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Normal bowel movements in infants and young children

2.2024
Author Dr. Jürgen Hower, paediatrician from Mühlheim a.d. Ruhr (Germany)

What constitutes a normal defecation pattern in infants and young children? The authors of this study have collected available data on stool frequency and consistency in healthy children up to the age of 4 to establish reference values.

Study description:
Seventy-five relevant studies involving 16,393 children were included in the analysis, with differentiation between two age categories: young infants aged 0-14 weeks and young children aged 15 weeks to 4 years. 

Results:
In young infants, the mean defecation frequency was 21.8 per week (95% CI 3.9-35.2), compared to 10.9 (95% CI 5.7-16.7) in older infants and toddlers (P < 0.001). Young human milk-fed infants had the highest mean defecation frequency with 23.2 defecations per week (95% CI 8.8-38.1), followed by formula-fed infants with 13.7 defecations (95% CI 5.4-23.9). The documented frequency for mixed-fed infants was 20.7 defecations per week (95% CI 7.0-30.2). Hard stools were infrequently reported in infants (1.5%) compared with young children (10.5%). The data showed a decrease in frequency of soft/watery stools as the infant age increased (27.0% in infants compared to 6.2% in young children). Overall, infants fed with human milk had softer stools compared to formula-fed infants.

Conclusion: Compared to young children, young infants have softer and more frequent bowel movements. The findings of this meticulously conducted meta-analysis align with the experiences of midwives and paediatricians in practice. Despite the broad range of what can be considered normal, the different symptom assessment methods used in the different studies, and their potential limitations, the results of this meta-analysis provide numerical reference values for evaluating normal stool frequency and consistency. These standardised reference values can also be used to identify symptoms associated with irritable bowel syndrome, which may manifest as motility issues (changes in stool frequency and consistency) in early infancy and childhood, alongside symptoms such as colic, increased spitting up, constipation, and bloating. This is a carefully conducted, well-documented and useful study for all those involved in the care of infants and young children in their daily lives.

References:
Baaleman DF, Wegh CAM 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 Jun 16;261: 113559. doi: 10.1016/j.jpeds.2023.113559. Epub ahead of print. PMID: 37331467.
Weidler EM, Self MM, Czyzewski DI et al. Stooling Characteristics in Children With Irritable Bowel Syndrome. Clin Gastroenterol Hepatol. 2017 Jan;15(1):140-141. doi: 10.1016/j.cgh.2016.08.021. Epub 2016 Aug 25. PMID: 27567692; PMCID: PMC5161651.

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