The NUK Book

Baby poo/poop/stool is not the most exciting topic for new parents, but important none the less.

Every mother on Earth has at some time or another noted the color, consistency, frequency, or other characteristic of her child's stools.  Poo tells us how our children are feeling, if they are eating enough fiber or too much fruit. It indicates illness and frequently explains a child's temperament on a particular day; so if you've ever wondered if your running mental inventory of your child's bowels is normal, rest assured that it certainly is.

But there are times when a particularly odd diaper change confounds us and we're too embarrassed to ask what's going on. Don't be afraid to ask your mother, pediatrician, or a good friend because chances are that they've seen it all before and will help guide you toward the appropriate response.

Baby's First Bowels

New parents are sometimes surprised when their precious bundle produces a thick, gooey, black or green poo in the first few days of life. Pediatrician Dr. Kris Rehm, MD, of Old Harding Pediatric Group in Nashville, Tennessee, says, "They are made up of meconium, the substance in an infant's intestines while he is in utero. It must be passed before normal digestion and the first regular stool can be passed."

The term "regular stool" is a bit of an oxymoron since baby poo covers a wide range of colors and frequencies. Most breastfed babies produce a runny yellow-orange stool, often containing what appear to be tiny seeds, while bottle-fed infants have firmer, somewhat darker BMs.

Young babies can make up to ten dirty diapers a day, while others have as few as two or three. Dr. Rehm says, "By two months of age, it's not uncommon for a breastfed baby to go a few days betweens stools—some [go] only once a week. This is because breast milk leaves very little solid waste behind."  However if a formula, bottle-fed baby goes less than once a day, it may indicate constipation.

Starting Solids

When you recover from the shock of the consistency and frequency of your newborn's movements, you'll be floored all over again when your darling begins eating her first foods—strained carrots, creamed peas, and pureed blueberries—thus giving you your first experience with pumpkin orange, army green, or neon blue poo-poo. And just when you think you've seen it all, your older toddler will produce a violent purple poop after digesting grape Jello, grape Kool-Aid, or anything else injected with large amounts of food coloring.

Solid food means solid waste and most likely firmer, less frequent bowel movements. Since little ones aren't the most adept chewers, it's common to see bits of food in a dirty diaper—even entire beans or chunks of fruit. Other household items like pennies, diamond earrings, and Barbie shoes have been known to make their way into dirty diapers too!

Although trimming your little one's nails can be a bit unnerving, especially at first, keeping nails short is important to your baby's safety.

Because they lack muscle control, infants can easily scratch and cut their own delicate skin while happily waving their hands and feet. It's also important to keep babies' nails trimmed once they start interacting and playing with other kids who could be scratched, especially in childcare settings.

Some parents find it easier to accomplish the nail-trimming task with a partner: one person holding the baby to keep the little one from squirming and the other trimming the nails. First, find a good position that allows you easy access to your baby's hands. This may mean placing your baby in your lap, sitting with him or her in a rocker, or even waiting until your baby's asleep. Make sure you are in an area with good lighting so that you can see what you're doing. Hold your baby's palm and finger steady with one hand and cut with the other.

You should cut your baby's nails with baby nail scissors, which have rounded tips for safety, or baby clippers. Many baby nail-care kits also come with nail files or emery boards, but if you cut your baby's nails short enough and make sure to keep the nail edges rounded instead of jagged, it isn't necessary to use these. However, if you're hesitant to try baby nail scissors or clippers and your baby will sit long enough to cooperate, you can use an emery board to file the nails down without the risk of giving your little one any nicks.

If you accidentally draw blood (a common occurrence with fussy, fidgeting babies), don't worry. Using a sterile gauze pad, gently apply pressure to stop the bleeding. But don't put a bandage around the tiny cut — babies will inevitably put their fingers in their mouths and can dislodge the bandage and choke on it.

Because babies' nails tend to grow quickly from infancy to toddlerhood, they may need to be trimmed as often as once or twice a week. Some newborns need their nails to be trimmed even more often than that during the first few weeks of life.

Although many parents use soothers to soothe their babies, some parents absolutely hate the idea of using them. Others are sure they won't use one before their baby is born but change their minds when faced with a crying baby.  

