Diarrhea refers to increased frequency and a watery consistency of stools. While this may be defined as having more than three bowel movements in a 24 hour period in adults, it is not as clearly defined in toddlers. Infants and young children may pass stool more than three times in a day and this may still be within a normal bowel habit. However, in these cases the stool should be soft, smooth and sausage-shaped in older children on solids while it is a mushy in babies who are still on a milk-only diet. With diarrhea in babies, the diarrhea stool is very watery.
Most cases of acute diarrhea in adults and children are due to infections. Children are frequently affected with the rotavirus viral diarrhea which causes a diarrheal illness for a few days. However, there are cases where young children and infants may experience recurrent and sometimes even persistet diarrhea. This type of chronic diarrhea could be due to several possible causes but sometimes the exact cause is not identified. However, it has been noted that in most cases this chronic diarrhea, that is often termed toddler diarrhea, is linked to dietary factors.
What is Toddler’s Diarrhea?
Toddler’s diarrhea is recurrent bouts or persistent loose and watery stool in children between 6 months and 3 years of age. This is believed to be linked to fruit juices and fat in milk. Fiber may also play some role. It is important to note that toddler’s diarrhea is not the same as diarrhea seen with conditions like celiac disease. This is a separate condition altogether.
In toddler’s diarrhea there is no abnormality of the bowels like inflammation which may occur with infections. However, there appears to be undigested nutrients in the intestines which draws out water from the body thereby making the stool very watery. In addition, fluid and fiber intake also seems to prevent water from being reabsorbed from the colon to form soft but solid stool. The exact reason why this occurs is not fully understood.
Is toddler’s diarrhea caused by fruit juice?
At one time it was thought that toddler’s diarrhea is due entirely to fruit juices. However, it is now evident that the condition is more complex than previously thought. Fruit juices often do play a role in contributing towards toddler’s diarrhea. Remember that low fat as well as low or high fiber intake may also be involved.
The fruit sugar, fructose, from fruit juices when delivered into the small intestine of a young child in excessive amount, drags water from the intestinal wall into the intestinal lumen. The excessive water hampers the proper reabsorption to form soft ut solid stool in toddler’s diarrhea.
It is important to note that this is not a food intolerance or malabsorption syndrome, although a similar phenomenon can arise with undigested nutrients in food intolerances and malabsorption syndromes in older children and adults.
Symptoms of Toddler’s Diarrhea
Toddler’s diarrhea is a specific type of diarrhea in small children, and usually presents with:
- Yellowish to brown watery stools.
- Passed between 2 to 6 times daily, and sometimes as many as 10 bowel movements.
- Particles of undigested food may be visible in the stool.
Usually children with toddler’s diarhea do not have problems with growth and development. In fact young children with toddler’s diarrhea may continue with life as normal and not even be interrupted with play. The condition often resolves by 5 to 6 years of age at the latest. However, steps should be taken to manage and prevent it from continuing.
In toddler’s diarrhea, investigative procedures like a colonoscopy are usually not necessary. The diagnosis is reached on the child’s symptoms as well as exclusing other possible causes of chronic diarrhea. These other causes of chronic diarrhea in small children that should be considered includes:
- 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)
- Irritable bowel syndrome (IBS) which can occur in young children, although rare.
- Fructose malabsorption
- Celiac disease
- Malnutrition, more commonly seen in poor countries as well as due to neglect.
- 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 focuses on dietary managed through one or more of the following measures:
- 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 may help and should be according to a pediatrician’s directions.
- Avoiding anti-diarrheal medication as this can sometimes worsen the illness, especially if there are infections.
- 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.