Toddler's diarrhoea is a common cause of persistent (chronic) diarrhoea in young children. It mainly affects children between the ages of 1 and 5 years and is more common in boys. Toddler's diarrhoea is not serious and the child is well. The diarrhoea 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 a normal amount of fibre (but not a high-fibre diet).
What are the symptoms of toddler's diarrhoea?
Toddler's diarrhoea is also known as chronic nonspecific diarrhoea. Affected children develop three or more watery loose stools (bowel motions) per day. Sometimes it can be 10 or more. 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, sweetcorn, etc). These 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 just toddler's diarrhoea is otherwise well, grows normally, plays normally and is usually not bothered about the diarrhoea. An examination by a doctor doesn't reveal anything abnormal. 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.
If your child develops diarrhoea for the first time and it persists for more than a few days, or they seem unwell or have other symptoms, it is important to see a doctor. Do not assume your child's symptoms are due to toddler's diarrhoea without a diagnosis from the doctor.
What is the cause of toddler's diarrhoea?
The cause is not clear. 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 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 rather than 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 an intolerance of a type of food.
What is the treatment for toddler's diarrhoea?
Often, no treatment is needed, 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, 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.
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 preschool 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.
You may find that giving a higher-fat food (whole milk yoghurt, milk pudding, ice cream, cheese) at the end of a meal can help reduce toddler's diarrhoea.
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. However, 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, if you do give your child squash or juice, make sure that it is very well diluted. And then, aim to increase the dilution gradually over time.
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 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 obtain most of their daily calories from juice and don't eat very much solid food.
Some toddlers get into the habit of drinking almost constantly. This is often for comfort rather than because they are thirsty. While children do need plenty of fluids, 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.
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 (faeces). Fibre is present in many foods, in particular in fruit, wholemeal bread and vegetables.
Fibre has an action a bit like blotting paper and absorbs water in the bowel. So, if your child has a low-fibre diet, it may help to increase the fibre in the diet to normal levels. This is simply achieved 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 your child has a balanced diet with plenty of vegetables and fruit, but some are more likely to cause toddler's diarrhoea than others. Foods to consider reducing if your child has 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.
Further reading and references
Guarino A, Lo Vecchio A, Berni Canani R; Chronic diarrhoea in children. Best Pract Res Clin Gastroenterol. 2012 Oct26(5):649-61. doi: 10.1016/j.bpg.2012.11.004.
Lee KS, Kang DS, Yu J, et al; How to do in persistent diarrhea of children?: concepts and treatments of chronic diarrhea. Pediatr Gastroenterol Hepatol Nutr. 2012 Dec15(4):229-36. doi: 10.5223/pghn.2012.15.4.229. Epub 2012 Dec 31.