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Diarrhoea is relatively common in young children and usually passes after a day or two.

Cause

There are numerous possible causes of diarrhoea, including food poisoning, but by far the commonest in children is a viral infection, such as in gastroenteritis. Like vomiting, diarrhoea can accompany many infections, both bacterial and viral. Less commonly it may be a signpost to more serious illness such as appendicitis.

Chronic or persistent diarrhoea commonly follows a bout of gastroenteritis, in which case the persistence of the diarrhoea is due to lactose intolerance. The lining of the wall of the bowel is (temporarily) damaged during the bout of gastro, so that it cannot absorb complex sugars (including lactose). Lactose is a component of milk and causes a watery, often sweet smelling diarrhoea which may burn the child’s buttocks. The treatment is a lactose-free milk (unless the child is still breastfed). The condition usually resolves itself within a few weeks as the lining of the bowel wall heals.

Other causes of chronic diarrhoea include Giardia, coeliac disease, and other less common conditions. Some toddlers with chronic diarrhoea may be drinking too much fruit juice. In many toddlers, no cause for the diarrhoea is found (toddler’s diarrhoea).

Clinical features

Diarrhoea is defined as the passage of large, loose, frequent or watery bowel movements. The colour may vary from brown to green, and the smell can be offensive. The most serious problem associated with diarrhoea is the possibility of it leading to dehydration.

Investigations

If the diarrhoea is due to a specific virus, germ or parasite, stool specimens (see p. 51) may reveal which organism is responsible.

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