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Printed at: 05:55:13 / 19-04-2021

Dietary Management of Toddler Diarrhoea

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What is Toddler Diarrhoea?

Toddler diarrhoea is the most common cause of persistent diarrhoea in young children. Generally, it occurs between one and four years of age. It is not a serious problem; your child is usually well and their weight gain and growth is normal. Children with toddler diarrhoea will often have three or more watery loose stools per day. The stools are usually more foul smelling than normal and often undigested food is visible e.g. peas, carrots and sweetcorn. Children with toddler diarrhoea will often want to go to the toilet shortly after eating. Occasionally the stools are firmer in the morning and get looser/softer later on in the day. Parents can find the diarrhoea both a worry and an inconvenience, but it often resolves by four to five years of age.

What causes Toddler Diarrhoea?

  • The cause is not fully understood, but food may be a possible cause and a possible treatment.
  • It is not due to poor absorption of food and is not a serious bowel problem.
  • Your child will usually still get all the nutrients they need from the food they eat, and continue to grow well.

Dietary management

Fat

  • Low fat diets may contribute to toddler diarrhoea.
  • Fat slows digestion and the speed at which food passes through the gut.
  • Eating more fat may help to stop the diarrhoea.
  • For children under five, healthy eating guidelines are not as strict as those which apply to adults. Try giving your toddler more foods containing fat. Aim to provide 35-40% of daily energy from fat (approx. 40g of fat daily from a range of foods)

Suggested foods to include:
– Dairy products eg full fat milk, yoghurts, cheese, custard, rice pudding.
– Snack foods eg crackers, scones, pancakes or crumpets with margarine or butter, plain cake or biscuits, breadsticks or vegetables with creamy dips.
– Meat products: chicken, lamb, beef, minced meat, sausages, burgers.
– Add fat to starchy food eg bread with margarine or butter, potato mashed with margarine or butter, pasta with cheese sauce.

You may wish to choose monounsaturated or polyunsaturated margarines such as those made from olive, rapeseed, sunflower and corn oils as these are healthier fats.

Fluid
 Young children’s digestive systems struggle to cope with large fluid intakes,
which can lead to an increase of fluid in the large bowel. Even a slight
increase of fluid in the large bowel can cause stools to become more frequent
and looser than before.
 Avoid excessive fluid intake. A toddler is not likely to need more than 6-8 cups
(200ml size) of fluid each day.
 Where possible, offer your child water or milk to drink.

Fruit Juices
 Fruit drinks such as pure fruit juice and squash should be limited as they often contain high levels of fructose (natural fruit sugars). Absorption of fructose is poor in young children. When these drinks are digested, the release of fructose promotes faster stomach emptying and quicker gut transit which can worsen toddler diarrhoea.
 Drinks which are classed as “no added sugar” may be sweetened with artificial sweeteners such as sorbitol. These should also be limited as they can have a similar effect as fruit juices.
 If giving pure fruit juice or fruit smoothie, ensure this has been well diluted (1 part juice to 10 parts water is recommended for young children). The quantity should be limited to one small beaker, glass of diluted juice or smoothie per day. Clear juices such as apple, grape and blueberry juices should be avoided altogether as these have high levels of indigestible sugars.
Note: Although fresh, tinned and frozen fruit also contains natural fructose, the digestion of this fructose is slowed by the presence of fibre. It does not usually have the same effect as fruit juice, in causing loose stools, unless eaten in large quantities.

Fibre
 Fibre is important to keep your gut healthy.
 Having a very high fibre or low fibre intake can make toddler diarrhoea worse.
 Fibre can help to soak up excess fluid in the large bowel, so if your child has a low fibre diet this process does not happen effectively and loose stools can occur. If you child currently has a very low fibre diet, try the following:
– Change from white bread and low fibre cereals to wholemeal or wholegrain products e.g. wholemeal or seeded bread, Shredded wheat, Weetabix or Shreddies, brown rice or pasta.
– Include more fruit and vegetables.
 If a child has a high fibre diet, the effect of large amounts of fibre passing through the gut causes irritation and can trigger loose stools. If your child eats a lot of high fibre foods, try the following:
– Give your child lower fibre foods such as white bread, white rice, and white pasta, low fibre breakfast cereals e.g. Cornflakes or Rice Krispies as a temporary measure.
– If your child eats a lot of fruit and vegetable portions these could also be reduced as a temporary measure. Remember that a child’s portion of fruit or vegetable is what fits in the palm of their hand.

Once the diarrhoea has settled
Your toddler needs a healthy diet, so some of these suggestions should only be used for a short time to help settle toddler diarrhoea, with a view to returning to a healthy, balanced diet when the symptoms resolve.

Whilst changes such as reducing sugary drinks and increasing fruit and vegetable intake can help improve the balance of the diet and could be encouraged on an ongoing basis, other changes such as increase in fatty foods and reduction in foods containing fibre can be relaxed once the diarrhoea has resolved. You should gradually give fewer fatty foods and more foods containing fibre including wholemeal bread, high fibre cereals, fruit and vegetables.

If symptoms recur, you may need to implement the changes for a longer period of time. Children under the age of 5 years are recommended by the Department of Health to have a vitamin supplement containing vitamins A, C and D on a daily basis. This should help to address shortfalls linked with reduced intake of fruit and vegetables. If your child’s diet is limited in other areas, an age-appropriate multivitamin and mineral supplement may be useful. This will ensure they meet their requirements for micronutrients.