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Stools – Unusual Color

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Definition

A stool color other than brown or tan

Causes

  • Almost always due to food coloring or food additives
  • Stool color relates more to what is eaten than to any disease
  • In children with diarrhea, the gastrointestinal (GI) passage time is very rapid. Stools often come out the same color as the Kool-Aid or Jell-O that went in.

Clues to unusual stool colors

Red 

  • Blood from lower GI tract bleeding
  • Foods: red Jell-O, red or grape Kool-Aid, red cereals, tomato juice or soup, tomato skin, cranberries, beets, red licorice, Fire Cheetos
  • Medicines: red medicines (e.g., Amoxicillin), occasionally other medicines that turn red in the GI tract (e.g., Omnicef)

Black 

  • Blood from stomach bleeding (stomach acid turns blood to a dark, tar-like color)
  • Foods: licorice, Oreo cookies, grape juice
  • Medicines: iron, bismuth (e.g., Pepto-Bismol)
  • Other: cigarette ashes, charcoal
  • Bile: Dark green stools from bile may look black under poor lighting. Smearing a piece of stool on white paper and looking at it under a bright light often confirms that the color is actually dark green.

Green 

  • Foods: green Jell-O, grape-flavored Pedialyte (turns bright green), green fruit snacks, spinach or other leafy vegetables. Dark green stools (e.g., spinach) may look black under poor lighting.
  • Medicines: iron (e.g., in formula)
  • Bile: Most dark green stools are normal and due to bile. Bile-stained loose stools are seen with diarrhea illnesses and normal breastfed stools (especially during the first 2 months of life). While bile is more commonly seen with diarrhea, it can also cause green formed stools.

White or light gray 

  • Foods: milk-only diet
  • Medicines: aluminum hydroxide (antacids), barium sulfate from barium enema
  • Liver disease: Young infants with blocked bile ducts have stools that are light gray or pale yellow

See more appropriate topic (instead of this one) if

  • Looks like blood and child hasn't swallowed any red food, red medicine or Omnicef, see Stools, Blood In 
  • Yellow eyes and under 1 month of age, see Jaundiced Newborn 

When to Call Your Doctor

Call your doctor now (night or day) if

  • Your child looks or acts very sick

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • You think your child needs to be seen

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Stool is light gray or whitish and occurs 2 or more times
  • Abnormal color is unexplained and persists over 24 hours (EXCEPTION: green stools)
  • Suspected food is eliminated and abnormal color persists over 48 hours

Parent care at home if

  • Unusual stool color probably from food or medicine and you don't think your child needs to be seen
  • Green stools

Home Care Advice for Unusually Colored Stools

Reassurance

  • Unusual colors of the stool are almost always due to food coloring
  • The only colors that may relate to disease are red, black and white
  • All other colors are not due to a medical problem

Green stools

  • Green color of the stools is almost always normal and due to bile
  • While it is more commonly seen with diarrhea, sometimes it occurs with formed stools
  • It usually only lasts for a few days, but it can recur
  • If you think it's due to iron medication, be sure your child is not taking too much

Avoid

  • Eliminate the suspected food or drink from the diet. The unusual color should disappear.

Sample

  • For persistent unusual color, bring in a stool sample for testing. Keep it in the refrigerator until you leave.

Call your doctor if

  • Unexplained color persists over 24 hours
  • Suspected food is eliminated and the abnormal color persists over 48 hours
  • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. Benaroch R. Red-colored stool. Consult Pediatr. 2007;6:365.
  2. Borowitz SM, Hayden GF. In plain sight: the macroscopic stool examination. Contemp Pediatr. 1990;7:115-121.
  3. Chen S, Chang M, Du C, et. al. Screening for biliary atresia by infant stool color card in Taiwan. Pediatrics. 2006;117(4):1147-1154.
  4. Middleton J. Green-colored stool. Consult Pediatr. 2007;10:580.
  5. Nelson JS. Red stools and Omnicef. J Pediatr. 2000; 136: 853-854.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 8/1/2010
Last Revised: 10/1/2010 4:09:09 PM

Content Set: Pediatric HouseCalls Symptom Checker
Version Year: 2011

Copyright 1994-2011 Barton D. Schmitt, M.D.

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