May 1, 1987

Infrequent Defecation in Children

Author Affiliations

West Chester, Pa

West Chester, Pa

JAMA. 1987;257(17):2293. doi:10.1001/jama.1987.03390170049025

To the Editor.—  I am writing in reference to the question concerning infrequent defecation or Hirschsprung's disease and the reply to it by Dr Kirschner in the Jan 23/30, 1987, issue of JAMA.1 There are several points stated, implied, or omitted that should upset any physician caring for children.In the first place, two stools per week in a baby who is primarily breast-fed is, of itself, no cause for alarm. As there is little waste in breast milk, many children will go longer than a week between bowel movements; in this case, the supplemental bottle may be modifying the pattern. The main point of concern would be the foul odor of these soft stools (the green color may arise from iron in the formula). Good growth argues against a malabsorption problem, but nevertheless cystic fibrosis should be of at least equal concern to Hirschsprung's disease. Furthermore, the results