Toddler Diarrhea

One troublesome diet-related problem occurring in preschool children is 'toddler diarrhea.' Young children are susceptible to gastrointestinal infections because of immature, inexperienced immune systems and poor hygiene from their habit of 'mouthing' almost everything they handle. Children are also prone to develop loose stools in response to minor nongastrointestinal infections. However, some children suffer frequent episodes of loose watery stools with or without increased stool frequency and without evidence of infection. These episodes of diarrhea may last weeks or months. Since it may be difficult to distinguish this diarrhea from other significant gastrointestinal pathology, affected children may be subjected to a lot of unrewarding clinical investigation.

Children with toddler diarrhea usually grow normally, unlike most children with significant gastrointestinal pathology. Typically, they are untroubled by their diarrhea although their parents are understandably very concerned - parents have to cope with loose stools in incontinent children! Investigation of toddler diarrhea should include stool microscopy and stool culture to look for evidence of infection and fat maldigestion. Results are usually normal although parents frequently state that the children's stools contain 'undigested food.' On questioning, 'undigested food' means tomato skins, bean husks, and other substances always present in stools but not obvious in formed stools. The fluid stools make these normal food residues more noticeable than usual.

The balance of macronutrients in affected children's diets may be at least partly responsible for toddler diarrhea. Young children who drink a lot of sugared fluids can have loose stools due to sugars reaching the large bowel and causing osmotic diarrhea particularly when fructose corn starch is used since the fructose is poorly absorbed without associated glucose. Sorbitol, sometimes used as a artificial sweetener, is also unabsorbed and can cause loose stools. In the 1992 National Diet and Nutrition Survey children aged 1=2-4/2 years drank on average 1.5 l of sugar-containing drinks and 1 l of 'diet' drinks per week. Some drank much more. On average, 6% of food energy came from soft drinks in children 1)2-4)2 years old. High intakes of food-derived refined carbohydrates add to osmotic diarrhea. Sugar, preserves, confectionery, and sweetened drinks contribute around 20% of the total energy intake of 4-10-year-olds in the UK.

Diets high in refined carbohydrates are commonly low in nonstarch polysaccharides (NSP) and in the proportion of energy derived from fat. Reducing the intake of refined sugars and carbohydrates, increasing the fat content of the diet to 30-35% total energy, and increasing the intake of unrefined carbohydrates and NSP usually result in less fluid stools. The improved continence that comes with age also helps resolution of toddler diarrhea. Most affected children are free of major symptoms by school age. Some retain tendencies to loose stools in response to infection and stress throughout life.

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