Definition & Facts

What is chronic diarrhea in children?

Chronic diarrhea is passing loose, watery stools three or more times a day for at least 4 weeks. Children with chronic diarrhea may have loose, watery stools continually, or their diarrhea may come and go. Chronic diarrhea can affect children of any age.

Diarrhea that lasts only a short time is called acute diarrhea. Acute diarrhea, a common problem in children, usually lasts a few days and goes away on its own.

What are the complications of chronic diarrhea in children?

Malabsorption

Certain diseases and conditions that cause chronic diarrhea may cause malabsorption—a condition in which a child’s body can’t absorb nutrients from foods, resulting in shortages of protein, calories, and vitamins. See a list of malabsorption symptoms.

A child who does not absorb enough nutrients from the food he or she eats may become malnourished. Malnourishment during the years when nutrition is important to a child’s normal growth and development can result in health problems.

Dehydration

Chronic diarrhea may lead to dehydration. With diarrhea, especially acute diarrhea, a child’s body loses more fluid and electrolytes in loose stools than solid stools. See a list of dehydration symptoms.

Symptoms & Causes

What are the symptoms of chronic diarrhea in children?

The main symptom of chronic diarrhea in children is passing loose, watery stools three or more times a day for at least 4 weeks.

Depending on the cause, children with chronic diarrhea may also have one or more of the following symptoms:

• bloody stools
• chills
• fever
• loss of control of bowel movements
• nausea or vomiting
• pain or cramping in the abdomen

Chronic diarrhea may cause malabsorption and may lead to dehydration.

What are the symptoms of malabsorption and dehydration in children?

Malabsorption

Symptoms of malabsorption may include

• bloating
• changes in appetite
• gas
• loose, greasy, foul-smelling bowel movements
• weight loss or poor weight gain

Dehydration

Symptoms of dehydration may include

• thirst
• urinating less than usual, or no wet diapers for 3 hours or more
• lack of energy
• dry mouth
• no tears when crying
• decreased skin turgor, meaning that when your child’s skin is pinched and released, the skin does not flatten back to normal right away
• sunken eyes, cheeks, or soft spot in the skull

What causes chronic diarrhea in children?

Common diseases and disorders that cause chronic diarrhea in children include

• infections of the digestive tract
• celiac disease
• functional gastrointestinal (GI) disorders
• food allergies and intolerances
• inflammatory bowel disease
• small intestinal bacterial overgrowth

Infections of the digestive tract

Infections from harmful viruses, bacteria, or parasites sometimes lead to chronic diarrhea. Children may become infected through contaminated water, beverages, or food; or through person-to-person contact. After an infection, some children have problems digesting carbohydrates such as lactose or proteins in foods such as milk, milk products, or soy. These problems can cause prolonged diarrhea—often for up to 6 weeks—after an infection. Also, some bacterial and parasitic infections that cause diarrhea do not go away quickly without treatment.

Read more about infections that cause diarrhea, such as foodborne illnesses and viral gastroenteritis.

Celiac disease

Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye. Gluten is common in foods such as bread, pasta, cookies, and cakes. Celiac disease can cause chronic diarrhea in children of any age.

Functional GI disorders

In functional GI disorders, symptoms are caused by changes in how the digestive tract works. Children with a functional GI disorder have frequent symptoms, yet the digestive tract does not become damaged. Functional GI disorders are not diseases; they are groups of symptoms that occur together.

Two functional GI disorders that cause chronic diarrhea in children are toddler’s diarrhea and irritable bowel syndrome (IBS).

Toddler’s diarrhea
Toddler’s diarrhea—also called functional diarrhea, or chronic nonspecific diarrhea of childhood—is a common cause of chronic diarrhea in toddlers (ages 1 to 3), and preschool-age children (ages 3 to 5). Children with toddler’s diarrhea pass four or more watery or loose stools a day and do not have any other symptoms. They typically are growing well, gaining weight, and are healthy.

Toddler’s diarrhea develops between the ages of 6 months and 3 years, and it usually goes away on its own by the time children begin grade school. Researchers think that drinking too many sugar-sweetened beverages, especially those high in high-fructose corn syrup and sorbitol, may cause toddler’s diarrhea.

IBS
The most common symptoms of IBS are abdominal pain, discomfort, or cramping; along with diarrhea, constipation, or both. The pain or discomfort of IBS typically gets better with the passage of stool or gas. IBS does not cause symptoms such as weight loss, vomiting, or blood in the stool.

IBS is a common cause of chronic diarrhea in grade school-age children and adolescents. Doctors rarely diagnose IBS in younger children because younger children are not able to report symptoms of IBS such as abdominal pain or discomfort.

