White Poop in Babies and Children: Causes and Treatment

White poop or acholia is a sign of illness. Know why it happens and what you should do when you observe it.

Observing changes in the color of poop is very common in childhood. However, not all of these variations are normal and it’s important to know what signs you should talk to your pediatrician about. White poop is a red flag and we’re going to tell you why it happens. Keep reading!

What does white poop represent?

This type of poop is called acholia and represents the lack of its usual pigment, called stercobilinogen. The liver usually produces this substance, which comes from bile.

Why does acholia occur?

When, for some reason, the bile can’t reach the digestive tract, the stool becomes paler or totally white. There are many conditions capable of producing this situation and they’re classified according to the place where they occur:

• Intrahepatic causes: These are diseases that occur within the liver and that mainly affect the production of bile. Among them, hepatitis stands out.
• Extrahepatic causes: These include those conditions that cause an obstruction in the bile ducts at some point in the path that joins the liver with the intestine. For example, biliary atresia.

When flow in the bile duct stops, bile is trapped inside liver cells (hepatocytes) and this causes damage to the function and structure of the liver. This condition is known as cholestasis.

Diseases linked to white poop

• Perinatal infections
• Biliary atresia
• Malformations of the bile duct, such as common bile duct cysts
• Hepatitis (viral, toxic, or drug-related)
• Genetic diseases, such as Alagille syndrome
• Inborn errors of metabolism, such as cystic fibrosis
• Hereditary defects, such as familial progressive intrahepatic cholestasis (CIFP)
• Bile duct tumors
• Primary sclerosing cholangitis
• Autoimmune disorders

All of these health conditions can cause cholestasis and, consequently, white poop. It’s important to know that not all of them appear in the same stages of life and that, in order to arrive at the final diagnosis, consultation with a specialist in pediatric hepatologist is necessary.

What other symptoms accompany white poop?

As we mentioned earlier, when bile doesn’t reach the intestine, it’s retained within the liver. This causes various types of damage that cause noticeable signs and symptoms in the child.

Below, we’ll detail those that most frequently accompany white poop:

1. Enlargement of the liver (hepatomegaly): The accumulation of bile causes the organ to expand and, in turn, harden. It can be felt from outside the abdomen and, in severe cases, it can be seen with the naked eye.
2. A yellowish tint of the skin and mucous membranes (jaundice): When bile can’t escape through the bile duct, it’s released into the blood and travels throughout the body. Its pigments (bilirubin) are deposited on the skin and mucous membranes and cause them a very characteristic yellowish coloration.
3. Darkening of the urine (choluria): As with jaundice, the bile that travels through the blood leaves the body through the urine. This causes the fluid to take on a darker color than usual, similar to that of cola drinks.
4. Abdominal pain or heaviness: This occurs as a consequence of the enlargement of the liver and the accumulation of fluids in the abdomen.
5. Nausea and vomiting.
6. Itchy skin – Bilirubin deposits make the skin itchy.
7. Spleen enlargement: Due to congestion of the abdominal blood vessels.
8. Malnutrition: This occurs as a consequence of the difficulties in the absorption of nutrients that occur when bile doesn’t reach the intestine.

When should I consult the pediatrician?

Although infant and toddler poop tends to vary over time, it’s important to know which changes you can expect and which are a red flag.

What Treatments Are There For White Poop?

This will depend on the underlying cause. As we’ve seen, there are many diseases that can cause it. Early diagnosis and medical knowledge about the most frequent causes at each age play a fundamental role here.

Whenever there are reversible causes, the goal will be to correct them and allow the liver to return to its normal state of health.

For example, if the child is suffering from hepatitis due to drugs (such as paracetamol) or secondary to intoxication (such as alcohol), the correct thing to do is to stop taking these substances and offer the appropriate measures to accelerate recovery. Among them, “antidote” medications and good nutritional and hydration support.

However, when the causes of acholia aren’t reversible, treatment will seek to provide the necessary support to ensure survival until liver and bile duct transplantation takes place.

This care of the child will be carried forward in many ways:

• Palliative surgeries, to re-establish bile flow through alternative circuits
• Medicines that stimulate bile flow, such as ursodeoxycholic acid
• Appropriate nutritional treatment, with strict growth control
• Infection control
• Periodic multidisciplinary monitoring

About white poop in babies and children

Changes in poop motivate countless visits to the pediatrician and often generate a lot of concern in parents.

On the one hand, these changes can be completely normal and to be expected during the digestive system’s maturation process. On the other hand, they can warn us of the existence of certain health conditions that require more attention. Just like when white poop appears.

Finally, it’s important to ask your pediatrician what to expect at each moment of life and to know those warning signs that shouldn’t be ignored.