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The most common form of diarrhea in children is functional diarrhea, where the intestines are healthy. Infectious diarrhea is common in children and is most often caused by viruses.

Definition of diarrhea

The word is a compound word derived from the Greek words dia and rheo. It can be described as an imbalance between absorption and secretion in the gastrointestinal tract.

Diarrhea is not necessarily a symptom of a disease and can be a normal condition.

According to the World Health Organization, diarrhea is defined as more than 3 loose or watery stools per day. Frequent, formed stools, as well as watery, mushy stools in breastfed infants, are not considered diarrhea.

If diarrhea lasts for more than 14 days, it is considered chronic. In this case, a comprehensive assessment of the coexisting symptoms should be made and, if deemed necessary, further investigation should be carried out.

What are the causes of diarrhea?

The most common cause of diarrhea in children is part of the functional digestive disorders, which means that the intestine is healthy. Functional diarrhea in young children is also called toddler’s diarrhea. Another term used is “peas and carrots” because food residues (peas and carrots) may be found in the stool, as some plant fibers do not have time to be broken down by the bacteria in the large intestine. This is a completely harmless condition that resolves before school age.

According to the Rome IV criteria for functional diarrhea, the child must have at least 4 daily, painless, bulky, unformed stools. Symptoms must last longer than 4 weeks and have an age of onset of 6-60 months.

Diarrhea can be caused by:

• Celiac disease (gluten enteropathy)
• Food allergy or intolerance (e.g. to cow’s milk)
• Pancreatic insufficiency
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
• Constipation
• Chronic intestinal infection: Giardia lamblia, cryptosporidium, entamoeba
• Lactose intolerance (uncommon in preschoolers).
• Hyperthyroidism (rare before adolescence)

Can dietary treatment help with functional diarrhea?

In the case of functional diarrhea can be helped by reducing the amount of carbohydrates and fiber, as well as increasing the amount of fat in the food, in order to slow down the speed of food passing through the digestive tract.

In older children, probiotics may have some positive effect and possibly a low-FODMAP diet, i.e. a diet containing small amounts of fermentable carbohydrates and some sweeteners.

Importance of history

• Form of bowel movements – quantity, consistency, color, presence of blood or mucus (Bristol scale)
• Precipitating or relieving factors – bowel movements, flatulence, meals, stress
• Other symptoms – abdominal pain, nausea, vomiting, constipation, weight loss, decreased appetite, fever
• Heredity – especially celiac disease, inflammatory bowel disease
• Diet – excessive consumption of sweeteners or fruit juices
• Medications – antibiotics, laxatives
• Travel abroad, well water

Psychosocial factors

• Problems in everyday life- affected sleep or activities
• Problems at school – school absences, bullying, learning difficulties, affected school performance
• Problems during free time – avoidance of activities or social interactions
• Problems in the family environment – financial issues, friction, abuse
• Psychological problems – stress, depression, phobias, eating disorders

Warning signs (red flags) that require further investigation:

• Affected growth curves
• Poor general condition, reduced endurance, fatigue
• Diarrhea with blood
• Nocturnal diarrhea
• Prolonged diarrhea and vomiting
• Anemia, iron deficiency, affected liver markers
• Delayed puberty
• Recurrent fever
• Inheritance of celiac disease or inflammatory bowel disease

Diarrhea due to infection

Common in preschool age and usually of viral etiology. Less commonly caused by bacteria or parasites. However, parasites can be detected in the stool without causing symptoms.

Most children with infectious diarrhea with or without vomiting can remain at home with appropriate advice and measures for hydration. Children with acute diarrhea, however, especially young children, are at risk of dehydration without adequate oral hydration and therefore clinical assessment of their condition is necessary.

Most infections are self-limiting. It is important that children with diarrhea receive sufficient amounts of fluids with the right amount of electrolytes and sugar. It is important to use formulations appropriate for the child’s age.

When is urgent clinical assessment necessary?

• Young children with compromised general condition
• Suspected significant dehydration
• Presence of severe abdominal pain
• Bloody diarrhea

In any case, it is necessary to investigate cases of diarrhea with long-term symptoms (lasting weeks) even if the child’s general condition is relatively good.