Purpose <p>Anorectal malformations (ARM) are a common reason for protective colostomy in children, but there is no consensus on the best type or location. The objective of this study is to assess the prevalence of colostomy malposition in clinical settings with limited expertise in the management of patients with anorectal malformations, as well as the associated complications of colostomy.</p> Methods <p>Medical records of all children with ARM treated at our hospital between 2005 and 2019 were retrospectively reviewed. The incidence of stoma complications and the rates of colostomy revision during ARM repair were compared by colostomy type and location.</p> Results <p>The study included 276 children. A proximal colostomy was performed in 205 cases (74.3%) and a distal colostomy in 71 cases (25.7%). Loop colostomies were done in 233 patients (84.4%), while split colostomies were done in 43 (15.6%). Stoma-related complications occurred in 65 patients (23.6%), with prolapse (8.3%) and maceration (4.0%) being the most common. Complications were significantly lower with proximal colostomies (20.2% vs. 32.9%, <i>p</i> = 0.036) and loop stomas (21.0% vs. 37.2%, <i>p</i> = 0.030). Stoma revision due to malposition was needed in 39.4% of patients with distal colostomies, but none with proximal colostomies (<i>p</i> &lt; 0.0001).</p> Conclusions <p>Colostomy in children with ARM is associated with a high overall complication rate. In particular, many distal colostomies are incorrectly placed too distally, which complicates subsequent corrective surgery.</p>