Toddler loose stool when to worry

Healthy young children can have diarrhea that is not related to infection and/or underlying disease, called toddler’s diarrhea, or non-specific diarrhea of childhood.  Toddler’s diarrhea typically occurs in children aged 6 months to 5 years, and is most common among children 2–4 years old. Stools may be loose or watery and frequent, occurring more than three times a day. Usually, diarrhea occurs during the day, but up to 25 percent of kids with toddler’s diarrhea pass stool at night as well. The stool may look brown, green, or yellow, and may contain undigested food pieces. A child with toddler’s diarrhea typically does NOT have abdominal pain, vomiting, weight loss, or poor weight gain.

Causes of toddler’s diarrhea

Food and fluid may move more quickly through a child’s intestinal tract so that there is less time for the intestines to absorb bile, water, and sugars back into the blood vessels from the intestinal surface. Excess bile in the stool may give it a yellow or green appearance. Excess water and undigested sugar in the intestines leads to loose, frequent stools. Foods high in indigestible fiber like vegetables and fruits may appear “whole” or undigested in the stools. Bacteria in the large intestine feed on the excess undigested sugars, creating more fluid and gas as a by-product. This also contributes to loose or “explosive” stools and gassiness.

Young children are often picky eaters, preferring foods that are high in sugars. Having a diet high in certain sugars can cause or contribute to toddler’s diarrhea.

How do I know if my child has toddler’s diarrhea?

Make an appointment to see your pediatrician if your child has frequent loose stools lasting more than a couple of weeks. Before the appointment, consider keeping a written log of your child’s stool patterns for at least one week. Each day, write down the frequency and consistency of your child’s bowel movements as well as a diary of the types of foods and drinks he or she consumes. This will help your doctor make the diagnosis of toddler’s diarrhea or decide if further evaluation is needed to look for other causes of diarrhea. Remember, if the diagnosis of toddler’s diarrhea is made after consulting with your pediatrician, this is not considered a disease, but rather a harmless condition of childhood. The vast majority of children outgrow toddler’s diarrhea with time and/or by following dietary interventions.

If a child has blood in the stool, vomiting, poor weight gain or weight loss, abdominal pain, refusal to eat/drink, or fever, call your doctor to discuss being seen sooner. These “red flag” symptoms indicate that something more serious than toddler’s diarrhea is going on and further evaluation and/or treatment may be needed.

Tips to help with toddler’s diarrhea

  • Avoid prune, pear, and apple juice, which are high in the indigestible sugar called sorbitol.
  • Avoid foods and drinks that contain high fructose corn syrup.
  • Limit all juice intake to less than 4 ounces per day. Have water or milk to drink instead.
  • Avoid foods with artificial sweeteners (may be labeled “diet” or “light”).
  • Make sure the diet includes healthy fats, such as nuts or nut butters, eggs, dairy fat, and plant-based oils.
  • If your child has skin irritation on his or her bottom due to frequent loose stools, clean the skin with lukewarm water, use a zinc oxide-based diaper ointment and allow your child to have time diaper-free with the skin exposed to air if/when possible.

Additional resources:

Toddler’s diarrhea (gikids.org)

Written by Haley Neef, MD
Updated January 2020

Toddler's diarrhoea is also known as chronic nonspecific diarrhoea. Affected children develop three or more watery loose stools (bowel motions) per day. Sometimes it can be 10 or more. The stools are often more smelly and pale than usual. You can often see bits of vegetable food in the stools (such as bits of carrot, sweetcorn, etc). These have come from a recent meal. Mild tummy (abdominal) pain sometimes occurs but is unusual. Some affected children develop constipation which alternates with diarrhoea.

A child with just toddler's diarrhoea is otherwise well, grows normally, plays normally and is usually not bothered about the diarrhoea. An examination by a doctor doesn't reveal anything abnormal. No further tests are usually needed if the child is otherwise well. Symptoms usually go, with or without treatment, by the age of 5-6 years.

If your child develops diarrhoea for the first time and it persists for more than a few days, or they seem unwell or have other symptoms, it is important to see a doctor. Do not assume your child's symptoms are due to toddler's diarrhoea without a diagnosis from the doctor.

