What is ’toddler diarrhoea’?
Toddler diarrhoea is when young children have chronic diarrhoea, but they’re otherwise healthy and developing well. It mainly affects children between the ages of 1 and 5 years and is more common in boys. Toddler diarrhoea is not serious if the child is well. Symptoms usually go, with or without treatment, by the age of 5-6 years.
Affected children will have at least two or more watery loose stools (bowel motions) per day but may have as many as ten a day. The stools are often more smelly and pale than usual. You can often see bits of vegetable food in the stools such as bits of carrot and corn, etc.
NOTE: If your child develops diarrhoea for the first time and it persists for more than a few days, or if they seem unwell e.g. temperature and vomiting, or have other symptoms such as struggling to drink enough, or less responsive, it is important to see a doctor. If your child has chronic loose stools, and you are concerned about their growth and development, it is important to see your GP or specialist paediatric gastroenterologist to rule out other causes such as coeliac disease. Do not assume your child’s symptoms are due to toddler diarrhoea without a diagnosis from a doctor.
What causes toddler diarrhoea?
It is not known what causes toddler diarrhoea. However, the diet of young children is thought to contribute to the cause (see further information below). It is thought that the balance of fluid, fibre, undigested sugars and other undigested foods that reach the colon may be upset in some children. This can increase the amount of fluid (water) that is kept in the colon rather than being absorbed into the body. As the child grows, the colon becomes more efficient, and the condition usually clears up.
Toddler diarrhoea is not due to poor absorption (malabsorption) of food or to a serious bowel problem, nor is it due to an intolerance of any type of food. Therefore, it is important not to eliminate foods or put your child on a restricted diet such as a gluten-free diet or dairy-free diet as there is no evidence to support these diets. In addition, gluten containing foods and dairy foods provide many important nutrients required for healthy growth and development.
What is the treatment for toddler’s diarrhoea?
Often, no treatment is needed, particularly if symptoms are mild. In many cases the diarrhoea will go or become less severe as the child gets older. In some cases, minor dietary changes of the “4 Fs” may help: fat, fluid, fruit and fibre.
Children should not eat a low-fat diet. They should get around 35% of their energy from the fat in their food. Fat slows the digestion in the gut and the speed at which the food passes through the system. Children should be given a range of foods with different fats in them. Full-fat milk and products like cheese and yoghurt, butter, vegetable oils and spreads, avocado, meat, fish, eggs, almond/cashew/peanut butter, nuts and seeds all contain fats.
While children need plenty of fluids, excessive amounts of fluids can contribute to toddler’s diarrhoea, even if they are drinking water. Sugary drinks (soft drinks and juices) can increase the diarrhoea. Encourage drinking water or full fat milk only.
Fructose is the natural sugar found in fruit. The immature gut cannot absorb fructose easily. If too much is eaten it can irritate the gut, causing the contents to go through too quickly. It may help to limit foods high in fructose, some of these include apples, dried fruit, figs, fruit Juice, mango, pear and pear juice, plums, watermelon, the juice of tinned fruit, and honey.
Changing the fibre content of the diet may be helpful, as very low- or high-fibre intakes may make symptoms worse in some children The fibre in the foods works by soaking up some of the water in the gut, making the stool more bulky, which helps to slow down the transit time and consistency of the stool. However, too much fibre can also irritate the gut, causing the contents to move through too quickly. A dietitian can help by examining your child’s diet and advising on the amount and type of fibre required.
An Accredited Practising Dietitian can help you adjust your child’s diet to help improve toddler’s diarrhoea while ensuring they are still consuming a healthy and well-balanced diet for optimum growth and development.
HOEKSTRA JH. Toddler diarrhoea: more a nutritional disorder than a disease. Archives of Disease in Childhood 1998;79:2-5.