Diarrhea refers to increased frequency and water content of stools.
Small children between 6 months and 3 years of age (toddlers) who drink a lot of fruit juices (especially apple juice) may have an ‘unexplained’ chronic diarrhea (lasting more than 2 weeks). Fruit sugar fructose from fruit juices, delivered into the small intestine of a small child in excessive amount, drags water from the intestinal wall into intestinal hollow, thus causing the so-called toddler’s diarrhea.
Symptoms of Toddler’s Diarrhea
Toddler’s diarrhea is a specific type of diarrhea in small children, and usually presents with:
- 2-6 brown, watery stools with particles of undigested food
- Toddler looks healthy and does not lose weight
In toddler’s diarrhea, colonoscopy and other investigations show nothing so diagnosis is based purely on toddler’s symptoms.
Other causes of chronic diarrhea in small children should be considered:
- Excessive ingesting of lactose, lactulose, sorbitol, magnesium hydroxide, carbonated drinks or fluids in general, and low intake of fats (no milk in diet) (1)
- Food allergy (commonly to milk, wheat, eggs, nuts, tree-nuts, soy)
- Chronic infection (e.g. tuberculosis)
- Fructose malabsorption
- Celiac disease
- Malnutrition – in poor countries
- Intestinal parasites (giardia, Entamoeba hystolytica, cryptosporidium, intestinal worms)
- Encopresis (from Greek kopros = dung) is stool soiling of non-organic origin in chronically constipated children over 4 years of age; it occurs when a fresh stool passes the impacted stool. This is also called paradoxical diarrhea.
- Crohn’s disease (rare in children)
- Cystic fibrosis
- Primary lactose intolerance (rare in toddlers)
- Hereditary fructose intolerance (rare)
Treatment of toddler’s diarrhea is by appropriate diet:
- Fruit juices should be limited or dropped and partly replaced with milk. Fruit juice from white (but not black) grapes and citruses (oranges, lemons) may be fine.
- Avoiding fruits, and foods high in fructose, sorbitol (apples, pears, prunes, peaches, cherries, dates, figs, honey, certain sodas, “sugar free” chewing gum, “low calorie” foods, foods sweetened by HFCS). Bananas, berries, citruses, and pineapple may be fine.
- Increasing food fat and fiber content; more details can be obtained by pediatrician
- Avoiding anti-diarrheal medications
- Vitamins or mineral supplements should be added to the diet only if blood test show their deficiency
Diarrhea usually ceases in several days or weeks after the change of drinking habit. Toddler’s diarrhea is not likely to continue or appear after age of four if a child has no other fructose absorption abnormality.
About Fruit Juices (2):
- Fruit juices have no nutritional value for infants below 6 months of age; they also promote caries.
- Fruit juices have no more nutritional value over fresh fruits in infants over 6 months of age.
- Fruit juices should not be used instead of milk in toddlers since milk is important source of calcium.
- Fruit juices are not appropriate for fluid replacement in dehydration since they are low in sodium.
- Toddler’s diarrhea (pedclerk.bsd.uchicago.edu)
- Facts about fruits (allergyadvisor.com)
Article reviewed by Dr. Greg. Last updated on September 9, 2012