If you decide to use a soother:

• use an orthodontic pacifier
• keep it as clean as possible – sterilize it as you would any other bottle-feeding nipple
• renew your baby's soother often – as with nipples, check regularly for cracks, splits and holes, which can trap germs, and replace with a new soother immediately
• never dip the pacifier in sweet foods such as honey or orange juice to stop your baby crying (BDHF 2005) - this can lead to rapid tooth decay
• try limiting soother use to key times, such as, during spells of colic or just for settling. Prolonged use of pacifiers has been linked to middle ear infections and other problems
• you could wait for your baby to need a soother rather than automatically giving it to them
• try to "wean" your child off their soother before their first birthday (it is much easier to do it then, than at two to three years old) and definitely before their permanent teeth come through (usually at the age of six)
• don't let using a pacifier become a habit

Getting rid of the soother:  If your child is using their soother all the time or not giving it up as soon as you would like, try these ideas:

• gradually decrease the times when you let your child use their pacifier
• restrict soother use to key times during the day, such as bedtime or when your child is ill.
• Be firm.
• reward your child with fun activities, stickers or star charts - don't give them sweets instead of their soother
• point out older girls and boys, who don't use pacifiers, to your child - pre-schoolers love being more grown-up
• encourage your child to give all their soothers away to a person who is important to them, such as a grandparent or a new baby.

Remember your child will grow out of their reliance on their soother.

The potential problem

If your breasts have been surgically enlarged with silicone or saline implants, your nipples may be more or less sensitive than normal. Once you've delivered a baby and your milk has come in, you may have exaggerated breast engorgement with pain, fever, and chills that are more intense than usual.

Note: If your breasts were augmented because of underdeveloped (hypoplastic) breasts, you may have trouble producing enough milk. Use a pump after each nursing session to stimulate production.

Can I breastfeed?

It's likely, but it depends on the kind of surgery you had. Incisions made under the fold of the breast or through the armpit shouldn't cause any trouble. The most popular method, making a "smile" incision around the areola, puts you at greater risk for problems.

If the nerves around the areola were not cut or damaged during surgery, you may be able to nurse fully or partially. Nerves are vital to breastfeeding because they trigger the brain to release prolactin and oxytocin, two hormones that affect milk production.

Your chances of breastfeeding also improve if your milk duct system is intact. There's no evidence that silicone from silicone implants leaks into breast milk, but even if it did, it probably wouldn't harm your baby. Silicone is very similar to a substance used to treat babies' stomach gas.

Solution

You won't know the full extent of nerve damage — if any — until you try to nurse.

Let your baby's doctor know about your surgery. She'll need to keep a close eye on your baby's weight gain to make sure he's getting enough to eat.

If you're able to produce only a portion of the breast milk your baby needs, you'll need to supplement with formula.

If you're thinking about getting breast implants but want to nurse your baby, postpone surgery until after you've given birth and breastfed your last child.

Have you had implants and tried to breastfeed? Please share your experience with us.

by Mizin Kawasaki, M.D.

Women have been warned for decades that they will spoil their children if they respond too readily to their children's needs: mothers are supposed to approach babies and children with restraint and keep them at a distance. Thus, child-rearing experts admonish parents that babies should not fall asleep at the breast. These experts decry the possibility that a baby may become too dependent upon the breast and his mother.

Standard child-rearing advice suggests instead that a young baby should learn how to comfort himself with an inanimate object such as a blanket, a safe baby toy, a pacifier, or even a mother's tee shirt. Encouraging a baby to become attached to an object in early childhood may result, however, in a lifelong fixation on a specific object. Steven Barrie-Anthony reports that this type of attachment may be exhibited by adults who treasure certain objects, like a childhood pillow.1

Therapists are inclined to think that an attachment to things is healthier than an addiction to vices. Indeed, a man who clings to the same childhood pillow for decades may be perfectly healthy. At the same time, one has to wonder why a person develops such a keenly obsessive devotion to an object in the first place. Evidently, therapists are disinclined to address the root cause of obsessive attachment to objects, which is undoubtedly the experience of maternal detachment during childhood.

Over the past century, child-rearing experts have been advising mothers to separate themselves from their young babies and children, but they have been doing this without understanding the consequences of offering such advice. A friend relayed to me the edicts of the pediatrician who told her how to rear her children in the 1960s. She was not to spoil her children by comforting them with her love and warm embrace: instead, she was to keep her distance and control her silly maternal emotions. She followed his advice, however unwillingly, and she has been left to wonder how her beloved and kind children matured into troubled adults. Children are not spoiled by receiving too much love.

