From the Guidelines
Excessive stooling in children is most commonly caused by viral gastroenteritis, such as rotavirus or norovirus, which typically resolves within 3-7 days. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, the primary cause of excessive stooling in kids can be attributed to infectious agents, with viral infections being the most frequent. Other causes may include bacterial infections, food intolerances, and certain medical conditions.
Common Causes
- Viral gastroenteritis (like rotavirus or norovirus)
- Bacterial infections from organisms like Salmonella, E. coli, or Shigella
- Food intolerances, particularly lactose intolerance
- Excessive consumption of fruit juices or sorbitol-containing foods
- Antibiotics disrupting normal gut flora
Management
- Preventing dehydration with oral rehydration solutions like Pedialyte (5-10 mL/kg after each loose stool)
- Continuing feeding, especially breast milk for infants
- Probiotics containing Lactobacillus or Saccharomyces boulardii may help reduce duration
- Avoiding anti-diarrheal medications in young children unless specifically prescribed is crucial, as medications like loperamide can decrease the muscular tone and motility of the intestinal wall, but may also increase the risk of adverse events, including ileus, abdominal distension, and lethargy, particularly in children under 3 years old 1.
When to Seek Medical Attention
- Signs of dehydration (decreased urination, dry mouth, lethargy)
- Bloody stools
- High fever
- Severe abdominal pain
- Diarrhea lasting more than 3-4 days, as these may indicate more serious conditions requiring specific treatment.
From the Research
Causes of Excessive Stooling in Children
Excessive stooling in children can be caused by various factors, including:
- Infections, such as viral or parasitic infections, which can lead to conditions like celiac disease (CD) or inflammatory bowel disease (IBD) 2
- Intestinal infections, which can trigger the development of CD or IBD 2
- Vaccinations and use of antibiotics, which can also contribute to the development of CD or IBD 2
- Gluten consumption, which can cause CD in genetically predisposed individuals 2
- Other factors, such as duration of breast-feeding, which can also play a role in the development of CD or IBD 2
Association with Celiac Disease and Inflammatory Bowel Disease
There is evidence to suggest that children with CD or IBD are at a higher risk of developing excessive stooling:
- A systematic review and meta-analysis found an increased risk of CD in patients with IBD, and an increased risk of IBD in patients with CD 3
- A nationwide register-based cohort study found a bidirectional association between CD and IBD, with a higher risk of developing IBD in patients with CD, and a higher risk of developing CD in patients with IBD 4
- The study also found that the diagnostic interval between CD and IBD was usually less than 1 year, but the risk of developing the other condition remained high even after 10 years of follow-up 4
Possible Underlying Mechanisms
The exact mechanisms underlying the association between CD, IBD, and excessive stooling are not fully understood, but may involve: