Bowel patterns change from person to person and there is no one standard that fits everyone. For most people, having 1-2 soft bowel movements without it being too watery or too painful is normal. However, if your child has one bowel movement every 2-3 days and does not routinely have abdominal pain, or if your child poops 4 times a day without stomach pains, then that is likely a normal pattern for your child.
Diarrhea, most simply, is described as loose, watery bowel movements that usually occur more frequently and with more urgency than your usual pattern. Most people think of diarrhea as being caused by some sort of stomach bug. Infection is certainly a common cause for diarrhea, but other causes include malabsorption problems and limited diets. I want to spend some time discussing dietary causes of diarrhea, most commonly what is called toddler’s diarrhea.
In order to have normal stools, the body needs a good combination of fiber, carbohydrates, fluid, and protein. Toddler’s diarrhea usually presents as 5-10 large, watery stools per day that occurs off and on for months. Usually this occurs in a child who drinks too much fruit juice. Fruit juice is not a bad thing, but is best if limited to about 4 oz. per day. In children who drink mostly fruit juice, their bodies are getting too much sorbitol and fructose (sugars), which their body cannot absorb in large quantities. When this happens, more water is drawn into the intestines and makes the stool more watery.
Toddler’s diarrhea is diagnosed by any combination of diet history, physical exam, and labs from the stool or a blood draw. Children with toddler’s diarrhea are otherwise healthy, growing well, and have none or limited stomach pain with the diarrhea. Any other serious medical problem should be ruled out. Sometimes it is ruled out by a trial of simply changing the diet, but sometimes more of an investigation is warranted.
To treat toddler’s diarrhea, limiting fruit juice to 4 oz. per day and increasing the amount of whole milk to about 16-24 oz. per day helps. Also, adding more fiber through fresh fruit, bread, cereal, beans, and vegetables will improve the diarrhea. A healthy range of dietary options is especially important in children between 6 months and 5 years old, since these children’s digestive systems are still relatively immature.
Toddler’s diarrhea is still the most common cause of chronic diarrhea in children. It is usually harmless but annoying. Children at this age are usually very picky and strong-willed about what food they will eat, but be persistent in offering a wide variety of foods. If your child likes grazing throughout the day and carrying a sippy cup, make sure you water-down the juice and offer healthy snacks.