Modified Bristol scale for children

The modified Bristol scale for children drops types 3 and 5 from the original seven, leaving five steps. When 14 paediatric gastroenterologists scored 32 stool photographs, the intraclass correlation was 0.85 between raters and 0.87 within raters.

This study validated that modified scale for parents, grandparents and day-care workers scoring children aged one to three, both toilet trained and not. On general stool photographs the intraclass correlation was 0.71 and 0.79, and on photographs of stools in a nappy it was 0.93 and 0.93. When the same person scored again a week later, kappa was 0.71 and 0.77.

The validated ages were one to three years, both toilet trained and not. A separate scale exists for newborns, and this app does not include it.

The original Bristol stool form scale was published in 1997, and the original paper measured how adult stool form relates to gut transit time. It was not built as a table that names diseases.

In a study that scored stool photographs inside nappies by machine, agreement with the researchers was 77.0 percent once consistency was grouped into four classes, and 60.3 percent when the original seven steps were kept.

This app is for a carer logging a child's nappies

This scale was validated for carers scoring children aged one to three. Younger babies have a different ruler, which this app does not carry. Adults logging their own use a different scale, in the adult stool diary. Adult stool diary

What this app does not do

It states no probability, makes no diagnosis, gives no risk score and names no disease. It sends no notifications. It records and counts, and that is all. If you are worried about your child, take this log to a paediatrician.

The American Academy of Pediatrics says mustardy yellow is the colour for most breastfed babies, that formula-fed babies pass yellow-tan with hints of green, and that all the shades of yellow, brown and even green that follow are perfectly acceptable; a changing palette once solids begin is not uncommon. It also says white stool is rare but should be brought to a doctor as soon as possible, that any amount of blood should be evaluated, and that black stool deserves attention because blood turns black on its way through the gut, while a newborn's first few black, tarry meconium stools are not what that alert is about.

The NHS says the first stool, meconium, is sticky and greenish-black and turns yellow or mustard after a few days, that pale stool should be raised with a health visitor or GP, and that a definite change of any kind, blood included, is a reason to talk to a doctor.

The Korea Disease Control and Prevention Agency's health information portal says that a baby of three months or younger who repeatedly passes pale lemon-coloured or grey stool needs to be seen in paediatrics. It names no disease.