A Functional Medicine Approach to Loose Stool in Pediatrics

Children 0 to 18 years old will have multiple episodes of loose stool throughout their life. As kids encounter their natural environment, they are bound to pick up a microbe that temporarily disrupts their gut or consume food their stomach does not agree with. A distinguishing factor between these random occurrences and chronic loose stools is how often it happens. When loose stools become a child's regular bowel movement or multiple loose stools occur daily, it's time to get an evaluation and proper care. It's estimated that in the United States, 9% of hospitalizations in children are due to diarrhea. Evaluating the underlying cause and taking preventative measures can assist your child in healthier bowel habits.

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What is Loose Stool?

Your stool should have a solid form and consistency to it. When a bowel movement is soft, mushy, watery, or lacks shape, that is considered loose stool. Often a foul or strong odor can accompany loose stools. There are instances where you can see undigested food, mucous, blood, or color variation in this type of stool.

Loose Stool vs. Diarrhea

Multiple consecutive bouts of loose stools are considered diarrhea. Having three or more episodes of loose stool in a day can be an acute or chronic case of diarrhea. Acute diarrhea results from a pathogenic gut disturbance, antibiotic use, or food poisoning, whereas chronic diarrhea is usually a food allergy, food intolerance, chronic digestive tract infection, or an intestinal disorder.

In children, diarrhea falls into one of four categories. Osmotic diarrhea is when the stool contains undigested and unabsorbable particles, like in the case of lactose intolerance. Secretory diarrhea occurs when there is an excess section of chloride and water, often due to a bacterial infection. Inflammatory diarrhea is caused by inflammatory bowel conditions such as ulcerative colitis or Crohn's disease. Lastly, malabsorptive diarrhea is when stool is loose as a result of decreased absorption. Conditions such as pancreatic insufficiency and short bowel syndrome are known causes of malabsorptive diarrhea.

What Foods Can Cause Loose Stools?

Specific foods can be triggers for loose stools. If your child has a food allergy, sensitivity, or intolerance, that could be causing bowel movement discomfort. Doing an elimination diet or food allergy and sensitivity testing could confirm foods that are disrupting their gastrointestinal tract. Specific food categories that cause loose stools include high-sugar diets, lactose foods like cow's milk, FODMAPs like onions, garlic, legumes, gluten, fatty foods, and caffeine, or foods with spices.

Additional Causes of Loose Stool in Pediatric Population

Loose stool can be a result of acute or chronic issues. Acute episodes can be a result of an isolated incident such as food poisoning, whereas chronic loose stools are related to gastrointestinal disorders, food intolerance, and other medical conditions. If episodic loose stools turn to diarrhea or loose stools become a child's typical bowel movement, you'll want to consider these causative factors.

Food Poisoning and Infections

Pathogenic contaminated food can lead to acute episodes of loose stools. These pathogens infect children through spoiled food, oral/fecal transmission, and poor sanitation. Common conditions associated with this are gastroenteritis caused by viruses, bacterial strains, or parasites. The most common gastrointestinal viral infection in the United States that causes loose stools is Norovirus. Bacterial pathogens that are culprits of gastroenteritis include Campylobacter, E.coli, Salmonella, and C. Diff, while parasitic causes include Giardia and Cryptosporidium.

Toddler Diarrhea

Also known as functional diarrhea, this condition is defined as having more than four loose stools per day. This can begin at six months of age and is a common cause of chronic diarrhea in children ages 1 to 5. It has been correlated to dietary issues such as high carbohydrate content, low fat, high fiber, and excessive fluid intake. Some young children may also be affected if they have an immature digestive tract, resulting in a fast transit time.

Lactose Intolerance

Children who lack the enzyme lactase have an issue digesting lactose. This is the sugar component of milk and milk products, which can cause gut disturbances when your body can not properly digest it. The general onset of lactose intolerance is around age 2, but more commonly seen after five years old. Premature infants can have a developmental lactase deficiency due to an immature GI tract that does not start producing lactase until 34 weeks in utero.

Digestive Disorders

Functional, inflammatory, and infectious gut conditions can all cause loose stools. Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), such as Ulcerative Colitis and Crohn’s disease, all cause loose stool due to inflammation and irritation to the lining of the digestive tract. SIBO, which is Small Intestinal Bacterial Overgrowth, can occur in the pediatric population due to the overuse of PPI drugs, functional gut disorders, or motility issues. Addressing these specific conditions and their root cause would be the best approach to treating the symptom of loose stools.

Medications

Antibiotic use is a leading cause of medication-induced loose stools in children. When kids take an oral antibiotic for a bacterial infection, one side effect could be diarrhea. A study from Turkey assessed the use of antibiotics and antibiotic-associated diarrhea (ADD). They found outcomes varied based on the region, possibly due to nutritional influences on the microbiome. The study found that 10.4% of the participants had ADD, with the highest percentage occurring in those treated with Cephalosporin antibiotics.

Functional Medicine Root Cause Tests for Loose Stool in Children

The following tests may help uncover the root causes of loose stools in children:

Blood Tests

A CBC and a CMP are good baseline tests. These will look at blood count, indicate possible infections, provide electrolyte status that can be associated with diarrhea, and give context to kidney function.

Food Sensitivity and Allergy Testing

Two types of tests can be done to determine if the foods your child is eating are causing loose stools. Alletess Laboratory offers a 184-item Food Sensitivity blood spot test that evaluates IgG immune reactions that can lead to gut disturbances. Infinite Allergy has a test that measures 88 common food antigens for an IgE-mediated Food Allergy response.

