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Diarrhea accounts for approximately 500,000,000 deaths per year in developing countries. In the US it accounts for 10% of outpatients visits. Unlike adults, toddlers get dehydrated faster due to diarrhea which leads to complications which can be fatal.

The impact of diarrhea in toddlers

Diarrhea in toddlers can lead to serious complications. Hence it should be evaluated and treated promptly. The two most important adverse effects of diarrhea in toddlers are:

  • Dehydration – Unlike adults dehydration develops faster in children. Dehydration can be mild, moderate or severe. If dehydration is not identified and not corrected it could lead to serious complications.  It can be fatal if severe dehydration is not corrected promptly.
  • Malabsorption – Infections like rotavirus infection  damage the inner lining of the gastrointestinal tract. This affects the digestion and absorption of nutrients. The most common malabsorption is that of carbohydrates like lactose. 

Diarrhea_toddler%281%29.jpgCauses of diarrhea in toddlers

Though chronic non-specific diarrhea is commonly as called as Toddler’s diarrhea, diarrhea in toddlers can be due to many causes. The causes are broadly classified in to:

  • Infections
  • Malabsorption
  • Food allergy

Toddler’s diarrhea – It is a chronic nonspecific diarrhea seen in children. This is seen in children of six months to five years of age. The probable causes include excessive intake of fluids, malabsorption especially carbohydrate malabsorption and poorly developed digestive tract. It is characterized by 5-10 watery stools per day, undigested food particles in stool and diarrhea lasting for weeks followed by weeks of normal stools.

Infections - Rotavirus infection is one of the most common infectious causes of diarrhea in toddlers. It accounts for 10% of all cases of diarrhea in children. The available data shows that rotavirus infection is responsible 500,000 physician visits and 70,000 hospitalizations. 1 in 200,000 toddlers affected by rotavirus diarrhea die due to it.   Diarrhea due to viral infection is commonly called as stomach flu. Bacterial and parasitic infections can also cause diarrhea in toddlers.

Food allergy -Milk and milk products can cause diarrhea in susceptible children who have milk protein allergy. It goes away on its own when the child is about 3-5 years of age.

Malabsorption - Malabsorptive states like lactose intolerance can cause diarrhea in toddlers. Other malabsorptive states causing diarrhea in children include celiac disease, Giardiasis and cystic fibrosis.

Treatment of diarrhea in toddlers

Treatment of diarrhea in toddlers essentially consists of two components and they are:

  • Correction of dehydration
  • Treating the underlying cause

Correction of dehydration

The modality of correcting dehydration depends on its severity which has to be assessed at the physician’s office. Toddlers with severe dehydration are to be hospitalized to correct dehydration. Intravenous fluids should be administered to correct dehydration and prevent complications. Toddlers with mild and moderate dehydration can be treated at home.
Toddlers with moderate dehydration should receive oral dehydration therapy (ORT). They need to take 100ml of ORT solution (like Pedialyte). A simple method to calculate the amount of fluid to given is to give 2 oz per hour of ORT fluid. This constitutes the maintenance therapy in correcting dehydration. If the toddler has ongoing episodes of loose stools he/she should receive an additional amount of 10ml/kg fluid. If the toddler is also affected by vomiting a single dose of ondansetron can be given to control vomiting. This facilitates the use of ORT.

Treating the underlying cause

  • Viral infection - Viral infection is the most common cause of diarrhea in toddlers. These infections are self-limiting and will subside in 3-5 days. There is no need to treat the infection and antibiotics are ineffective. Care should be taken to maintain hydration till the toddler gets cured of the infection
  • Bacterial infection – In case of bacterial infection, appropriate antibiotics should be given
  • Parasitic infection – Giardiasis is one of the common causes of diarrhea in toddlers. It can be treated with a course of metronidazole.
  • Toddler’s diarrhea- This is a harmless condition which will subside on its own as the child grows older. Care should be taken to prevent dehydration.
  • Malabsorption- The offending agent should be eliminated. In lactose intolerance, lactose should be eliminated from the diet and lactose free diet should be given. If it is due to celiac disease, gluten free diet should be given. 

Other supportive measures

Probiotic supplements by replenishing the gut flora (the good bacteria of the gut) eliminates the disease causing organisms and helps in the recovery from diarrhea. Probiotics are available as supplements or alternatively yogurt can be taken which is rich in probiotics. Zinc supplements hasten the recovery from infectious diarrhea by improving the immunity.

Fruit juices should be avoided as they can worsen diarrhea. Dried cereals, grains, bread, crackers, rice, noodles, and mashed potatoes can be given. BRAT diet is usually advised in toddlers with diarrhea. This includes Banana, Rice, Applesauce and Toast. But the recent recommendation by the American Academy of Pediatrics is that toddlers with diarrhea resume eating a normal, well-balanced diet consisting of vegetables, fruits, yogurt and complex carbohydrates within 24 hours of falling sick. 

  • Nelson Textbook of Pediatrics, 18th edition

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