Food allergies and intolerances

Food allergies, lactose intolerance, fructose intolerance, and sucrose intolerance are common causes of chronic diarrhea.

Food allergies
Milk, milk products, and soy allergies are the most common food allergies that affect the digestive tract in children. Food allergies usually appear in the first year of life. Many children outgrow allergies to milk, milk-products, and soy by age 3. Allergies to other foods such as cereal grains, eggs, and seafood may also affect the digestive tract in children.

Lactose intolerance
Lactose intolerance is a common condition that may cause diarrhea after eating foods or drinking beverages that contain milk or milk products. Low levels of lactase—the enzyme that helps digest lactose—or lactase deficiency, and malabsorption of lactose cause lactose intolerance.

The most common type of lactase deficiency in children develops over time, beginning after about age 2, when a child’s body begins to produce less lactase. Children who have lactase deficiency may not experience symptoms of lactose intolerance until they become older teenagers or adults.

Infants—newborns to age 1—rarely have lactose intolerance at birth. However, premature infants may experience lactose intolerance for a short time after birth. People sometimes mistake milk allergy, which can cause diarrhea in infants, for lactose intolerance.

Fructose intolerance
Fructose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and soft drinks as a sweetener called high-fructose corn syrup. Fructose malabsorption causes fructose intolerance. The amount of fructose that a child’s body can absorb varies. A child’s ability to absorb fructose increases with age. Some children may be able to tolerate more fructose as they get older.

Sucrose intolerance
Sucrose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain sucrose, also known as table sugar or white sugar. Sucrose malabsorption causes sucrose intolerance. Children who are sucrose intolerant lack the enzyme that helps digest sucrose. Most children with sucrose intolerance are better able to tolerate sucrose as they get older.

Inflammatory bowel disease (IBD)

The two main types of IBD are Crohn’s disease and ulcerative colitis. These disorders can affect children at any age. However, they commonly begin in the grade school years or in adolescence.

Small intestinal bacterial overgrowth (SIBO)

SIBO is an increase in the number of bacteria or a change in the type of bacteria in your small intestine. SIBO is often related to diseases that damage the digestive system such as Crohn’s disease.

Diagnosis

How do doctors find the cause of chronic diarrhea in children?

To find the cause of a child’s chronic diarrhea, doctors may use information from the child’s medical and family history, a physical exam, or tests.

Medical and family history

Your child’s doctor will ask you for information about your child’s symptoms, such as

• how long your child has had diarrhea
• how much stool your child passes
• how often your child has diarrhea
• how your child’s stool looks, such as color and consistency
• whether your child has other symptoms along with diarrhea

The doctor will ask about the foods your child eats and beverages he or she drinks. The doctor may recommend keeping a diary of what your child eats and drinks and his or her bowel habits.

Your child’s doctor may also ask about family medical history. Some of the conditions that cause chronic diarrhea, such as Crohn’s disease and ulcerative colitis, run in families.

Physical exam

During a physical exam, a doctor typically

• checks blood pressure and pulse
• checks for symptoms of dehydration and malabsorption
• listens to sounds in your child’s abdomen using a stethoscope
• taps on your child’s abdomen to check for pain or tenderness

What tests do doctors use to find the cause of chronic diarrhea in children?

Doctors may use the following tests to help find the cause of a child’s chronic diarrhea:

Stool test

Stool tests can show the presence of blood and signs of infection, food allergies, and digestive tract problems, such as malabsorption of certain sugars, proteins, or nutrients. A health care professional will give you a container for catching and storing a sample of your child’s stool, along with instructions on where to send or take the sample for testing. A doctor may also do a digital rectal exam to check for blood in your child’s stool.

Blood tests

A health care professional may take a sample of your child’s blood to test for signs of certain diseases or disorders that can cause chronic diarrhea, such as infections or celiac disease.

Hydrogen breath tests

This test measures the amount of hydrogen in a child’s breath. Normally, little hydrogen is found in your child’s breath. However, bacteria break down sugars—such as lactose, fructose, and sucrose—that are not digested by the small intestine and produce high levels of hydrogen. By measuring the amount of hydrogen in your child’s breath, a doctor can diagnose

• lactose intolerance
• fructose intolerance
• sucrose intolerance
• small intestinal bacterial overgrowth (SIBO)

For a lactose intolerance test, your child will drink a beverage that contains a known amount of lactose. For a fructose intolerance test, your child will drink a beverage that contains a known amount of fructose For a sucrose intolerance test, your child will drink a beverage that contains a known amount of sucrose. For a SIBO test, your child will drink a beverage that contains a known amount of sugar. Your child will then breathe into a balloon-type container that measures hydrogen. If the hydrogen level is high, your doctor will diagnose one of these disorders.

