Appearance of Urate Crystals in a Baby's Diaper

If you've noted a reddish orange stain on your baby's diaper you may be feeling panicky thinking that its blood. While it's important to make sure it isn't blood, the "brick colored" stain of urate crystals is a very common cause of this frightening finding in newborns. What exactly are urate crystals and why do they occur? When could they be a reason for concern?

Urate Crystals in a  Diaper

It is not uncommon to find urate crystals, which have an orange or red, brick dust color, in a newborn baby's diaper, even cloth diapers. Unfortunately, this appearance can easily be mistaken for blood, leaving parents anxious and worried.

At the same time that these crystals cause anxiety, they are very common. In fact, one older study found urate crystals in the urine of 64 percent of newborn babies. Of course, they aren't visible on a diaper that often. Though they are a common cause of parental concern, and most commonly are a normal finding, urate crystals are not spoken of to the degree of many other findings in a newborn baby.

Urate crystals are especially common during a baby's first few days of life when she might still be losing weight while breastfeeding, though they may be found in babies who are gaining weight as well.

Causes 

Urate crystals are most common in infants who are breastfed.

During the first few days of life, breast milk contains colostrum, the wonderful fluid rich in immune factors and nutrition which make breastfeeding so beneficial in boosting a newborn's immune function.

Urate crystals are made up of uric acid, an end product of normal metabolism. Babies are born with a high blood uric acid level because of the amount they get across the placenta, and this is quickly excreted in the urine and stool.

If a baby is not making much urine at this time, these urate crystals will be especially concentrated and easy to see. This does not mean, however, that your baby is dehydrated. Instead, you can make sure your baby is properly drinking and urinating enough with a few simple questions.

Making Sure Your Baby Is Hydrated and Urinating

During your baby's first week, you should expect:

• At least two wet diapers and three bowel movements on day two that are likely still thick, tarry, and black (meconium)
• At least five to six wet diapers and three bowel movements on day three, with the bowel movements becoming looser and greenish to yellow in color (transitional stools)
• At least six wet diapers and three yellow, soft and watery bowel movements on day four

If your baby is having fewer wet diapers than expected, get your baby evaluated right away to check her weight and to see if she is feeding well.

If breastfeeding, a lactation consultant might be helpful to evaluate your milk supply and make sure your baby is latching on and sucking well.

If your baby is being fed baby formula, then you should make sure that you are preparing it correctly and that she is eating enough each day.

Bottom Line 

Most of the time, urate crystals in a baby's diaper in the first three days of life are normal in a breastfeeding infant.

During this time the crystals are harmless, a problem only because they can cause parents to fear there is a problem or undergo unnecessary tests looking for blood in the urine of their newborn.

Urate crystals which persist for longer than three days can be a sign of dehydration or an indication that a baby is not getting enough milk. Talking to your physician or lactation consultant can help you get to the bottom of this. Rarely, urate crystals, especially those present in a child beyond the first week of life, could signify a serious condition such as kidney dysfunction or other metabolic disorders which result in hyperuricemia.

Sources

Amin, R., Eid, L., Edvarsson, V., Fairbanks, L., and A. Moudgil. An Unusual Cause of Pink Diaper in An Infant. Pediatric Nephrology. 2016. 1(14):575.

Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.

Rhodes, G., Hammel, C., and L. Berman. Urinary Constituents of the Newborn Infant. Journal of Pediatrics. 1962. 60(1):18-23.