See the separate leaflet called Acute Diarrhoea in Children for more information about other causes of childhood diarrhoea.

The cause is not clear. The small bowel (small intestine) digests and absorbs food into the body and works normally in affected children. The large bowel (colon) normally absorbs any excess water and forms stools.

It is thought that the balance of fluid, fibre, undigested sugars and other undigested foods that reach the colon may be upset in affected children. This can increase the amount of fluid (water) that is kept in the colon rather than being absorbed into the body. In young children, even a slight increase in fluid left in the colon can cause stools to become more frequent and runny than normal. As the child grows, the colon becomes more efficient and the condition goes.

Toddler's diarrhoea is not due to poor absorption (malabsorption) of food or to a serious bowel problem. It is also not due to an intolerance of a type of food.

Often, no treatment is needed, particularly if symptoms are mild. The child is usually not concerned. Reassurance that it will ease in time may be all that is required. However, in many cases the diarrhoea will go, or become less severe, if the child changes certain eating and drinking habits. Many toddlers develop eating and drinking habits that are not ideal and these may contribute to causing the diarrhoea. One or more of the following may be relevant. They are the '4 Fs': fat, fluid, fruit juices and fibre.

Toddler's diarrhoea is more common in children who eat a low-fat diet. Although a low-fat diet is good for adults to help prevent heart disease, it is not good for young children. The diet of preschool children should have about 35-40% fat. In general, this means drinking whole milk rather than semi-skimmed or skimmed and to include foods such as yoghurts, milk puddings, cheeses and dairy products.

You may find that giving a higher-fat food (whole milk yoghurt, milk pudding, ice cream, cheese) at the end of a meal can help reduce toddler's diarrhoea.

Do not give children too much fruit juice or squash. Some children only drink fruit juice to quench their thirst. It is best to give water to children for most drinks and keep fruit juice as a treat. However, some children have become used to squash or juice on a regular basis and may become upset if they are suddenly denied their usual drink. In this case, if you do give your child squash or juice, make sure that it is very well diluted. And then, aim to increase the dilution gradually over time.

Too much juice or squash is not good for the following reasons:

  • Fruit juices contain various sugars (carbohydrates). Some types of sugar are not digested or absorbed and so get to the large bowel (colon). Here they may act to keep water in the bowel and cause watery stools. Clear apple juice seems to be the worst, as it contains a lot of certain sugars. Cloudy juices that contain some fibre are not as bad.
  • The sugar in juice and squash contains a lot of calories. This can reduce the appetite for normal meals. Therefore, the child tends to eat less fat and fibre at normal mealtimes. Some children seem to obtain most of their daily calories from juice and don't eat very much solid food.

Some toddlers get into the habit of drinking almost constantly. This is often for comfort rather than because they are thirsty. While children do need plenty of fluids, more than 5-8 drinks a day can contribute to toddler's diarrhoea, even if they are drinking water. It may be worth considering limiting drinks to meal and snack times.

Changing the fibre content of the diet may be helpful, as very low- or high-fibre intakes may make symptoms worse in some children. Fibre (roughage) is the part of plant food that is not digested. It stays in the gut and is passed in the stools (faeces). Fibre is present in many foods, in particular in fruit, wholemeal bread and vegetables.

Fibre has an action a bit like blotting paper and absorbs water in the bowel. So, if your child has a low-fibre diet, it may help to increase the fibre in the diet to normal levels. This is simply achieved by eating a healthy balanced diet that includes some fruit and vegetables.

However, a high-fibre diet may make things worse, as too much fibre can cause loose stools, especially in toddlers. It is important that your child has a balanced diet with plenty of vegetables and fruit, but some are more likely to cause toddler's diarrhoea than others. Foods to consider reducing if your child has toddler's diarrhoea include:

  • High-fibre cereals (eg, Weetabix®, porridge, muesli, cereals with raisins).
  • Wholemeal bread.
  • Peas, sweetcorn, baked beans, lentils and pulses.
  • Grapes and raisins.