Toddler’s Diarrhea

Toddler’s diarrhea or chronic nonspecific diarrhea is benign condition in a thriving, healthy child. Stools are loose and reveal identifiable remains of recent food intake. Rapid intestinal transit may be the cause of this benign condition. It has been shown in small intestinal motility studies that fasting activity was normal, but postprandial motility was abnormal. The initiation of postprandial activity is accompanied by disruption of MMCs. In toddler’s diarrhea, the MMCs continue and go along with increased intestinal transit. Another mechanism may be the dumping of bile acids and hydroxy fatty acids into the colon, leading to cholerrheic diarrhea. This was substantiated by stool examination. The precipitating event of chronic nonspecific diarrhea is often an acute episode of gastroenteritis with watery diarrhea. Study of intestinal biopsies revealed normal morphology, but increased adenyl cyclase activity and Na,K-ATPase activity, in keeping with the assumption of recovering mucosa. It was also claimed that correction of a low fat intake leads to resumption of symptoms. Clinically these children have a nonspecific diarrheal pattern, grow normally, and are obviously well. Some might have their symptoms reduced by diminishing their consumption of fructose, sorbitol, and other sugars dependent on facilitated mucosal transport.

This might hold for an irritable bowel syndrome–like picture with predominant diarrhea and without pain in older children, but as in adults, distinct mild abnormalities or forms of diseases are found in increasing numbers, such as lactose intolerance, microscopic colitis, fructose malabsorption, food hypersensitivities, and celiac disease.

Symptoms improve with dietary modifications: increased fat and fiber intake, limited fluid intake, and avoidance of fruit juices.

Summary:

Chronic non-specific diarrhoea (toddler diarrhoea)

  • • Occurs from 6mths to 5yrs.

  • • Presents with colicky intestinal pain, ↑ flatus, abdominal distension, loose stools with undigested food (‘peas and carrots’ stools).

  • • Child is otherwise well and thriving.

  • • Examination and investigations are normal.

Treatment

Reassurance; dietary (↑ fat intake; normalize fibre intake; ↓ milk, fruit juice, and sugary drink intake); loperamide occasionally may be necessary.