© 2001 Blackwell Science Ltd

ORIGINAL RESEARCH Ambulatory Child Health (2001) 7: 23–26

Normal bowel habit during the first 6 weeks inhealthy, term infants

Anna Griffin and R Mark BeattiePeterborough District Hospital, Thorpe Road, Peterborough, UK

ABSTRACT

Objective The bowel habit in the first few weeks is relevant in the assessment ofsymptoms which are often nonspecific and may or may not be indicative ofunderlying pathology. There is very little available data. We thereforeundertook a study to investigate the normal bowel habit in healthy, terminfants.

Design, setting Infants were assessed by the health visitor at the initial contact (10–14 days) and sample and at the 6-week check. Details of feeding method and bowel habit were

collected by simple questionnaire.Results A total of 238 infants were recruited after 14 exclusions; 87.3% of babies

passed meconium within 24 and 99.2% within 48 hours of birth. The majorityof infants at 2 weeks passed at least one stool every day (95.3%). At6 weeks most babies (87.8%) continued to pass a daily stool, although therange widened, with 98.3% passing a stool within the range three or moreper day to once every 3 days.

Implications for This study suggests in the first 2 weeks of life that most infants have a practice daily bowel motion. By 6 weeks, although the range has increased, 98.3%

will have a bowel motion at least once every 3 days. This means a bowelfrequency of less than every 3 days is unusual and requires consideration ofunderlying pathology.

Keywords bowel habit, constipation, infants

Background

It is well known that failure to pass meconium in thefirst 24–48 hours falls outside the normal range andthat when this happens in term infants they should be closely observed for any suggestion of underlyingpathology such as Hirschsprung’s disease.1 However,the normal bowel habit of well, term infants during thesubsequent few weeks is less well studied and is rele-vant in the assessment of the many symptoms which

may present during this period. Newborn babiespresent with multiple symptoms, which can be organicor nonorganic, and constipation is often implicated asa factor. Information about the normal bowel habit iscrucial in the assessment of such infants, both to reas-sure and to decide which babies fall outside the normalrange and are candidates for further evaluation.

We therefore undertook a study to look at the bowelhabit of healthy term infants during the first 6 weeksof life.

24 A Griffin and R M Beattie ORIGINAL RESEARCH

Patients and methodsBabies were recruited prospectively over a 6-weekperiod by health visitors in the defined geographicaldistrict of Peterborough, UK, which has an averagebirth rate of 3000 per year. Recruitment was by healthvisitors who, as primary care health professionals, see all newborn babies routinely for initial contact at10–14 days and then at 6 weeks for routine health sur-veillance, which includes assessment of feeding,weight gain and development. At such visits it isroutine to ask about feedingand bowel habit.

Recruitment to the study was confined to healthy, terminfants. Babies who wereborn preterm or were unwellduring the neonatal period,necessitating either admis-sion to hospital or a visit to the primary care physicianwith an acute medical illnesswere excluded. In addition, any baby that was fedeither a soya milk or hydrolysed milk formula feed was excluded.

Information was gathered using a simple question-naire administered at the initial contact (10–14 days)and at the 6-week check. This included date of birth, date of initial and follow-up check, time to firstpassage of meconium, bowel habit and feedingmethod. Bowel habit was assessed using a tick box as more than 3 stools per day, 1–3 stools per day, alternate days, every third day and less frequently.

We did not do a prospective record, as we were con-cerned this would over-focus the group on bowel

habit and therefore undertook the study at two fixedpoints, relying on the parents’ responses to specificquestions.

Statistical methods

Data from different groups was compared using thechi-square test of statistical significance in a 2 ¥ 2 contingency table.

ResultsA total of 252 questionnaireswere returned, of which 14were excluded. Five babieshad been patients on thespecial care baby unit, fivehad been admitted to hos-pital, three were being fedsoya milk and one form wasnot filled in correctly. Thepredicted birth rate for the

defined geographical area during the study periodwas 350, which gives a questionnaire return ofapproximately 72%.

The analysis showed that 87.3% of infants passedmeconium within 24 hours and 99.2% by 48 hours.Only two babies passed meconium after 48 hours:both were breast fed and both had a normal bowelhabit during the subsequent 6 weeks. There was noassociation between the time at which meconium waspassed and the method of feeding.

Bowel habit at the initial check

At the initial contact (Table 1), 95.3% of babiesopened their bowels at least once a day and 48.7%

© 2001 Blackwell Science Ltd, Ambulatory Child Health 7(1), 23–26

At 6 weeks 87.8% of infants open theirbowels at least once a day, 98.3% willhave a bowel motion at least onceevery 3 days.

Table 1: Bowel habit at the initial check

Stool pattern Bottle fed (n = 104(%) ) Breast fed (n = 128(%) ) Mixed fed (n = 6(%)) Total (n = 238(%) )

3+ per day 31 (29.8) 82 (64) 3 116 (48.8)1–3 per day 67 (64.4) 41 (32) 3 111 (46.6)Alternate days 4 (3.8) 2 – 6 (2.5)Every third day 2 – – 2More than 3 days – 2 2Variable – 1 – 1

ORIGINAL RESEARCH Bowel habit in healthy newborn infants 25

more than three times a day. Only 11 babies (4.7%)fell outside this range. In the group, 53.8% werebreast fed, 43.7% were bottle fed and 2.5% mixed(bottle and breast). Breast-fed babies were more likelyto pass three or more stools per day and bottle-fedbabies 1–3 stools per day (P < 0.05).

