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A normal pattern of stool evacuation is felt to be a sign of health in children of all ages. Especially during the first months of life, parents pay close attention to the frequency and the characteristics of their children's defecation. Any deviation from what is felt to be normal for children by any family member may trigger a call to the nurse or a visit to the pediatrician. Thus, it is not surprising that approximately 3% of general pediatric outpatient visits and 25% of pedialric gastroenterology consultations are related to a complaint of defecation disorder (1). Chronic constipation is a source of anxiety for parents who worry that a serious disease may be causing the symptom. Yet only a small minority of children have an organic etiology for constipation. Beyond the neonatal period, the most common cause of constipation is functional constipation, which has also been called idiopathic constipation, functional fecal retention, and withholding constipation.
In most cases the parents are worried that the child's stools are too large, too hard, painful or too infrequent. The normal frequency of bowel movements at different ages has been defined (Table 1). Infants have a mean of 4 stools per day during the first week of life. This frequency gradually declines to a mean average of 1.7 stools per day at 2 years of age and 1.2 stools per day at 4 years of age (2,3). Some normal breastfed babies do not have stools for several days or longer (4). After 4 years, the frequency of bowel movements remains unchanged.
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