Toddler’s diarrhoea is different from older children’s diarrhoea. Toddler’s diarrhoea is actually quite a “normal” occurrence in early childhood in the sense that this type of diarrhoea tends to happen quite frequently in children aged between one to five. Typically, they do not fall sick even when they pass four or more watery stools a day, but continue to grow well, gain weight and remain healthy. Toddler diarrhoea is also more common in boys than girls.
Older children’s diarrhoea is more often caused by viruses, bacteria, parasites, allergies and the use of some medication. The most notable diarrhoea caused by pathogens are:
Malaysia is one of the countries that has a widespread presence of Gardia. However, a 2021 study shows that the prevalence of Gardia has fallen in Malaysia in the last 10 years. The mean rate of the infection is around 13.7%. Gardia is more prevalent in rural communities than in urban communities although both segments of society are affected. Gardia can affect people of all ages but is especially common in children younger than five years old. It is associated with underweight, stunting and wasting, especially among children of Malaysia’s indigenous groups.
Toddler’s Diarrhoea
This is not to say that toddlers are not prone to diarrhea caused by the same viruses, bacteria and parasites that affect adults and older children. Toddlers are susceptible too, to the same acute or chronic diarrhoea except that they have an additional type of diarrhoea that is caused by an immature digestive system which the child will grow out of in due time.
Toddler’s diarrhoea is also known as chronic nonspecific diarrhoea of childhood. It is one of the most common causes of chronic gastroenteritis in otherwise healthy children.
This type of diarrhoea typically occurs in children aged between six months and five years old but is most common in children aged two to four years old.
What the Stools are like
The child will have loose, watery, pale or even brown, green or yellow large stools. The stools may be smellier than usual and often contain pieces of undigested food.
Because of the immaturity of their digestive system, food and fluid may move so quickly through the child’s intestinal tract, that the intestines have no time to absorb bile, water and sugars back into the blood vessels.
One of the reasons why stools may appear yellow or green is because of the excess bile in the stool. The excess water and undigested sugar in the intestines lead to loose, watery stools. Foods that are high in undigestible fibre like fruits and vegetables may lead to whole, undigested pieces in the stools. Bacteria in the large intestines feed on the excess undigested sugars which creates more fluid and gas as a by-product. This contributes to loose, explosive stools and gassiness.
Frequent Bowel Movements
Typically, the child may have four to 10 bowel movements a day. Most of the time, bowel movements are in the day time but up to 25% of children with toddler’s diarrhoea will have bowel movements at night as well. Despite the frequency of these bowel movements, there will be no abdominal pain, vomiting, weight loss or poor weight gain.
Toddler’s diarrhoea may last more than three weeks followed by weeks of normal bowel movement. In time, children will outgrow toddler’s diarrhoea by the time they reach school age.
Is it Toddler’s Diarrhoea or is it Something more Serious?
If the child has:
Then you should take him to a doctor as these symptoms indicate something more serious than toddler’s diarrhoea.
The Danger of Diarrhoea and Dehydration in Young Children
Young children with acute or viral diarrhoea (not toddler’s diarrhoea) may have a fever and/or may vomit. The child loses vast amounts of fluid from the diarrhoea and vomiting. The most crucial aspect about treating diarrhoea is to prevent the child from getting dehydrated. The younger the child, the more susceptible he is to dehydration than teens and adults. This is because they have smaller bodies and have smaller reserves of water.
When dehydration happens, the body doesn’t have enough fluids and water to function properly. The human body is two-thirds water. A loss of water causes blood volume to fall, and it is blood that carries oxygen throughout the body to keep all the organs functioning well. When severe dehydration occurs, it can lead to brain damage or worse.
Signs of dehydration include:
The child should be taken to a doctor immediately if he exhibits any of these symptoms.
Causes of Toddler’s Diarrhoea
Studies say that toddler’s diarrhoea is more of a nutritional disorder than a disease. Toddlers with their small bodies have shorter intestines than adults. Intestines grow longer over time. There are two types of intestines: the small intestine and the large intestines. The small intestine digests the food and absorbs nutrients while the large intestines absorb water and produces vitamins.
Due to the speed of food moving through these shorter intestines, it has been said that some children have fast gut transit time. Before the intestines can absorb the food and water, they exit the body leaving undigested food particles and a lot of fluid in the stools.
Numerous studies show that nutritional factors play a key role in toddler’s diarrhoea. The diet of children has changed dramatically over the years. The more developed and affluent society becomes, the more it is likely to consume ready-made, lifestyle, prepackaged food and beverages. For instance, drinking plain water is out of fashion. It is now replaced by juices, fancy drinks and sodas attractively packaged in tetra pak cartons and plastic bottles. These drinks have a high amount of fructose, glucose and sorbitol. A toddler’s digestive system is not able to able to absorb fructose easily. At the same time, the intake of grain, fruit and vegetables is declining. This results in a large number of children not meeting the minimum fibre intake recommendations.
