Constipation in infancy and childhood - New insights into pathophysiological aspects and treatment - Chapter 2 - Infant Stool Form Scale: development and results

Q: What is the purpose of developing the infant stool form scale?

To describe stool consistency, amount, and colour in infants and to test whether it helps distinguish differences by gestational age and feeding type while assessing observer reliability.

Q: Did the study find differences between term and preterm infants’ stool characteristics?

No differences were found in stool characteristics between preterm and term infants.

Q: How did feeding type relate to stool amount?

Breastfed infants had smaller stool amounts than formula-fed infants (p<0.001).

Q: What does the “Amsterdam” stool form scale conclude for clinical use?

It is useful for assessing defecation patterns in both premature and term-born infants.

Oct 13, 2026

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Background: For infants, an instrument describing stool characteristics has yet to be developed. Aim: Develop an infant stool scale describing consistency, amount and colour, then test differences between term and preterm infants, breastfed and formula-fed infants, and evaluate interobserver and intraobserver variability. Methods: Gestational age, postnatal age and feeding type were recorded with each photograph; 555 infant stool photos were scored twice using the new 4- and 6-category scale. Results: No differences between term and preterm stool characteristics; breastfed infants showed smaller stool amounts (p<0.001). Reliability was good to excellent. Conclusion: The “Amsterdam” stool form scale supports assessment of defecation patterns in both premature and term-born infants.

LanguageEnglish

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Pages15

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CHAPTER 2

Infant Stool Form Scale: development and results

Abstract

Introduction

Methods

Scale development

Results

Conclusion

UvA-DARE (Digital Academic Repository) Constipation in infancy and childhood : New insights into pathophysiological aspects and treatment Bekkali, N. L. H. Publication date 2010 Link to publication Citation for published version (APA): Bekkali, N. L. H. (2010) . Constipation in infancy and childhood : New insights into pathophysiological aspects and treatment. [Thesis, fully internal, Universiteit van Amsterdam] . General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons) . Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: [https://uba.uva.nl/en/contact](https://uba.uva.nl/en/contact), or a letter to: Library of the University of Amsterdam, Secretariat, P.O. Box 19185 , 1000 GD Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam ( [http](https://dare. uva. nl)[s](https://dare. uva. nl)[://dare. uva. nl](https://dare. uva. nl)) Download date:13 Oct 2026 CHAPTER 2 Infant Stool Form Scale: development and results Noor Bekkali Sofie Hamers Johannes Reitsma Letty van Toledo Marc Benninga Journal of Pediatrics 2009; 154 (4): 521-526 ABSTRACT Background For infants an instrument describing stool characteristics has yet to be developed. Aim To develop an infant stool scale describing consistency, amount and colour and test its usefulness by assessing the differences between term and preterm infants, between breastfed and formula fed infants and examining interobserver and intraobserver variability. Methods Information about gestational age, postnatal age, and feeding type was collected in relation to each photograph taken. An infant stool form scale describing consistency (4-point scale), amount (4-point scale) and colour (6 categories) was developed. All photographs were scored twice with the newly developed scale to assess interobserver and intraobserver variability. Consensus database describing stool characteristics was developed. Results A total of 555 photographs of infant stools were analysed. Sixty (11%) of the infants were term and 495 (89%) were born prematurely. No differences were found in stool characteristics between preterm and term infants. Breastfed infants had smaller amounts of stools compared with formula-fed infants (p<0.001). The interobserver weighed Κ value (95% CI) was good for consistency and amount; simple Κ value was good for colour. For observers I and II, intraobserver Κ values were excellent. Conclusion This “Amsterdam” stool form scale is useful to assess defecation patterns in both premature and term born infants. INTRODUCTION To date, a stool form scale describing stool characteristics such as consistency, amount and colour of faeces in infants has yet to be developed. In adults, the Bristol Stool Form Scale (BSFS) appears to be a reliable tool for describing and classifying stool appearance. 1 It consists of a 7-point scale in which stool consistency together with form of stool are described for every point in this scale. For example, score 1 describes stools that are hard lumps, like nuts (hard to pass) while score 4 describes stools like a sausage or snake, smooth and soft. The BSFS is used in clinical practice to monitor change in intestinal function. Higher stool water content was associated with more rapid gastrointestinal transit and higher scores on the BSFS. (1) The converse was true for stool with less water content. 1 More import

FAQs

What is the purpose of developing the infant stool form scale?

To describe stool consistency, amount, and colour in infants and to test whether it helps distinguish differences by gestational age and feeding type while assessing observer reliability.

Did the study find differences between term and preterm infants’ stool characteristics?

No differences were found in stool characteristics between preterm and term infants.

How did feeding type relate to stool amount?

Breastfed infants had smaller stool amounts than formula-fed infants (p<0.001).

What does the “Amsterdam” stool form scale conclude for clinical use?

It is useful for assessing defecation patterns in both premature and term-born infants.

Oct 13, 2026

Upload by Kyle