toddler's diarrhea

Also known as chronic nonspecific diarrhea of childhood, this is a perplexing condition for parents and doctors alike. It is defined as a diarrhea

that lasts for more than two weeks
usually consists of 5-10 watery stools per day (often with undigested food particles in the stool
in a child between about 6 months to 4 or 5 years old
who is growing and developing normally and otherwise seems healthy
there is no detectable medical cause for the diarrhea such as infection, food malabsorption or allergy, etc.

Among the causes that have to be ruled out medically (and the corresponding test) are included

bacterial intestinal infection - stool culture
infection with the parasite Giardia lamblia- giardia antibody test
infection with Clostridium difficile - C. diff toxin test

The child's diet must be evaluated. Fluid intake may play a factor. Studies have shown a link between excessive fluid consumption and toddlers diarrhea, as well as high carbohydrate, low fat diets. Excess fruit juice intake - especially apple juice - is often the cause of mysterious diarrhea (apple juice contains sorbitol, the "active ingredient" in prunes). If the child is being given any natural remedies or health foods, these need to be mentioned to the doctor and probably stopped to see if there is an improvement in the diarrhea.

Treatment is mostly dietary manipulation. Carbohydrates, especially fruit juices, are reduced and fat increased to 35-40% of the total calories. High fiber foods such as beans, fruit, breads, and cereals should be encouraged. Antidiarrheal medications are probably OK for very short periods of worsening symptoms, but should not be used for very long, nor very often. Cholestyramine is a bile-salt binding medication used to lower blood cholesterol. It is sometimes used to reduce the diarrhea; I have had some luck with it in the past but haven't used it recently.

Just remember the key: this is not a diagnosis applied to a sick child. If your child has systemic symptoms or anything beyond loose, watery stools - any blood or pus in the stool, any weight loss, an unhealthy appearance - further investigation is certainly imperative.

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