Typical Stool Frequency in Breastfed Infants
by Anne Eglash MD, IBCLC, FABM
What are normal stooling patterns for infants?
Lactation specialists are often asked about expected stool frequency. The authors of this systematic review and meta-analysis sought to identify what typical stooling patterns are for children ages 0-4 years of age, to avoid overdiagnosis or underdiagnosis of GI disorders.
They included 75 of 3756 studies from 43 different countries that reported on stool frequency and/or consistency among healthy children ages 0-4 years of age. Their exclusion criteria included infants less than 37 weeks gestation, children on medication or with illness.
The authors categorized the children into 2 groups-9875 infants who were under 14 weeks of age, and 5747 children aged 14 weeks-4 years.
They found that average stool frequency among all infants 0-14 weeks of age ranged from 0.6-5 stools a day. But what about breastfed vs formula fed? See the question!
- Among infants under 14 weeks of age, those who breastfed stooled more often each day than those who were fed formula.
- Approximately 5% of all infants under 14 weeks of age had hard stools.
- Approximately 10% of formula fed infants under 14 weeks of age had hard stools.
- Approximately 10% of children aged 14 weeks-4 years of age had hard stools.
- Changes in infant formula with the addition of prebiotics such as oligosaccharides are associated with less frequent stooling.
- There was no difference in defecation patterns among children based on geographic location.
See the Answer
To summarize available data on defecation frequency and stool consistency of healthy children up to age 4 in order to estimate normal references values.
Systematic review including cross-sectional, observational, and interventional studies published in English, that reported on defecation frequency and/or stool consistency in healthy children 0-4 years old.
Seventy-ﬁve studies were included with 16 393 children and 40 033 measurements of defecation frequency and/or stool consistency. Based on visual inspection of defecation frequency data, a differentiation was made between two age categories: young infants (0-14 weeks old) and young children (15 weeks-4 years old). Young infants had a mean defecation frequency of 21.8 per week (95 % CI, 3.9-35.2) compared with 10.9 (CI,5.7-16.7) in young children (P < .001). Among young infants, human milk-fed (HMF) infants had the highest mean defecation frequency per week (23.2 [CI, 8.8-38.1]), followed by formula-fed (FF) infants (13.7 [CI 5.4-23.9]), and mixed-fed (MF) infants (20.7 [CI, 7.0-30.2]). Hard stools were infrequently reported in young infants (1.5%) compared with young children (10.5%), and a reduction in the frequency of soft/watery stools was observed with higher age (27.0% in young infants compared with 6.2% in young children). HMF young infants had softer stools compared with FF young infants.
Young infants (0-14 weeks old) have softer and more frequent stools compared with young children.
This scoop on infant poop provides some clinical guidance to share with families. The authors found that among infants under 14 weeks of age, the average number of daily stools was 3.3, 3.0, and 2.0 for breastfed, mixed-fed, and formula fed infants respectively.
Among infants under 14 weeks of age, approximately 0.3% of breastfed infants had hard stools (hard to imagine!) vs 1.8% among formula fed infants.
Among children aged 14 weeks-4 years 10.5% had hard stools, with increased risk of hard stools with increased age. The authors found a very slight increased frequency of stooling associated with formula with prebiotics such as oligosaccharides.