Toddler's Diarrhoea

Affected children develop 3 or more watery loose stools (bowel motions) per day. Sometimes it can be 10 or more. The stools are more smelly and pale than usual. You can often see bits of vegetable food in the stools (such as bits of carrot, sweetcorn, etc). These have come from a recent meal. Mild abdominal (tummy) pain sometimes occurs, but is unusual.

A child with just toddler's diarrhoea is otherwise well, grows normally, plays normally, and is usually not bothered about the diarrhoea. An examination by a doctor is normal. No further tests are usually needed if the child is otherwise well. Symptoms usually go, with or without treatment, by the age of 5-6 years.

The cause is not fully understood. The small bowel (small intestine) digests and absorbs food into the body and works normally in affected children. The large bowel (colon) normally absorbs any excess water, and forms stools.

It is thought that the balance of fluid, fibre, undigested sugars, and other foods that reach the large bowel (colon) may be upset in affected children. This can increase the amount of fluid (water) that is kept in the bowel rather than being absorbed into the body. In young children, even a slight increase in fluid left in the large bowel can cause stools to become more frequent and runny than normal. As the child grows, the large bowel becomes more efficient, and the condition goes.

Toddlers diarrhoea is not due to malabsorption (poor absorption) of food, or to a serious bowel problem.

The child may not need any treatment, particularly if symptoms are mild. The child is usually not concerned. Reassurance that it will ease in time may be all that is required.

However, in many cases the diarrhoea will go if the child changes certain eating and drinking habits. Many toddlers develop eating and drinking habits that are not ideal, and may contribute to causing the diarrhoea. One or more of the following may be relevant. They are the 4 'Fs' - fat, fluid, fruit juices, and fibre.

Fat
Toddler's diarrhoea is more common in children who eat a low fat diet. Although a low fat diet is good for adults to help prevent heart disease, it is not good for young children. The diet of pre-school children should have about 35-40% fat. In general, this means drinking whole milk rather than semi-skimmed or skimmed, and to include foods such as yoghurts, milk puddings, cheeses, and dairy products.

Fluid and fruit juice
Do not give children too much fruit juice or squash. Some children only drink fruit juice to quench their thirst. It is best to give water to children for most drinks, and keep fruit juice as a treat. Too much juice or squash is not good for the following reasons.

• Fruit juices contain various sugars (carbohydrates). Some types of sugar are not digested or absorbed, and so get to the large bowel. Here they may act to keep water in the bowel and cause watery stools. Clear apple juice seems to be the worst as it contains a lot of certain sugars. Cloudy juices that contain some fibre are not as bad.
• The sugar in juice and squash contains a lot of calories. This can reduce the appetite for normal meals. Therefore, the child tends to eat less fat and fibre at normal mealtimes. Some children seem to get most of their daily calories from juice, and don't eat very much solid food.

Fibre
A diet with plenty of fibre such as fruit, wholemeal bread, and vegetables is best. Fibre has an action like 'blotting paper' and absorbs water in the bowel. This causes bulkier stools which are less runny.

Toddlers diarrhoea is not serious, and will go as the child becomes older. The diet of young children is often not ideal and is thought to contribute to the cause. The diarrhoea will often stop if the child:

• has a good amount of fat in the diet (whole milk etc)
• does not drink too much fruit juice or squash
• has meals that include enough fibre.

© EMIS and PIP 2004   Updated: November 2002   CHIQ Accredited