The anthropologist Ashley Montagu wrote often that children are not spoiled by receiving too much love but by not receiving enough love. This is an important perspective that defies the common perception of what spoils children. Children may become spoiled as a result of experiencing insufficient love. They crave attention and affection because they did not receive enough love in early childhood.

Young children need warm and loving human interaction, and they can receive it when they are breastfed on demand. Breastfeeding on demand bestows upon young children the security of knowing that they are cared for and loved. Current parenting practices today, however, include the withholding of maternal availability and the denial of breastfeeding's importance.

As increasing numbers of children experience greater deprivation, more individuals will be searching to find the love and security that they should have experienced during early childhood. Some individuals may be fortunate enough to share their concerns about life with caring family members and friends. Others may seek professional therapy for themselves or their children in order to learn how to rectify whatever troubles them about their existence, including perhaps the inability to love and to be loved.

The British psychiatrist Anthony Storr offers the following intriguing perspective on the analytical encounter: "In no other situation in life can anyone count on a devoted listener who is prepared to give so much time and skilled attention to the problems of a single individual without asking for any reciprocal return, other than professional remuneration. The patient may never have encountered anyone in his life who has paid him such attention or even been prepared to listen to his problems."2

Storr's assessment of the unique role of a skilled analyst seems to deny the existence of a healthy and loving relationship between mother and child. His outlook, however, makes sense since the value of mothering has been profoundly demeaned over the past century. In a world that esteems mothering, nevertheless, Storr's description of a skilled analyst would fit to a tee all loving and attentive mothers.

The majority of mothers are devoted, reliable, attentive, interested, and available; they also do not expect remuneration from their children. In addition, breastfeeding mothers are physically more available for their young children: they offer nurturing at the breast and are often highly attuned to their nurslings' needs. Without a doubt, loving and attentive breastfeeding mothers provide their offspring with the kind of attention that not even the most skilled analyst could possibly offer.

For those who appreciate the importance of breastfeeding and mothering, Storr's comment may be revised so that the first sentence would begin as follows: "In no other situation in life, other than the breastfeeding mother-child dyad, can anyone count on a devoted listener ..." The receipt of healthy maternal attention in the form of availability and breastfeeding early in life would probably diminish the need for many people to seek therapy and analysis later in life. At the same time, it is also much easier, less expensive, and more enjoyable to learn the meaning of love at the breast than it is to learn the same lesson on a therapist's couch.

Some may argue that this analogy is faulty since little verbal communication occurs between the breastfeeding mother and her baby. The anthropologist Walter Goldschmidt contends, though, that mother and infant do indeed have dialogues. He mentions this dialogue in the context of attachment, which he describes as the infant's search for the security of knowing that his need for care, love, food, and warmth will be met.

In the search for such security, the infant will seek support from his environment and will focus specifically on his mother. Goldschmidt elaborates further on infant behavior: "By the twelfth week it is responding to this mother-figure differently than it responds to others. The essential content of those dialogues are the request for the nurturant love and the assurance that it will be given. All those infant tricks to induce parental response and love are in the service of making a secure and satisfying attachment."3 Whether or not the baby succeeds in attaching to his mother depends upon the baby's temperament, as well as the mother's. Goldschmidt observes astutely that women vary in their commitment to and talent for motherhood.

Women who undertake the task of motherhood often make tremendous efforts to understand their babies. The babies who receive such attentive care early in life will indubitably learn not only how to grapple with their own emotions and needs but also to articulate their concerns and problems to others. If children can communicate well and someone cares to listen, especially the mother, then it is unlikely that the children will become spoiled.

Many children are now growing up, however, without the consistent presence and availability of a maternal figure. These children may have difficulty articulating their angst. Frustrated and miserable, these children may exhibit the spoiled behavior that so repels many parents. The development of such behavior could be prevented if more children were given the opportunity to receive the benefits and intimacy of loving and devoted maternal care.

1 Los Angeles Times, 1-20-05.

2 Storr, Anthony. Solitude. New York: Random House, 1988.

3 Goldschmidt, Walter. The Bridge to Humanity: How Affect Hunger Trumps the Selfish Gene. New York: Oxford University Press, 2006. Excerpted with permission of the author from Mothering with Breastfeeding and Maternal Care.