Bowel habit at the 6-week check

At the 6-week check (Table 2), 87.8% of babiesopened their bowels at least once a day, with 18.5%opening their bowels more than three times a day. A total of 26 babies passed stool less frequently than once daily, 15 passing stool on alternate days and eight every third day. Three (1.3%) infants passed stool less frequently than once every3 days.

The feeding patterns had changed and 61.7% ofinfants were now bottle fed, 26.8% breast fed (a fallof more than 50% between the initial and 6-weekchecks), 10.5% mixed (bottle and breast) and 1.2%bottle and solids. The tendency for breast-fed babies to pass more frequent stools had persisted(P < 0.05).

DiscussionWe have shown that 87.3% of babies pass meconiumwithin 24 hours and 99.2% within 48 hours of birth.The majority of infants at 2 weeks passed at least onestool every day (95.3%), and this is normal at that age.Babies who are breast fed (53.8%) pass stools morefrequently than babies who are bottle fed. At 6 weeks

the feed pattern had changed, with far fewer babiesbeing exclusively breast fed (28.6%). Breast-fedbabies still passed more stools than bottle-fed babies.Most babies continued to pass a daily stool (86.3%),although the range widened, with 98.3% passing astool within the range three or more stools per day toone stool every 3 days.

There have been previous studies. Nhyan (1952)reported that 97% of a group of 800 infants hadbetween one and nine bowel actions daily during thefirst week of life.2 Weaver et al. (1988) reported 240infants between the ages of 2 and 20 weeks, half ofwhom were fed breast milk and half formula milk, with93% having between one and seven bowel motionsper day. They found stool frequency higher in thebreast-fed group, although this difference disap-peared at weaning.3 Our study confirms these findingsand also shows that with time, bowel habit reduces infrequency. This is in keeping with the work of Thamet al. (1996) who showed in a cohort of Australian chil-dren aged between 0 and 2 years that the mean stoolfrequency decreased with age.4

We have also shown that the range of normal bowelhabit reported in preschool5 and by ourselves inprimary-school-age children,6 96% open their bowelsbetween three or more times daily and once every 3 days, is achieved in healthy term infants by age6 weeks.

Implications for practiceThis study suggests that in the first 2 weeks of lifemost infants have a daily bowel motion and to fall

© 2001 Blackwell Science Ltd, Ambulatory Child Health 7(1), 23–26

Table 2: Bowel habit at the 6-week check

Stool pattern Bottle fed (n = 147(%) ) Breast fed (n = 64(%) ) Mixed fed (n = 25(%) ) Total (n = 238(%) )

3 + per day 13 (8.8) 26 (40.6) 5 (20) 44 (18.5)1–3 per day 118 (80.3) 33 (51.6) 14 (56) 165 (69.3)Alternate days 11 (7.5) 2 2 15 (6.3)Every third day 5 (3.4) 1 2 8 (3.4)More than 3 days – 1 2 3 (1.3)Variable – 1 – 1

Two babies were on bottle feeds plus solids; both passed 1–3 stools per day.

26 A Griffin and R M Beattie ORIGINAL RESEARCH

outside this range is unusual. By 6 weeks the rangehas increased, although 98.3% will have a bowelmotion at least once every 3 days. This has importantimplications for practice. It includes recognition of thenormal bowel habit and as a consequence, aware-ness of what falls outside the normal range. In suchinfants, careful clinical review – including assess-ment of feeding and weight gain with the consid-eration of underlying pathology, which may includeconstipation (particularly if there is straining) – is appropriate.

This study therefore defines the stool frequency ofwell, term infants, and these results can be used as aguide to which infants require close observation forunderlying pathology.

References

1 Ghosh A and Griffiths D M (1998) Rectal biopsy in theinvestigation of constipation. Archives of Disease in Child-hood, 79: 266–268.

2 Nhyan W L (1952) Stool frequency of infants during thefirst weeks of life. Pediatrics, 10: 414–425.

3 Weaver L T, Ewing G and Taylor L C (1988) The bowelhabit of milk fed infants. Journal of Pediatric Gastroen-terology and Nutrition, 7: 568–571.

4 Tham E B A, Nathan R, Davidson G P and Moore D J(1996) Bowel habits of healthy Australian children aged 0–2 years. Journal of Pediatrics and Child Health, 32:504–507.

5 Weaver L T and Steiner H (1984) The bowel habit ofyoung children. Archives of Disease in Childhood, 59:649–652.

6 Yong D and Beattie R M (1998) Normal bowel habit andthe prevalence of constipation in primary school children.Ambulatory Child Health, 4: 277–282.

Biosketches

Anna Griffin is a Health Visitor.

Mark Beattie a Consultant Paediatrician.

Correspondence: Dr R M Beattie Paediatric Medical Unit, Southampton GeneralHospital, Tremona Road, Southampton, SO16 6YD,UK E-mail: RM.Beattie@btinternet.com

© 2001 Blackwell Science Ltd, Ambulatory Child Health 7(1), 23–26