Toddlerhood is a time when children are going through a lot of changes. Children enter pre-school, toilet-training begins, diets change, and sometimes stooling patterns become different as well. The latter issue often leads to parental worry. One of the most common changes that parents of toddlers bring up during visits with me is that their toddler’s stools seem very loose or watery (“diarrhea”). More often than not, the diagnosis ends up being “toddler’s diarrhea”, a harmless type of diarrhea that generally starts after a child is weaned. (Other names for this condition include “functional diarrhea of childhood” or “chronic non-specific diarrhea of childhood”.)
Toddler’s diarrhea occurs due to a relative immaturity of the intestinal tract of young children. Relatively speaking, sugars and some fluid get poorly absorbed. The stools often contain undigested food particles (carrots and corn being the most commonly noticed). The key differentiating factor that sets toddler’s diarrhea apart from other causes of diarrhea at this age is that except for loose stools, there are no other symptoms. There is no malabsorption of nutrients, so children with toddler’s diarrhea have normal growth and weight gain. Otherwise, they are perfectly healthy. There won’t be anything abnormal found during their physical exam. Tests are not generally needed, because those, too, will be normal.
Even though toddler’s diarrhea resolves on its own, I often tell families to follow the “4 Fs” as a guide to treatment:
Fruit juice & Fluid: Eliminate all juices, even those made from 100% fruit. The high amounts of fructose and other sugars in juice make stools more watery. Keep drinks limited to milk and water.
Fiber: By increasing fiber in a child’s diet, stools will become more firm. Fiber helps to absorb excess water from the colon, acting as a bulking agent.
Fat: Fat works to slow down how fast food passes through the digestive tract. The slower food moves through, the more time for water to be absorbed.
I also find it helpful to tack on few extra “4s” to remember the key features of toddler’s diarrhea:
4 weeks: Children have diarrhea for at least 4 weeks. Yet, they are otherwise healthy, growing well.
4 stools: Children have an average of 4 loose stools per day (typical range: 3-5). Stools are watery, without blood.
4 years: It usually resolves by the age of 4 years (occasionally taking a little longer) by which time, the colon matures and becomes more efficient.
If your toddler-aged child has chronic diarrhea, always discuss this with his/her doctor. If the diagnosis is toddler’s diarrhea, I hope these tips are useful. If you have any further questions, the pediatric gastroenterology team at Swedish is here to help.