baby's mouth, he or she will automatically suck. This reflex not only helps the newborn eat but also can calm him or her.

• Hand to mouth. Babies will try to find their mouths with their hands. This reflex may be why many babies bring their hands to the breast or bottle.

• Stepping. When you hold infants under their arms and let the soles of their feet touch the ground, they may place one foot in front of the other as if they're walking. This stepping reflex is most apparent after about the fourth day and disappears at about two months. Most babies won't actually learn to walk until almost a year later.

• Startle (Moro reflex). When startled by a noise or sudden movement, babies may throw both arms outward and cry. You may notice this if you put your baby in the bassinet or crib too quickly.

• Fencing (tonic neck reflex). If you turn your baby's head to one side while he or she is lying on his or her back, you may see this classic baby pose, in which one arm is crooked and raised behind the head and the other is straightened and extended away from the body in the direction the head is turned. Sometimes the baby's fist grabs a clump of hair and won't let go.

• Smiling. In the first few weeks of life, most of a newborn's smiles are involuntary, but it won't be long before the baby begins smiling in response to a person or situation.

If you're observant, you may notice some of these reflexes, but don't worry if you don't notice them. Your baby's health care provider may check for them during physical examinations.

If you want, you can encourage your baby's movement by gently cycling the arms and legs as he or she lies on his or her back. Or you might let the baby kick at your hands or a squeaky toy.

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