Stools - Unusual Color  
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Does this describe your child's symptoms?

Definition
  • A stool color other than brown, tan, yellow or green. Any shade of these is normal.

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. 
  • The only colors we worry about are red, black (not dark green) and white.

Clues to Unusual Stool Colors

Red:

  • "Bloody stools": 90% of red stools are NOT caused by blood
  • Blood from lower GI tract bleeding
  • Foods: red Jell-O, red or grape Kool-Aid, red cereals, red candy, red frosting, tomato juice or soup, tomato skin, cranberries, beets, red peppers, 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:

  • Green stools are always normal, but they can be mistaken for black stools.
  • Bile: Most dark green stools are caused by bile.
  • Green stools are more common in formula fed than breast fed infants, but normal with both.
  • Green stools are more common with diarrhea (rapid transit time), but also seen with formed stools.
  • Foods: green Jell-O, grape-flavored Pedialyte (turns bright green), green fruit snacks, spinach or other leafy vegetables. Dark green stools (e.g., after eating spinach) may look black under poor lighting.
  • Medicines: iron (e.g., in formula)

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.

If not, see these topics

First Aid:

 

When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
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 STOOLS - UNUSUAL COLOR

  1. 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.
  2. Green Stools:
    • Green color of the stools is always normal and usually caused by bile.
    • Green stools are more common in formula fed than breast fed infants, but normal with both.
    • Green stools are more common with diarrhea (rapid transit time), but also seen with formed stools.
    • If you think it's due to iron medication, be sure your child is not taking too much.
  3. Avoid: Eliminate the suspected food or drink from the diet. The unusual color should disappear.
  4. Sample: For persistent unusual color, bring in a stool sample for testing. Keep it in the refrigerator until you leave.
  5. 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.

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.

Last Reviewed: 9/15/2011

Last Revised: 8/1/2011

Content Set: Pediatric HouseCalls Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.