Comprehensive Stool Test

Obtaining a stool analysis will reveal if pathogenic microbes are causing inflammation and gut disturbances. Doctor's Data GI360 will test for dozens of bacteria, viruses, and parasites that are correlated to gastroenteritis, IBS, and IBD. These results, combined with a child's clinical picture, can assist your holistic practitioner in addressing the underlying cause of their loose stools.

Lactose Intolerance Test

A test specific to lactose intolerance is the Lactose Malabsorption Breath Test. When lactose can not be properly broken down due to a lack of lactase enzymes, it can cause opportunistic bacteria to grow in the digestive tract. This is an at-home test in which a lactose solution is consumed, followed by a breath collection series. Analysis of hydrogen from the collections will be performed in the lab to determine if high levels are present, indicating lactose intolerance. Breath tests like these can be challenging to complete on young children. In that case, your conventional doctor can order a Stool Acidity Test to determine lactose intolerance.

SIBO Breath Test

Testing for Small Intestinal Bacterial Overgrowth can be done through a 2-Hour Breath Test. This test assesses both methane and hydrogen gases, which in excess, can indicate bacterial overgrowth in the small intestines. This effectively determines causative factors in IBS, IBD, Celiac disease, or infections due to chronic PPI use.

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Further Labs to Check  

Intestinal Imaging

If your child has excessive loose stools leading to chronic diarrhea, they may need a visual investigation. A colonoscopy under anesthesia will examine the colon and the last portion of the small intestines. Biopsies can be done in this procedure if necessary. This is not a first line of investigation but may be recommended by a gastroenterologist if diarrhea is persistent and causation can not be determined otherwise.

Conventional Treatment for Loose Stool in Kids

Rehydration Therapy is the standard of care when loose stools have become diarrhea, and children are experiencing mild to moderate dehydration. Replenishing fluids and electrolytes is essential in these cases. Commercial over-the-counter oral rehydration products are the most commonly used. There are different electrolyte composition recommendations based on the cause of dehydration. But in general, 50 mL of Oral Rehydration Therapy solution per kilogram of body weight should be administered over a four-hour span.

Natural Treatment for Loose Stools in Pediatrics

Acute cases of loose stools do not necessarily need to be treated. This is much like a common cold in kids; it will work itself out. When loose stools become diarrhea or chronic, consider the below options for relief and healing.

What to Eat for Loose Stools?

Kids with loose stools can maintain their normal diet unless the foods they are eating are causing issues. Incorporating foods and monitoring foods that can worsen the situation is helpful. Offering starches that help absorbed fluids in the GI tract can be beneficial. Soluble fiber is a bulk-forming agent that can help reduce loose stools, but if too much is consumed, it can make these bowel movements worse. Soluble fiber food includes oats, flax seeds, apples, beans, and pears. Children should avoid sugary beverages such as fruit juices, sodas, and sports drinks.

To manage or avoid Toddler Diarrhea, you'll want to ensure your child is consuming enough fat in their diet. Children age 3 to 5 years old should have 35-40% fat content in their diet.

Supplements for Loose Stools

Certain supplements can help support the relief of diarrhea. Below are the top supplements recommended:

Digestive Support

Microflora support, along with decreasing inflammation in the gastrointestinal tract, can help with healing. Probiotics are particularly helpful in the prevention of antibiotic-associated diarrhea. The probiotic strain Lactobacillus rhamnosus GG (LGG) shows promising results for the treatment of infectious diarrhea, IBD, and Chronic Ulcerative Colitis.

Curcumin

The herbal extract Curcumin found in Turmeric has historically been used as a natural anti-inflammatory. A small study looking at pediatrics with inflammatory bowel disease reveals promising results with the use of Curcumin as a complementary treatment in conjunction with conventional IBD therapy. The doses used in this study that provided beneficial outcomes were titrated doses. The titration started at 500mg twice a day, then had incremental increases daily after three weeks. Symptoms scores in these patients were recorded at baseline and 9 weeks into treatment. In 3 of the 11 patients, scores reduced drastically, with two going into remission of symptoms.

Low Dose Zinc Sulfate

Historically, 20mg of Zinc has been recommended by the World Health Organization to help with acute diarrhea. A recent study evaluated the use of low dose Zinc Sulfate in 4,500 Tanzania children with acute diarrhea. It found Zinc Sulfate at 5mg had similar effectiveness at reducing loose stools while also eliminating the side effect of vomiting that 20mg can cause. Exploring the use of Zinc during episodes of acute diarrhea could be of value to decreasing your child's discomfort.

Complementary and Integrative Medicine for Loose Stools In Pediatrics

Acupuncture

The utilization of acupuncture in pediatric patients with IBS-D could be helpful. However, most of the evidence is available only in adult populations. For example, there is evidence that acupuncture can benefit adults with IBS-D symptoms. This study revealed that participants who received TCM external therapies such as acupuncture or moxibustion had a significant reduction in abdominal symptoms. Studies specific to pediatric populations would be great to enhance this integrative therapy.

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Summary

Loose stools are a leading cause of gastrointestinal discomfort in the pediatric population. Integrative medicine approaches can help children and families dealing with chronic loose stools. Looking at a child's dietary intake, possible infections, and underlying gut disorders can help determine the root cause of disordered bowel movements. Working with a holistic practitioner is an approach that would benefit a child's long-term health and well-being.