Limit fruit juices when treating toddler's diarrhea

It had been a rough couple of months for the 2-year-old with a recent serious infection requiring a hospital stay and IV antibiotics. The little girl had successfully cleared her initial infection, but was now experiencing seemingly endless weeks of diarrhea.

Probiotics were not helping the situation and stool tests did not reveal any bacteria or toxins as a source of her gastrointestinal problem. I brought up the possibility of toddler's diarrhea when the mom and I discussed the next step in the child's work-up.

Toddler's diarrhea is not well-known among parents, though it remains the leading cause of chronic diarrhea in kids under the age of 3. Authors of the American Academy of Pediatrics Nutrition Handbook explain that little ones with toddler's diarrhea, also known as “chronic nonspecific” diarrhea of childhood, appear quite healthy and have normal gastrointestinal function.

Toddler's diarrhea typically occurs two to five times during the day, but can be seen as often as a dozen times in a 24-hour period. Interestingly, in this condition loose stools are rarely produced overnight.

AAP experts advise against severe dietary restrictions or the use of fruit juices in kids experiencing diarrhea, since limiting fat intake and pushing noncitrus juices high in sorbitol (prune, pear, cherry and apple juices) can aggravate the condition.

Pediatricians at Riley Children's Hospital in Indianapolis agree, listing four factors which contribute to toddler's diarrhea: poor absorption of the sugars and carbohydrates found in abundance in fruit juices; unnecessary restriction of the dietary fat that is useful for slowing digestion and allowing nutrient absorption; overdoing fluid consumption leading to altered water and electrolyte absorption; and the presence of an immature digestive tract in toddlers.

The Riley group recommends treating this chronic nonspecific diarrhea by limiting toddler intake of fruit juices, sports drinks and colas, and avoiding the excess fluid intake that can occur with the 24/7 use of bottles or sippy cups.

Increasing dietary fat through the use of whole milk, butter and olive oil can help children with this gastrointestinal condition. Eating healthy fiber in the form of fresh fruits, breads, cereals and beans is also encouraged.

The good news is that the AAP reports that young patients with chronic nonspecific diarrhea tend to improve on a diet with about 30 percent of calories provided by fats and when no more than 4 to 6 ounces of juice are offered each day. The diarrheal episodes often resolve when the child learns to control stooling during successful toilet training.

Keep in mind that kids with toddler's diarrhea are healthy and have a normal growth pattern. Riley specialists note that worrisome symptoms such as abdominal pain, vomiting, fever, bloody or greasy stools, and weight loss should raise red flags as they are not characteristic of this benign toddler's diarrhea.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.