Fasting tests

To find out if a food allergy or intolerance is causing your child’s chronic diarrhea, the doctor may recommend that your child avoid foods with lactose, carbohydrates, wheat, or other ingredients to see if a change in diet reduces or stops the diarrhea.

Endoscopy

Your doctor may use endoscopy to look inside your child’s body to help find the cause of his or her chronic diarrhea. Endoscopic procedures include

• colonoscopy
• flexible sigmoidoscopy
• upper gastrointestinal (GI) endoscopy

Treatment

How do doctors treat chronic diarrhea in children?

How doctors treat chronic diarrhea in children depends on the cause. Doctors may be able to reduce or stop chronic diarrhea by treating the cause.

Infections of the digestive tract

Your child’s doctor may prescribe antibiotics to treat bacterial infections and medicines that target parasites to treat parasitic infections. If your child has long-lasting problems digesting certain carbohydrates or proteins after an infection, a doctor may recommend changes in the foods your child eats.

Your child’s doctor may prescribe antibiotics to treat your child’s small intestinal bacterial overgrowth (SIBO) and may recommend changes in what your child eats.

Functional GI disorders

Toddler’s diarrhea
For toddler’s diarrhea, treatment is usually not needed. Most children outgrow toddler’s diarrhea by the time they start school (around age 5). In many children, reducing sugar-sweetened beverages and increasing the amount of fiber and fat in the diet may improve symptoms of toddler’s diarrhea.

Irritable bowel syndrome
A doctor may treat your child’s irritable bowel syndrome with changes in what your child eats and medicines.

Food allergies and intolerances

Food allergies
If your child has a food allergy, his or her doctor will recommend avoiding foods that trigger the allergy. Keeping a diary of what your child eats and drinks and his or her bowel habits will help your child’s doctor find out what foods trigger the allergy.

Celiac disease
If your child has celiac disease, his or her doctor will recommend avoiding all foods and products that contain gluten.

Lactose intolerance
If your child is lactose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain milk or milk products. Most children with lactose intolerance can tolerate some amount of lactose in what they eat or drink. The amount of change needed in what a child eats or drinks depends on how much lactose a child can consume without symptoms. Your child’s doctor may recommend dietary supplements that contain lactase, the enzyme that helps digest lactose. Your child’s doctor may also recommend calcium supplements.

Fructose intolerance
If your child is fructose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain fructose.

Sucrose intolerance
If your child is sucrose intolerant, his or her doctor will recommend reducing or avoiding foods and beverages that contain sucrose.

Inflammatory bowel disease

A doctor may use medicines, surgery, and changes in what your child eats to treat inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis.

Eating, Diet, & Nutrition

How can what a child eats help prevent or treat chronic diarrhea?

Eating, diet, and nutrition play a major role in treating chronic diarrhea in children. Depending on the cause, changing what your child eats can reduce or stop chronic diarrhea. Changing what your child eats may also help manage symptoms of some of the causes of chronic diarrhea. Talk with your child’s doctor before changing what he or she eats. Your child’s doctor or a dietitian can recommend a healthy eating plan that is right for your child.

What should a child with chronic diarrhea eat?

A child with chronic diarrhea should eat foods that may improve symptoms and ensure good nutrition for normal growth and development.

Children whose chronic diarrhea was caused by an infection of the digestive tract should eat the foods they normally eat. If your child has long-lasting problems digesting certain carbohydrates or proteins after an infection, talk with your child’s doctor about what foods your child should eat.

Increasing the amount of fat and fiber your child eats may improve symptoms of toddler’s diarrhea.

What should a child with chronic diarrhea avoid eating?

What foods your child should avoid eating depends on the cause of chronic diarrhea. In general, your child should avoid foods that make symptoms worse.

To find out if certain foods trigger your child’s symptoms, keep a diary and track

• what your child eats each day
• what symptoms your child has
• when the symptoms occur
• what foods make the symptoms worse

Take your notes to your child’s doctor and talk about which foods seem to make your child’s symptoms worse. Your child may need to avoid these foods or eat less of them.

More information on what your child should eat or avoid eating if he or she has chronic diarrhea caused by certain digestive tract problems is available in these NIDDK health topics:

• Celiac Disease
• Crohn’s Disease
• Irritable Bowel Syndrome (IBS) in Children
• Lactose Intolerance
• Ulcerative Colitis

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support basic and clinical research into many diseases and conditions.

What are clinical trials and what role do children play in research?

Clinical trials are research studies involving people of all ages. Clinical trials look at safe and effective new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving quality of life. Research involving children helps scientists

• identify care that is best for a child
• find the best dose of medicines
• find treatments for conditions that only affect children
• treat conditions that behave differently in children
• understand how treatment affects a growing child’s body

Find out more about clinical trials and children.

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.