Saturday, October 29, 2011

What We Should Know About Toddler’s Diarrhea

I was supposed to post an entry about my son’s previous sickness due to hot weather as we have thought. But for some reason I do not have the time to post it.

My son experienced runny watery stool a week ago. Even if he is still super makulit and active, worries do not leave me. This is especially when he was having 3-5 watery stools a day and because of this he had developed nappy diaper rashes.  I was really not at ease and keep on searching on what is causing it. I noticed he have some teeth erupting. Although he is experiencing loose stool every time he had teeth it was not this watery.

Then I remember when he was 6 months he also had this problem plus vomiting. It happened when we brought him in the province and we travelled during really hot weather. His pediatician prescribed Erceflora, which contains 2 billions of probiotic microorganisms. So we bought it and mixed with his milk. After a day his runny stool frequency was reduced and after 2 days it is completely gone. I was relieved, and so I believe this hot weather was really the cause.

Unfortunately, it came back after 6 days. He had watery stools but it isn’t as frequent as before. So as always a worried mom, I am thinking of so many things like infections, lactose intolerance etc. Then I came across this site about Toddler's Diarrhea. These are some of the important details:

The parents of a 14 month old boy bring their son to your office with a 2 month history of 2-6 loose, non-foul smelling watery stools per day. At times there is undigested food in the bowel movement. The parents have gone through multiple diet changes and now the boy is only eating a low fat, no dairy products, lots of fruit juices, and minimal protein diet. He has had an extensive workup including negative stool cultures for bacteria and viruses, negative stool for ova and parasites, and no neutrophiles or blood in the stool. How would you approach this problem?

Toddler diarrhea is a common pediatric condition. In infants it is referred to as chronic diarrhea of infancy and in older children as irritable bowel syndrome. Common clinical characteristics include:

  1. Age between 6-30 months. Most are better by 4 years of age
  2. 2-6 watery stools per day. There can be periods of days without stools. Many stools contain undigested material and may drip down the child's leg from the diaper.
  3. Normal weight, height, and head circumference growth curves without falling off
  4. No evidence of infection
  5. Stools are hematest negative
  6. The child looks well and there is no evidence of malnutrition and no history of abdominal pain
  7. Growth may be compromised if the diet manipulations that have been tried to control the diarrhea have not been enough calories. 
  8. There is often a history of colic, gastroesophogeal reflux, and family history of irritable bowel syndrome. 
I was partially relieved when I read this. My son had 2-3 watery stool yesterday, he still active and eats well. I just noticed he is drinking a lot of fluids because of the humid hot weather now. I cannot give him antidiarrheal medicine because that might worsen his condition. So I browse further for the treatment and the following are recommended:

  1. Increase fat in the diet
  2. Decrease fluid in the diet
  3. Avoid fructose and sorbitol- decrease fruit juices
  4. Increase dietary fiber
  5. Normal diet for age
  6. Reassurance- this is difficult because parents have been to many physicians and are convinced that their child has a serious illness. It is important after making your recommendations to follow-up soon to reassure again and watch weight and height gains.
  7. There is no role for medications.
  8. The parents should be told that there is no serious sequelea and this is not a precursor to inflammatory bowel disease, chronic diarrhea as adults, or cancer
  9. Most children are better by 4 years of age, and are better by the time they become potty trained.
  10. The APA has recently (Dec 2010) investigated the use of probiotics and prebiotics in the treatment of gastrointestinal ailments in children. They preliminary, good data shows that taking probiotics can limit the duration of infectious diarrhea in children by up to 40 hours, and reduce the occurrences of diarrhea in children exposed to enteric viral infection (rota) and started on antibiotics. In healthy children, the use of probiotics and prebiotics have been found to be completely safe thus making their use worth a try.
Others recommend the BRAT diet (Banana, Rice, Applesauce, unbuttered Toast). For the increase in fat, we can give him whole-fat dairy, avocados, nuts and a little olive oil in his food. To add dietary fiber, we can also give him fresh fruit, and vegetables, whole grain breads and cereals and beans. Juice drinks as well as energy drinks (like Gatorade) must be avoided because of its high sugar content; instead we can give him clear drinks like water, electrolytes (like Pedialyte) and white grape juice.

There are tons of information in the web but we must not always rely on it and always look for the true symptoms in our children. Self medication is not highly recommended as well.

While this diagnosis can help us, we must observe our kids too for symptoms like any blood or pus in the stool, foul odour and greasy/oily stool, any weight loss and unhealthy appearance. In such case, we must ask for further investigation.

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