What are normal defecation patterns in healthy young children?
It should come as no surprise that stool patterns in young infants and children vary by age, by diet, and by place of residence. The data in this study can be used to counsel parents about the wide range of normal patterns.
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.
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI