Occasionally I hear from parents who are worried because their toddler seems to have regular loose poos, sometimes several times a day. Nappies look messy, stools may contain undigested food, and it can feel like something must be wrong. Sometimes this turns out to be Toddler Diarrhoea, also known in the medical literature as chronic non-specific diarrhoea of childhood. But before this can be conclusively diagnosed, there’s an important step that shouldn’t be skipped.
First: rule out other causes
Loose poos that persist for weeks should always be reviewed medically first.
That’s because chronic diarrhoea in children can have many different causes, including infection, food allergy, coeliac disease, inflammatory bowel disease, or constipation with overflow diarrhoea. Careful history, examination and sometimes investigation are needed to distinguish these conditions. Only once these possibilities have been considered can a health clinician confidently diagnose toddler diarrhoea.
This process can take some time (weeks not days) but it matters, because toddler diarrhoea is essentially a functional condition, meaning the bowel works a little differently but the child is otherwise healthy, and getting the right diagnosis means you can be confident in how you manage it.
Toddler diarrhoea or constipation?
One of the reasons a medical review is important is that loose poos don’t always mean diarrhoea. In fact, its much more likely that it’s constipation, and this looks very different in children compared how we experience and understand it in adults.
In many children, frequent loose poos are actually caused by constipation with overflow , meaning that a large amount of poo builds up in the bowel and softer poo leaks around it. This can look very similar to diarrhoea at first glance, but the underlying problem and the treatment are completely different. Here are some of the key differences doctors look for.
| Toddler Diarrhoea | Child Constipation | |
|---|---|---|
| Child’s overall health | Usually very well, active, growing normally | May have tummy pain, irritability, reduced appetite |
| Poo pattern | Several loose poos each day | Infrequent large poos, with small loose leaks between, or more than 3 poos a day |
| Poo appearance | Loose or watery, often with undigested food | May alternate between very large (wide) poos and smears or leaks |
| Pain when passing poo | Usually painless | Often painful or uncomfortable |
| Emotional behaviour | No significant changes | Can appear anxious, resistant around toileting |
| Withholding behaviour | Rare | Common (standing stiffly, crossing legs, hiding) |
| Abdominal bloating | Usually absent | Often present |
| Soiling in underwear | Uncommon | Common with overflow |
| Child’s growth | Normal | Usually normal but may have reduced appetite |
Constipation is extremely common in children (1 in 3 children do not have optimal bowel habits or health and are constipated), and many families are surprised to learn that it can actually cause loose poos. If you think your child has constipation symptoms, please download my free poo checker chart or access my free constipation guide.
What toddler diarrhoea actually is
In the medical literature, toddler diarrhoea is defined as:
- 3–6 loose poos per day
- lasting more than three weeks
- occurring in a child who is otherwise well and growing normally.
It most commonly affects children between about 1 and 5 years of age.
Children with this pattern are typically thriving, energetic and developing normally despite the frequent loose poos.
The underlying mechanisms are not fully understood, but research suggests it relates to gut motility and diet interacting together, particularly faster intestinal transit combined with diets that may be relatively low in fat and high in sugars or fluids.
Importantly, this condition is benign (harmless) and self-limiting. Most children simply grow out of it as the gut matures.
Manage, not fix
Once a proper diagnosis has been made, the focus usually shifts away from trying to “solve” the diarrhoea. Instead, it becomes about supporting the gut while making everyday life easier for your child and family.
This mindset change can be very helpful for parents. Instead of constantly worrying that something is wrong, you can understand that your child’s digestive system is simply developing at its own pace.
Practical things that can help
Research and clinical guidance suggest a few simple strategies that often improve symptoms.
1. Adjust drinks
Large amounts of fruit juice or sweet drinks can worsen loose poos because fructose and sorbitol draw water into the bowel. Moving towards mostly water and milk, and limiting fruit juice, can sometimes help.
2. Include healthy fats
Low-fat diets are associated with toddler diarrhoea. Adding normal toddler sources of fat such as full-fat dairy, olive oil, avocado or nut butters, can slow gut transit slightly and help poos become more formed.
3. Expect undigested food
Seeing pieces of sweetcorn, peas or carrot in poos is common. With faster gut transit, food simply passes through before it is fully broken down. While it can look alarming, it is usually completely harmless in children who are otherwise well.
4. Reduce stress around poo
Frequent loose poos can make toileting feel stressful for families, especially if accidents happen. Keeping spare clothes nearby, choosing easy-change clothing, and checking nappies or encouraging toilet visits after meals can make outings and nursery routines easier.
What to say to your child
Young children often sense adult concern around poo, so it helps to use language that normalise the experience, such as “your tummy is still learning how to make poo.” or “sometimes poo is runny when bodies are growing.” and “your tummy will get better at this as you get bigger.”
Keeping the tone calm and matter-of-fact helps children stay relaxed about their bodies.
The reassuring part
Loose poos in toddlers can feel worrying, but in many cases the explanation is simple. After other causes have been ruled out, toddler diarrhoea is usually a temporary stage of gut development. Supporting your child’s digestion, reducing pressure around poo, and remembering that the gut is still learning its rhythm can make this phase much easier to navigate.
And like so many parts of early childhood development, it usually resolves with time.
When to seek further medical advice
While toddler diarrhoea is usually harmless, there are some signs that should always prompt medical review.
Speak to your GP or health professional if your child:
- is not gaining weight or growing normally
- has blood or mucus in the poo
- has persistent abdominal pain
- develops night-time diarrhoea
- seems unwell, tired or lethargic
- has persistent vomiting
- has very pale, greasy or foul-smelling poos
- has diarrhoea lasting more than a few weeks without explanation
These symptoms may suggest a different underlying condition that needs investigation.
References
Kneepkens CMF, Hoekstra JH. Chronic nonspecific diarrhea of childhood: pathophysiology and management.Pediatr Clin North Am. 1996.
Poddar U. Toddler’s diarrhea: Is it an under-recognized entity? J Trop Pediatr. 2013.
Denk L. Diarrhea, Toddler’s. In: Pediatric Gastroenterology Reviews.
Savilahti E. Chronic nonspecific diarrhea in children. Acta Paediatr Scand. 1985.
Thiagarajah JR et al. Advances in evaluation of chronic diarrhea in infants. Gastroenterology. 2018.
Guarino A. Chronic diarrhoea in children. Paediatr Int Child Health. 2012.
Nurse Rebecca Mottram is an advocate for Baby Pottying and a potty training expert. She is the author of two books; The Baby Pottying Guide and Positively Potty, the host of the Go Potty Podcast and founder of the Little Bunny Bear shop. If you are trying to resolve a potty problem, you can explore Rebecca’s free resources, join her Facebook group or request a private consultation.