Frequent, loose, stinky stools in a 19 month old

[Monkey Keeper]

For the last couple of months, my toddler has been stooling very frequently--up to 6-8 times a day. The stools are very loose, usually the consistency of soft serve ice cream or maybe yogurt but often are so watery that little to no solids are visible on the diaper.  At the advice of our pediatrician, I eliminated all obvious dairy about a month ago. This improved his rash (he was battling a terrible diaper rash and had a consistent red, bumpy rash around his anus) and also coincided with a huge improvement in his sleep. 

However, the frequent stooling is still going on.Looking closely, I have noticed some mucous in his diapers, though a stool culture came back negative.  I have now eliminated hidden dairy as best I can (it is hard with two other kids with unrestricted diets who share food with him), beginning 2 days ago. I know that it can take quite some time for all of the milk protein to get flushed out. I also started him on probiotics today.

For reference, we eat an omnivorous diet, lots of fresh fruit and veggies and mostly whole grains.

Any thoughts on other causes of his frequent stooling? Thanks!

[lfpalmer]

So, the milk elimination seemed to help. Gosh that is a challenge to have siblings with unrestricted diets around him. Generally, 100% avoidance gives much more improvement than 99%. It's been a couple more days on a stricter no-dairy diet now, hopefully. If he still is not more improved, then there's more sleuthing to do.

The probiotic is a good idea. Most are fermented on milk and can have teeny traces of milk proteins left in them. You may have found or might wish to look for milk-free probiotics, to simplify the picture for now.  

Since he’s most likely sensitive to one food, it’s more likely that other foods are responsible for his continued symptoms. If his symptoms are pretty steady, then it’s likely something he’s getting nearly every day. I would suspect gluten next but it could be anything. It’s easier to try eliminating the most common allergens first, though at his age, if going through the effort of avoiding foods (and policing siblings) it might be easier to just do a full elimination diet.

Do you want some ideas on how to do any of these? Let me know then where you’d like to start. Let me know what he was consuming before solid foods (breastmilk or what kind of formula). It might give some clues.

IgG blood testing can give some hints but it’s not super accurate. There are some other tests as well but unfortunately none are as accurate as we’d like. They all can indicate some foods as allergens when a child is truly fine with them, and they can miss some important allergenic foods. Different children have different kinds of immune system responses. Some show up negative on all the blood or scratch tests while food challenges show absolute food reactions for them.

[Monkey Keeper]

Linda, THANK YOU for your response! We have been nearly 100% dairy free since Tuesday or Wednesday, though I can recall a couple small slips. (I have been dairy, soy, nut and egg free in the past when nursing my 2nd child, so I got pretty good at eliminating!) While the frequency has reduced to 3-4x a day, it still is very runny/watery and noxious.

Originally Posted by lfpalmer 
Let me know what he was consuming before solid foods (breastmilk or what kind of formula). It might give some clues.

He was 100% breast fed until 6m when he began taking table food. I cannot even remember what we started with, but he ate what we ate. I did do fruits/veggies/grains first and then added dairy and finally meat. He nursed until just about 19m; I am pregnant again, and I tend to lose most of my supply when pregnant, so he lost interest. His stooling issues really peaked when he weaned or shortly before as he was getting more cow milk at that point, I think.  He showed NO sensitivity to anything when he was exclusively breastfed, and I am very familiar with the symptoms due to my 2nd child. He was not remotely colicky. The only issue we had was projectile vomiting with Tylenol which we determined to be due to the red dye. We avoided red dye for quite some time but as he got older, artificial colors (as little as we eat them--in candy occasionally) seemed fine.

I am reticent to try a total elim diet without a very strong indication to do so. I would worry about his nutrition since he is no longer nursing and is very specific in his tastes (he eats a lot of things but on certain days only wants particular ones and just won't eat anything else).  He also is pretty light for his height and has gained very little in the last several months, so I worry about him losing weight.

I guess all of this says that we should at least pursue the IgG testing and go from there. 

[Monkey Keeper]

Just to update, we are having continued success with full elimination of diary. He scavenged a cup of milk from one of his sisters late last week and subsequently had gross stool, so we feel pretty confident it is most of the issue.  I also eliminated peanuts and peanut products as there seemed to be a correlation with more stinky/loose stools.  

Our other step was to have the Immunocap profile done. We were at the ped for an unrelated issues, and they are able to do the blood draw on site. Results should be in today or tomorrow, and I am anxious to see if it yields any further clues.

Thank you again.