Definition

• The stool color is strange or different
• Normal stool colors are any shade of brown, tan, yellow or green
• Colors that may be caused by a disease are red, black and white
• Dark green may look like black, but dark green is a normal color

Health Information

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 fluid that went in. Examples are Kool-Aid or Jell-O.
• 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 the lower GI tract bleeding is red
• Medicines. Red medicines (like Amoxicillin). Sometimes, other medicines that turn red in the GI tract (such as Omnicef)
• Foods. See list below.

Foods That Can Cause Red Stools:

• Red Jell-O, red or grape Kool-Aid
• Red candy, red licorice
• Red cereals
• Red frosting or food coloring
• Beets
• Cranberries or rhubarb
• Fire Cheetos
• Red peppers
• Tomato juice or soup, tomato skin

Black:

• Blood from stomach bleeding (stomach acid turns blood to a dark, tar-like color)
• Foods. Licorice, Oreo cookies, grape juice, blueberries
• Medicines. Iron, bismuth (Pepto-Bismol)
• Other. Cigarette ashes, charcoal
• Bile. Dark green stools from bile may look black under poor lighting. Smear a piece of stool on white paper. Look at it under a bright light. This often confirms that the color is really 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 breastfed infants. It can be normal with both.
• Green stools are more common with diarrhea. This is due to a fast transit time through the gut. However, formed stools can also be green.
• Dark green stools may look black under poor lighting. Eating spinach can cause dark green stools.
• Medicines. Iron (such as in formula)
• Foods. See list below.

Foods That Can Cause Green Stools:

• Green Jell-O
• Grape-flavored Pedialyte (turns bright green)
• Green fruit snacks
• Spinach or other leafy vegetables

White Or Light Gray:

• Foods. Milk-only diet
• Medicines. Aluminum hydroxide (antacids), barium sulfate from barium enema
• Liver disease. Babies with blocked bile ducts have stools that are light gray or pale yellow.

Care Advice

1. Overview:
   • Strange 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.
   • Normal stools are not always dark brown. Sometimes, they are light brown, tan or yellow.
   • Here is some care advice that should help.
2. Green Stools:
   • Green color of the stools is always normal. Most often, green stools are caused by bile.
   • Green stools are more common in formula-fed than breastfed infants. But, they can be normal with both.
   • Green stools are more common with diarrhea. This is due to a fast transit time through the gut. However, formed stools may also be green. This is normal and nothing to worry about.
   • If your child takes iron, be sure your child is not taking too much.
3. Avoid the Suspect:
   • Don’t eat the suspected food.
   • Don’t drink the suspected drink.
   • The strange stool color should go away within 48 hours.
4. Stool Sample:
   • If the strange stool color doesn’t go away, bring in a sample.
   • Keep it in the refrigerator until you leave.
5. What to Expect:
   • Remove the cause of the unusual color from the diet.
   • Then the stool should change back to normal color.
   • This should happen within 48 hours or 2 stools later.

Call Your Doctor If

• Strange color without a cause lasts more than 24 hours
• Suspected food is stopped and strange color lasts more than 48 hours
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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