Definition: Diarrhea is defined as stools of a looser consistency that occur at an increased frequency than usual. Diarrhea is a common illness in infants and children. It usually only lasts a short time, and most children have a complete and fairly quick recovery. Diarrhea alone rarely causes dehydration.
Cause: Diarrhea is usually caused by a viral infection of the intestines. This is called gastroenteritis. Rarely bacteria or parasites cause it. Diarrhea can also be due to excessive fruits or fruit juice or to a food allergy. If only one or two loose stools are passed, the cause was probably something your child ate.
Expected course: Diarrhea usually lasts from several days to a week, regardless of treatment. Sometimes loose stools can persist for several weeks in spite of treatment, although we would expect that the stools would be reduced in frequency. During a period of frequent, watery stools, the main goal of treatment is to keep up with the fluids lost in the diarrhea. Since one or two loose stools can mean nothing, don’t start dietary changes until there have been at least two or three loose stools. Diarrhea can be worsened or prolonged by the ingestion of certain foods or fluids.
Stool cultures or other labs are rarely indicated if the diarrhea has been present less than three week unless there is blood in the stool, there is a fever for more than 72 hours along with the diarrhea, or the child appears very sick.
Home Care and Diet
General Home Care
Remember that diarrhea usually lasts only a short amount of time, and doesn’t usually cause complications such as dehydration. Therefore, you can safely treat your child at home. The child’s diet may not need to change if the diarrhea is mild and there is no vomiting. If your infant is breast-feeding, continue to feed on demand. If your child is bottle-fed, continue feeding as usual with full-strength formula. Older children can continue their normal diet but should avoid foods that may make diarrhea worse, such as foods high in fat or sugar.
If diarrhea is more than mild or continues, you may need to follow more specific guidelines as listed below. Also, sometimes it is advised to offer extra fluids to help prevent dehydration in cases of worsening and ongoing diarrhea. In these cases you can offer your child electrolyte solutions such as PEDIALYTE, RICELYTE, LYTREN or KAOLECTROLYTE. There are also generic brands available. These solutions are available in a variety of flavors and freezer pops and can be found at supermarkets, pharmacies and discount stores. You can also make an emergency re-hydration solution at home. Talk to our nurses for the recipe. A child with mild diarrhea and no signs of dehydration does not need these fluids and should be fed a regular diet.
In a breast-fed infant, diarrhea may be diagnosed if your baby’s stools abruptly increase in number. Breast-feeding does not usually need to be discontinued because of mild to moderate diarrhea. If diarrhea is very frequent (hourly or more), call the office for an appointment
If on a milk-based formula, switch to one that is soy-based or lactose-free. Stay on the new formula until stools are normal for
2-3 days, and then gradually switch back to the original formula. If stools are hourly or more, call for an appointment
If your child is 4-6 months old and has already started solid foods
Foods that may help thicken stools are fresh bananas, rice cereal (made with soy formula or water), cooked carrots, squash, yams or potatoes. Bread products are also well tolerated.
Children Two Year of Age and Older
Avoid foods containing lactose. This includes all dairy foods unless you purchase specially labeled “lactose-free” foods. Avoid greasy or spicy foods, and foods high in sugar (including juices, soft drinks and teas).
Common Mistakes in the Treatment of Diarrhea
• Not all clear liquids are good to give to a child with diarrhea, vomiting, or signs of dehydration. Avoid giving clear liquids such as water or weak tea. They don't replace necessary minerals lost from diarrhea and/or vomiting. Also avoid giving apple juice, carbonated drinks, Jell-O water, chicken broth or strong and sugary sports drinks. All of these contain high amounts of sugars or fat that may make diarrhea worse, or they lack important minerals necessary for the infant or child who is dehydrated
• NEVER use boiled skim milk. This can cause serious complications, such as the occurrence of seizures, due to the high salt content.
• Electrolyte solution (such as PEDIATLYE, RICELYTE, KAOLECTROLYTE OR LYTREN) is not only tolerated better, but it also replaces electrolytes in the right proportions needed to prevent problems, and it contains calories that your baby needs. If you give water to a child who is at risk of dehydration, in large amounts, or for extended periods of time, the child may have seizures.
• Resuming lactose-containing foods or fruits/fruit juices too soon can cause diarrhea to flare up again.
• Over the counter medications are not recommended in the treatment of diarrhea in children. Diet therapy and extra fluids work best.
NOTE: If your child is over one year of age and refuses the electrolyte solution, try mixing it half-and-half with Gatorade or some other sports drink or adding part of a Popsicle to the electrolyte solution. If you are unable to get the electrolyte solution, you can use a dilute sports drink instead. Sometimes we have samples of electrolyte solution that we can share. If you need it, please ask us.
Call the Office…
• Your child does not urinate in more than eight hours. It is often easier to tell if your child has urinated if you place a tissue in the diaper to absorb wetness before it soaks into the diaper.
• Crying produces no tears.
• Any blood appears in the diarrhea.
• Constant abdominal pain develops (not intermittent cramping) that lasts for more than four hours.
• The diarrhea is watery and your child vomits the clear liquids three or more times.
• The diarrhea becomes severe (such as a bowel movement every hour for more than eight hours).
• Your child starts acting very ill and listless.
During Regular Office Hours if:
• Mucus or pus appears in the stools.
• A fever over 100 degrees Fahrenheit has been present for more than 72 hours.
• The diarrhea does not improve at all after 48 hours.
• Moderate diarrhea accompanied by intermittent cramping lasts more than one week.
• You have other concerns or questions.