When Toddler’s Diarrhea Won’t Quit, It’s Time to Consider CSID
As any parent can tell you, having children is messy business; and diapers are certainly among the messiest parts of raising babies and toddlers.
A bout of diarrhea in a toddler is especially unpleasant, but it’s usually caused by an infection (virus, bacteria, or parasite) and runs its course fairly quickly.
When common causes of diarrhea have been ruled out, a child is usually given a diagnosis of “toddler’s diarrhea.”
The Signs of Toddler’s Diarrhea
The hallmarks of toddler’s diarrhea are as follows:
- Four or more loose, watery stools a day, on most days
- No other signs of illness
- An active child who is gaining weight and doesn’t seem to be in pain or distress
Toddler’s diarrhea often develops between the ages of six months and a year and stops on its own during the preschool years.
Many doctors think it’s simply a function of a toddler’s short bowel. The plumbing inside hasn’t grown enough yet to let food have enough time to get digested, or broken down, and absorbed in the intestines and stomach.
As a child develops and the bowel gets longer, toddler’s diarrhea comes to an end.
Some research suggests that babies and toddlers who have too much fruit juice or other sugary beverages may develop toddler’s diarrhea.
It’s important to rule out diseases and conditions that might cause this diarrhea before resigning yourself to a few years of runny diapers.
If your toddler has frequent watery bowel movements several times a day, it’s time to think outside the (toy) box. Unless your child is diagnosed and treated, this condition could last for months or even years.
Questions to Ask Your Doctor
After the common causes of diarrhea have been ruled out, it’s time to talk with your child’s pediatrician about food allergies or other possible causes of their diarrhea, particularly if your child is not gaining weight or seems constantly fussy and uncomfortable.
If the problem continues, ask your pediatrician to refer you to a pediatric gastroenterologist (GI), who specializes in stomach and bowel conditions. This expert is more likely to have experience with less common causes of diarrhea, which a general doctor may not see often enough to diagnose.
When It’s Not Toddler’s Diarrhea: Common Alternatives
Infections, which can cause diarrhea in toddlers, are the first possible cause your doctor considers. Since infections often have other symptoms (fever, pain, vomiting), they are not easily confused with toddler’s diarrhea.
Food allergies make the immune system go way into overdrive when eating certain foods. A food allergy can trigger symptoms that range from mild (rash or hives, diarrhea, coughing, watery eyes) to severe (swelling of the lips, tongue, or throat). Common food allergens include tree nuts, fish and shellfish, and cow’s milk.
An allergy to gluten is called celiac disease. This is different from gluten intolerance, below, which is not an actual allergy.
Lactose and gluten intolerance are each caused by the lack of a specific digestive enzyme, or chemical, needed to break down a particular food.
With lactose intolerance, the body lacks enough of the enzyme lactase, which breaks down lactose, a type of sugar found in milk.
Gluten intolerance is different from gluten allergy but can cause similar symptoms, including diarrhea and bloating. This happens because the body is missing chemicals it needs to be able to process certain grains, such as wheat, barley, and rye. The most severe form of gluten intolerance is called celiac disease.
When It’s Not Toddler’s Diarrhea: Less Common Reasons
Irritable bowel syndrome (IBS) causes diarrhea, but it also causes pain and can slow growth.
Congenital Sucrase-Isomaltase Deficiency (CSID) is a rare, inherited condition in which the body doesn’t have the enzymes, sucrase and isomaltase, needed to digest certain sugars.
CSID may be the cause of your child’s stinky, relentless watery diarrhea and other symptoms, such as severe diaper rash from acidy poop that is constantly coating their poor little butts.
One of the telltale signs that toddler’s diarrhea is caused by CSID is the nature of the watery stool itself. Tuvia A. Marciano, DO, Director of Pediatric Inflammatory Bowel Disease and Chief of Pediatric Endoscopy at NYU Winthrop Hospital in Mineola, New York, says that Sucrose Intolerance prevents sugar-containing foods from being properly absorbed in the small bowel.
“When sugar is malabsorbed in the small bowel,” says Dr. Marciano, “it passes into the large intestine, where it is taken up by the gut bacteria and converted into hydrogen gas, which produces bloating and short-chain fatty acids that result in an acidic diarrhea. For infants, acidic diarrhea causes diaper rash with very red, angry skin almost resembling a burn. It is important when examining patients with diarrhea to look for this type of diaper rash, as it will clue the physician in to a diagnosis of sugar malabsorption.”
The important thing for a parent to remember is that stomach pain, bloating, or other signs of discomfort are not signs of toddler’s diarrhea. And while diarrhea, along with vomiting, can be caused by a gastrointestinal (GI) infection, they can also be symptoms of CSID.
Sugar intolerance is rare, so a parent has to play detective and ask their child’s doctor to consider all the clues as well.
This parental request is important because if CSID is not diagnosed, treated, and managed early, your child could be missing out on important nutrients that can’t be absorbed from sugar-containing foods because their system can’t break them down. Along with not getting proper nutrition, they might not reach a healthy weight.
Left untreated, CSID could lead to serious issues with your child’s growth and development because tissues and organs in their body may not get all the important vitamins and minerals they needed.
Don’t Panic, Do This
As part of assuming the role of detective, observe what happens if you try cutting back on apple juice or other sugary drinks. Does that stop diarrhea? If so, great. And even more reason to ask your doctor about CSID, now that you’ve established a sugar-diarrhea connection.
Most of all, be patient and try not to worry. True toddler’s diarrhea is not dangerous and ends as your child grows. It will be messy for a while, but it will likely be over before your kid heads off to kindergarten.