Loose, watery poop is a fairly common complaint that brings children in to their pediatrician’s office. Stomach and intestinal bugs are very common in children and are the main causes of diarrhea (we discussed these conditions in our last article). However, diarrhea has other causes besides just viruses, parasites, and bacteria. We will discuss the major ones below:
To many parent’s surprise, juice is a very common culprit of “toddler’s diarrhea.” Children’s intestines just can’t process the large amount of fluid, electrolytes, and carbohydrates. This can result in diarrhea. Often, just stopping juice intake is enough “cure” the loose stools.
Another common cause of loose stools and bloating in older children is lactase deficiency. Lactase is an enzyme that breaks down lactose (milk sugar) and is essential to digesting dairy. Usually, this issue doesn’t present until puberty. Symptoms occur between 30-120 minutes after ingesting lactose-containing products (most dairy products) and include diarrhea, nausea, vomiting, and bloating. Eliminating dairy should completely clear these symptoms.
Antibiotics used to treat pneumonia and ear infections are notorious for causing diarrhea. Making sure you take a probiotic (Culturelle is a common one I prescribe) can help prevent (but doesn’t eliminate) diarrhea caused by antibiotics. Once the antibiotic treatment is finished, the diarrhea should stop as well. Note: If the diarrhea persists after stopping the antibiotic or dramatically worsens make sure your child is immediately evaluated to make sure they have not developed C. difficile colitis (which is a rare but serious complication and may require a specific antibiotic to treat).
Although they are not as common, medical problems intrinsic to the intestines are also important causes of diarrhea. These conditions include: inflammatory bowel disease (Crohn’s or ulcerative colitis), eosinophilic gastroenteritis (thought to be an allergic reaction in the stomach and intestines), or genetic intestine malformation, which would cause the intestines to not absorb nutrients properly. Any of these diseases require a gastroenterologist to properly diagnose and treat.
Any time a child has diarrhea that persists longer than 7-10 days, he/she should be evaluated by a physician. Your child’s height and weight need to be plotted on a growth chart. The physician will take a careful past medical and family history. In addition, you should be able to provide a detailed diet history. The doctor may or may not take stool and blood samples depending on what he finds in your child’s history or on physical exam. Often, your doctor will try simple steps to decrease the diarrhea. Only if those fail or if something in the history or physical exam suggests intrinsic intestinal problem will you be referred on to a specialist.
Thankfully, the vast majority of children’s diarrhea is self-limited and resolves with only simple interventions. It is important, however, to work closely with your physician to avoid missing the rare case where the diarrhea is caused by something that would require referral to a specialist for further diagnosis and treatment.
For more information on how to treat diarrhea at home, and when you should bring your child to see their doctor, be sure to to check out The Scoop on Poop Part 2.