Normal defecation patterns in young healthy children vary by age, diet, and place of residence

Reference

Baaleman DF, Wegh CAM, de Leeuw TJM, et al. What are normal defecation patterns in healthy children up to four years of age? A systematic review and meta-analysis. J Pediatr 2023;261:113559. 

Synopsis

These authors searched PubMed, EMBASE, and the Cochrane Library for English-language cross-sectional, observational, and interventional studies that reported defecation patterns in healthy children 0 to 4 years of age. They included 75 studies with 16,393 children. The studies took place in well-child clinics, hospitals, day care centers, and in homes in 43 different countries across each of the 6 regions defined by the World Health Organization. For the purposes of determining defecation patterns, the studies were generally at moderate to high risk of bias (lots of crappy studies). Most of the studies (88%) used diaries to assess defecation frequency; only 8 studies used validated tools to assess stool consistency. The median weekly defecation frequency in young infants (aged 0 to 16 weeks) ranged from 7.0 to 44.9, and the median in young children (aged 15 weeks to 4 years) ranged from 6.2 to 17.9. Overall, 1.5% of young infants had hard stools and 27.0% had soft stools. However, 10.5% of young children had hard stools and 6.2% had soft stools. Only 4 studies compared defecation patterns by sex, and these found no differences. Not surprisingly, defecation frequency and stool consistency varied by diet, with breastfed infants defecating more frequently (23/week) and having softer stools. Finally, the authors reported marked variation in frequency by country.