With ready-made products replacing food fully prepared by parents, toddler’s diarrhoea is increasing but it is really the result of “new”trition over nutrition.
In summary, the causes of toddler’s diarrhoea include:
A: Excessive Fluid Intake can overwhelm the ability of a toddler’s digestive tract to absorb water and electrolytes. This results in diarrhoea.
B: Carbohydrate Malabsorption: Fruit juices contain large amounts of sugars such as sorbitol and fructose. Sugars such as fructose, glucose and lactose are carbohydrates, as are starches and fibre. All these carbohydrates are poorly absorbed in a toddler’s digestive tract and may provoke gastrointestinal symptoms such as flatulence and diarrhoea.
C: Low-fat but High-fibre diet: Many young children prefer sweet, juicy fruits and/or vegetables over meat or high fat foods. Fat can slow down a child’s digestion giving more time for the intestinal tract to absorb the nutrients. Diets high in fibre and low in fat may cause food to move through the intestines very quickly and this results in diarrhoea.
D: Immature Digestive Tract: Because a toddler’s digestive tract may not be fully mature at a young age, the nerves may signal a faster movement of food through the gut. This may not allow adequate time for absorption in diarrhoea.
The good news is, toddler’s diarrhoea can be treated by making a few adjustments to the child’s diet, especially regarding the Four Fs.
The Four Fs
Toddlers should not eat a low-fat diet. They should get around 35% of their energy from the fat in their food. Fat slows down the digestion rate. Adults need to eat less fat to guard against heart disease and obesity but this doesn’t apply to children. Toddlers should eat a range of foods with different kinds of fat in them such as milk, yoghurt, butter, cheese, avocado, meats, fish, eggs, santan, nuts and so on.
Children should drink six to eight cups of fluid per day. They shouldn’t be drinking too many sugary drinks. If they ask for all these drinks, you could give smaller amounts each time or you could set certain times when they can have juice. Encourage drinking plain water or milk. Toddlers should be having at least a half a litre of milk a day as part of their fluid intake.
Fructose is the natural sugar found in fruits. A toddler’s immature gut cannot absorb fructose easily. If too much is eaten, it can irritate the digestive tract and cause digestive problems. Some fruits such as jackfruit (Nangka) have a laxative effect. Eating too much of it and drinking water after eating it can cause diarrhoea. Refined sugars found in many ready-made foods such as candies, chocolates, cakes, biscuits and dessert can cause loose stools.
The fibre in the foods we eat acts a bit like sponge in the digestive system. It soaks up some of the water in the intestines, makes the contents bulkier and slows the digestion process down. The bulk helps the intestines push its contents to let us know it is ready to be passed out. If your child is eating a low fibre diet, increase it, although too much fbre can also irritate the digestive tract. Aim for about 12 to 18 grammes per day which is about 1/8 cup in cooking measurement terms. Some foods that provide fibre include: berries, pears, melon and oranges, broccoli, carrots, sweet corn, beans, peas, potatoes with skin and nuts.
For toddlers on growing-up milk, parents may notice that Galacto-oligosaccharides or GOS is in the ingredients list. GOS are prebiotics made up of plant sugars linked in chains. They are found naturally in dairy products, beans and certain vegetables.
These prebiotics are indigestible fibre that act as food for “good” bacteria to grow in the large intestines. Some of the “good” bacteria known to be effective against diarrhoea are Bifidobacteria and Lactobacilli, among others. According to research, GOS can improve stool frequency, decrease fecal Ph and stimulate the growth of beneficial intestinal bacteria such as Bifidobacteria and Lactobacilli.
A healthy digestive tract filled with rich gut microbiome (microorganisms including bacteria in the intestines) not only plays a key role in stabilising the bowels, it can affect the development of the child’s brain, immune system, lungs as well as body growth and overall health.
Morinaga Chil-kid
Morinaga Chil-kid is a fortified growing up milk specially designed for children’s growing up needs. Formulated in Japan for Asian children aged one to seven, Morinaga Chil-kid comes in a mild vanilla taste for high palatability among young children and is enriched with 45 essential nutrients carefully balanced for their optimal growth and development.
The nutrients include ARA+DHA, Galacto-oligosaccharides (GOS), five Nucleotides, Omega 3 & 6 LCPs (Long Chain Polyunsaturated Fatty Acids) as well as vitamins A, C, D E, K1 plus all the B-vitamins including Folic Acid, and minerals such as Calcium, Iodine, Zinc, Iron and many more.
Made with a balanced ratio of protein, fat and energy, this formulation complements children’s dietary needs and helps them achieve their daily Recommended Nutrition Intake (RNI).
Morinaga Chil-kid uses milk from dairy cows in the Netherlands and is packed in a state-of-the-art plant in the Netherlands where it goes through stringent quality assurance processes and a double inspection in Japan before it is released into the market.
For more information on Morinaga Chil-kid, please visit the website here.