Skip to Content
Newborn Screening Ontario
Biliary Atresia Screening


Did you see pale poop in your child's diaper? Click here to contact Newborn Screening Ontario.

Avez-vous trouvé du caca pâle dans la couche de votre bébé ? Cliquez ici pour contacter Dépistage Néonatal Ontario.

What is biliary atresia?

Biliary atresia is a rare but serious disease of the liver and bile ducts. Bile is a digestive fluid that is made in the liver and empties into the intestine to help digest food. It enters the stool (poop) giving it a darker colour. In biliary atresia, bile cannot get from the liver to the stool, causing acholic (pale in colour) stool. This blockage causes buildup of bile in the liver, which can damage it. Without treatment, this can lead to liver failure and eventually death. Treatment for biliary atresia is a surgery to allow bile to move from the liver to the intestines.

How do you screen for biliary atresia?

Parents are the primary screeners with the help of an infant stool colour card (ISCC) to identify pale stools, which are often an early symptom of biliary atresia. Parents are given the ISCC by the birth hospital or midwifery practice group. Parents will compare their child’s stool colour to the images on the ISCC during regular diaper changes for the first month of life. If they detect pale stool, they can contact NSO using the contact methods shown on the card. When identification and treatment start early, babies with biliary atresia can have a better chance to grow and develop normally.

What does this mean for you?


  • Use the ISCC to screen your child’s poop for the first month of life.
  • If pale poop is present, contact NSO through the contact information on the card.
  • If follow up is required, NSO will refer your baby to a specialist for more testing, which usually involves blood work to start.

Hospitals/Birth Centres/Midwifery Practices:

  • In January 2023, NSO made ISCCs available to hospitals and midwifery clinics so they could be provided to all families with newborns in Ontario. ISCCs are available to order, free of charge, using the same distributor used for newborn screening dried bloodspot collection cards.
  • The ISCC itself is easy to follow. A brief explanation to parents should be all that is required for its use.
  • Resources and educational support are available on our website, including translated copies of the ISCC.

If you have any questions about biliary atresia screening, please don’t hesitate to contact us at:


Newborn Screening Ontario would like to acknowledge:

Dr. Rick Schreiber and Perinatal Services BC for sharing materials and guidance for Ontario’s provincial implementation of biliary atresia screening.

The Health Promotion Administration, Ministry of Health and Welfare, Taiwan, and Professor Mei-Hwei Chang, National Taiwan University, College of Medicine for authorizing the use of stool colour photos on the infant stool colour card.