Toddler’s diarrhoea is a common condition that doesn’t usually mean anything serious, so long as your child is growing well, keeping up with their developmental milestones and doesn’t have other symptoms. As the name implies, it affects those aged 1 to 5. Children usually pass loose stool at least twice a day, but sometimes up to 10 times, and it might appear a bit paler and more smelly than usual, possibly with some undigested food. It's thought to be a combination of their developing gut and a less than ideal diet. It's more common in boys, although it's not clear why.
Toddler’s diarrhoea falls under the category, “diagnosis of exclusion”. This means that there is no specific test or examination for it, but by eliminating other causes, it rests on that it is most likely toddler’s diarrhoea. Gastroenteritis or stomach bugs can commonly cause diarrhoea, but this last for only a few days, and they sometimes have vomiting, stomach pains and cramps and a mild fever. Malabsorption is a particular medical condition that may lead them to fail to grow or gain weight, and it may be something that runs in the family. Allergies or intolerances like lactose and gluten can create a similar picture, and they also experience abdominal cramps and bloating. They should have no other symptoms or pain, no blood or mucus in the stool, and they should be their usual selves, playing, alert and eating as usual.
It's not clear what causes toddler’s diarrhoea. One working theory is that the digestive system is under-developed, and the final part of the gut, the large bowel (or colon) is where water is absorbed from the digested food, but it may not reabsorb enough, or stool may pass through too quickly, making it less formed and more watery at the other end. As the diarrhoea has cleared in most children by the time they start school, this theory would fit with the bowel maturing in its development.
No treatment is usually needed for mild toddler’s diarrhoea. It’s important to not make too much of it so they don’t become self-conscious – keep checking nappies regularly or, once trained, allow them to feel comfortable to go to the toilet as often as they need, and inform their nursery or school of the same. Potty training can go ahead in the same way. It can be tempting to take a shortcut and get medications from the pharmacy to bulk up the stool, but this shouldn’t be necessary after a few changes in their diet and reassuring yourself it’s nothing serious. Sometimes diet can contribute, and a good rule of thumb is to consider the four F’s - fibre, fat, fluid and fruit juice. Fibre is essential for all of us, to help bulk out stool by absorbing water, so it passes easily down and out. It’s found in wholemeal bread, high fibre cereals like Weetabix or muesli with raisins, lentils, pulses, fruit such as grapes, and vegetables. Too little fibre can cause less absorption of water, and increasing this slightly may help. Too much fibre can be the cause of loose stool, so it’s important to maintain a balanced diet with a little of everything. Exactly the opposite message to what we tell adults, toddlers need relatively a high fat content in their diet, and changing semi-skimmed milk to whole milk, and giving them full fat yoghurt or cheese, can help toddler's diarrhoea. Again, contrary to what we usually say, but too much fluid can contribute, even if it’s just water. Some toddlers seem to comfort drink. Try to limit drinks to mealtimes and snacktimes to see if this helps. Finally, fruit juice and squash – every child’s favourite – can contribute to toddler’s diarrhoea. Try to keep these to just treats rather than maintaining their fluid balance – their teeth will thank you too.
If your child has diarrhoea lasting longer than 2 weeks and not improving, even if toddler’s diarrhoea seems to fit, it’s best to get this checked out by their doctor and formally diagnosed. If your child has other concerning signs like blood or mucus in their stool, a persistent fever or vomiting, persistent abdominal pain, they are struggling to maintain fluids, or they seem more irritable and drowsy than usual, you should seek your doctor’s help urgently.