Clinical Questions List
Typical Stool Frequency in Breastfed Infants

CQ #288 - November 14, 2023

by Anne Eglash MD, IBCLC, FABM

#LactFact

Among infants less than 14 weeks of age, those who are formula fed stool less often than those who are breastfed.

What are Normal Defecation Patterns in Healthy Children up to Four Years of Age? A Systematic Review and Meta-Analysis
The Journal of Pediatrics Vol 261, 113559 October 2023
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!

What do you think are accurate statements regarding stool frequency and consistency among children based on this systematic review and meta-analysis? Choose 1 or more:
  1. Among infants under 14 weeks of age, those who breastfed stooled more often each day than those who were fed formula.
  2. Approximately 5% of all infants under 14 weeks of age had hard stools.
  3. Approximately 10% of formula fed infants under 14 weeks of age had hard stools.
  4. Approximately 10% of children aged 14 weeks-4 years of age had hard stools.
  5. Changes in infant formula with the addition of prebiotics such as oligosaccharides are associated with less frequent stooling.
  6. There was no difference in defecation patterns among children based on geographic location.

Click here to view the answer to this question.

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Comments (8)
    Allison

    My fourth child had thick (peanut butter like) stools several times around 3-4 months of age, and struggled to pass them, before any introduction of any substance other than breastmilk.
    It was so bizarre that I consulted our physician, and we monitored her for a while, and tried to see if my diet/medication correlated. We never found a correlation, but it did resolve.
    It was however alarming how many nurses I spoke with that dismissed my concern. Every one of them told me it was common. We reside in an area of the US with incredibly low exclusive breastfeeding rates.

    Kallyn Lang

    My son also presented like this. It was a gut motility issue, related to congenital hypotonia that was not picked up on. I, too, was dismissed until he was diagnosed at 10 months of age with 22q Deletion Syndrome.

    Shyamala Sathiaseelan

    There is something that I want to share. Whenever a mother posts in forums asking her baby poops after or during every feed, people come back and say it is normal. Actually it is a sign of lactose overload or lactose intolerance. Two very different reasons but they are not normal. Both of them can be dealt with and the issues sorted.

    IABLE

    I agree that for a child after the first few weeks, stooling with each feeding can be a sign of lactose overload. However I would not say lactose intolerance, as that is a very, very rare situation in a newborn.

    Shyamala Sathiaseelan

    I have seen many cases of secondary/temporary lactose intolerance In my practice, confirmed by a stool test for reducing substances positive. this happens in case of antibiotics given to baby or mother or in case of a stomach infection

    IABLE

    Thanks for clarifying. Yes, infants who have injury to their intestinal brush border due to illness/meds lose the lactose digesting enzyme called lactase for a limited time, until their gut heals.

    Shyamala Sathiaseelan

    Yes, and the gut heals better by intake of probiotics and lactase enzyme.

    Njoku Faustina

    My experience with exclusive breastfeeding was that my baby was having frequent loose stools, this was ok with me and my baby was doing well on breastmilk.
    Another breastfeeding mother I interviewed said that her baby on exclusive breastmilk opened her bowel at 3-4 days intervals, when she reported to her physician, she was told that not a problem, and that her baby was having a balanced diet with breastmilk.
    The defecation pattern of breastfed babies in our geographical location is usually associated to the feeding habit of the mother and that is why it is believed in our culture that a breastfeeding mother should avoid certain meals.

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