Toddler's diarrhoea

What are the symptoms of toddler's diarrhoea?

Toddler's diarrhoea is also known as chronic nonspecific diarrhoea. Affected children have three or more watery loose stools (bowel motions) per day but they can have more than 10 episodes a day. The stools are often smellier and more pale than usual.

It is often possible to see pieces of undigested vegetable food in the stools (such as bits of carrot, sweetcorn, etc) which have come from a recent meal. Mild tummy (abdominal) pain sometimes occurs but is unusual. Some affected children develop constipation which alternates with diarrhoea.

A child with toddler's diarrhoea is otherwise well, grows normally and behaves normally. Examination does not find any abnormalities. Symptoms usually settle by the age of 5-6 years.

When to see a doctor about toddler's diarrhoea

If a child develops diarrhoea for the first time and it persists for more than a few days, or they seem unwell or have other symptoms, medical advice should be sought. Most children under 5 years of age with a typical history and normal examination will not need any further tests. Sometimes another condition, such as coeliac disease or an inflammatory bowel disease, might be suspected and these may require further tests (blood tests or stool test).

See the separate leaflet called Acute diarrhoea in children for more information about other causes of childhood diarrhoea.

What is the cause of toddler's diarrhoea?

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

Toddler's diarrhoea is not due to poor absorption (malabsorption) of food or to a serious bowel problem. It is also not due to any food intolerance.

What is the treatment for toddler's diarrhoea?

No treatment

No treatment is needed, particularly if symptoms are mild. Reassurance that it will ease in time may be all that is required. However, in many cases the diarrhoea will go, or become less severe, if the child changes certain eating and drinking habits.

Many toddlers develop eating and drinking habits that are not ideal and these 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 often thought to be good for adults to help prevent heart disease, it is not good for young children. The diet of preschool children should have about 35-40% fat.

In general, this means drinking whole milk rather than semi-skimmed or skimmed.

A higher-fat food (such as whole milk yoghurt, milk pudding, ice cream or cheese) at the end of a meal may help to reduce toddler's diarrhoea.

Fruit juice

Children should not drink much fruit juice or squash. It is best to give water to children for most drinks and keep fruit juice as an occasional 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 (colon). 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 these 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 have become used to squash or juice on a regular basis and may become upset if they are suddenly denied their usual drink. In this case, juice should be very well diluted and then this dilution should be increased over time until the child can drink water happily.

Fluid

Some toddlers get into the habit of drinking almost constantly. This is often for comfort rather than because they are thirsty. Children do need plenty of fluids but more than 5-8 drinks a day can contribute to toddler's diarrhoea, even if they are drinking water. It may be worth considering limiting drinks to meal and snack times.

Fibre

Changing the fibre content of the diet may be helpful, as very low- or high-fibre intakes may make symptoms worse in some children. Fibre (roughage) is the part of plant food that is not digested. It stays in the gut and is passed in the stools. Fibre is present in many foods, particularly in fruit, wholemeal bread and vegetables.

Fibre acts a bit like blotting paper and absorbs water in the bowel. A child with a low-fibre diet may be helped by increasing the fibre in the diet to normal levels, by eating a healthy balanced diet that includes some fruit and vegetables.

However, a high-fibre diet may make things worse, as too much fibre can cause loose stools, especially in toddlers. It is important that children have a balanced diet but some foods are more likely to cause toddler's diarrhoea than others. Foods to consider reducing in toddler's diarrhoea include:

• High-fibre cereals (eg, Weetabix®, porridge, muesli, cereals with raisins).

• Wholemeal bread.

• Peas, sweetcorn, baked beans, lentils and pulses.

• Grapes and raisins.