Dr Mike Thomson, Paediatric Gastroenterologist, The Portland Hospital
Q. My toddler suffers from persistent diarrhoea. What could be causing this?
A. So called “Toddler’s diarrhoea” is a diagnosis of exclusion, i.e. if there are no warning signs then this is what is left. Warning signs include poor growth, poor weight gain, tiredness, anaemia and any presence of blood or slimy mucous in the bowel motions. Diarrhoea can be transient after a viral gastro-enteritis and represents sensitisation or allergy to cow’s milk protein with occasionally secondary lactose intolerance. People get confused between lactose intolerance, which is due to a rare enzyme missing in the small bowel with lack of digestion of lactose, and the much more common cow’s milk protein allergy which leads to diarrhoea in many children. Other conditions that need to be thought of in the younger child include Coeliac disease, which is a gluten problem and blood tests are available for this. In a child over the age of 3-5 years then rarer conditions such as inflammatory bowel disease (ulcerative colitis and Crohn’s disease) can present with diarrhoea but often there is abdominal pain and other issues such as mouth ulcers and lethargy and general unwellness at the same time. If important conditions such as these are excluded, and this might include the need for endoscopy, then we are sometimes left with a child with simple diarrhoea and this used to be called “Peas and carrots” diarrhoea or “Toddler’s diarrhoea” – this is when the time taken for undigested food particles, such as a piece of sweetcorn, to appear after being eaten, may be as little as 1-2 hours. Dietary manipulation with increased fat, decreased fibre and decreased juice and fruit in the diet – which doesn’t sound like a healthy diet, but is aimed at slowing the bowel’s speed – can be effective, and it is unusual, apart from reassurance to the parents, that any other intervention is necessary - and we don’t usually use anti-diarrhoea drugs in children. Occasionally children can present with what is called spurious diarrhoea where there is a blockage with a large amount of poo in the rectum and the children are getting leakage of loose bowel motions from above around this blockage and this is a form of constipation and usually needs an x-ray to be diagnosed. In summary any child with nutritional problems, growth problems, anaemia, abdominal pain or blood and mucous in the bowel motions needs to be taken seriously and usually a Paediatric Gastroenterologist would be involved in their care. Stool testing is usually not very helpful and we must always remember that children who have been abroad might pick up bugs such as Giardia and the commonest cause of self-limiting diarrhoea is of course gastro-enteritis.
For further information or to book an appointment please contact Dr Thomson's secretary.
Telephone: 020 7390 8315
Fax: 020 7390 6505