Clinical Question

What are normal defecation patterns in healthy young children?

Bottom Line

Stool patterns in infants and young children vary by age, diet, and place of residence. The data from the study can be used to counsel parents about the wide range of normal defecation patterns. (Level of Evidence = 2a−)

Synopsis

The authors searched PubMed, EMBASE, and the Cochrane Library for English-language, cross-sectional, observational, and interventional studies that reported defecation patterns in healthy children up to four years of age. They included 75 studies with 16,393 children. The studies took place in well-child clinics, hospitals, daycare centers, and homes in 43 different countries across each of the six 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. Most of the studies (88%) used diaries to assess defecation frequency; only eight studies used validated tools to assess stool consistency. The median defecation frequency in infants (up to 14 weeks of age) ranged from 7.0 to 44.9 times per week, and the median in young children (15 weeks to four years of age) ranged from 6.2 to 17.9 times per week. Overall, 1.5% of 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. Four studies compared defecation patterns by sex and found no differences. Defecation frequency and stool consistency varied by diet, and breastfed infants defecated more frequently (23 times per week) and had softer stools. The authors reported marked variation in frequency by country.