Infrequent Defecation in Children-Reply

Barbara S. Kirschner, MD
JAMA. 1987;257(17):2293. doi:10.1001/jama.1987.03390170049026.
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In Reply.—  I think that Dr Conn's comments on my response to the question on infrequent defecation or Hirschsprung's disease are not supported by others who have written about disorders in the passage of stools in infants.The first paragraph specifically states that the spontaneous passage of large soft stools is unusual for Hirschsprung's disease. I discussed this disorder in some detail to address the specific questions raised by the corresponding physician. In my experience, the absence of abdominal distention has not proved to be a reliable sign to exclude Hirschsprung's disease in children with unusual difficulty with defecation.Certainly no pediatrician would oppose performing a sweat test on any child with malodorous stools, although a weight gain of 3 kg in four months would make this diagnosis an unlikely explanation.Of note, the first recommendation for infrequent stooling was that adequate fluid intake be provided. The other recommendations were


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