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Diarrhea

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Does this describe your child's symptoms?

 

Definition

  • Diarrhea is the sudden increase in the frequency and looseness of stools

  • The main risk of diarrhea is dehydration

  • Loose or runny stools do not cause dehydration

  • Frequent, watery stools can cause dehydration

Causes

  • Viral gastroenteritis (viral infection of the stomach and intestines) is the usual cause

  • Bacteria (e.g., Salmonella or Shigella) cause some diarrhea. The main food-borne bacteria are Campylobacter,Salmonella and E.coli.

  • Food-poisoning: Rapid onset of vomiting and diarrhea within hours after eating a food contaminated with toxins (e.g. cream dishes that are not properly refrigerated). The symptoms usually resolve in less than 24 hours without a need for medical care.

  • Giardia (a parasite) occasionally, especially in child care centers

Dehydration: How to Recognize

  • Dehydration means that the body has lost excessive fluids, usually from vomiting and/or diarrhea. An associated weight loss of more than 3% is required. In general, mild diarrhea, mild vomiting or a mild decrease in fluid intake does not cause dehydration.

  • Dehydration is the most important complication of diarrhea.

  • The following are signs of dehydration:

  • Decreased urination (no urine in more than 8 hours) occurs early in the process of dehydration. So does a dark yellow, concentrated yellow. If the urine is light straw colored, your child is not dehydrated.

  • Dry tongue and inside of the mouth. Dry lips are not helpful.

  • Dry eyes with decreased or absent tears

  • In infants, a depressed or sunken soft spot

  • Delayed capillary refill longer than 2 seconds. This refers to the return of a pink color to the thumbnail after you press it and make it pale. Ask your doctor to teach you how to do this test.

  • Irritable, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.

  • A child with severe dehydration becomes too weak to stand or very dizzy if tries to stand.

Definition of Diarrhea in Breastfed Infants

  • The stools of a breastfed infant are normal unless they contain mucus or blood or develop a new bad odor.

  • The looseness (normally runny and seedy), color (normally yellow) and frequency of stools (normally more than 6/day) are not much help.  Breastfed babies may normally even pass some green stools surrounded by a water ring (normal bile can come out green if intestinal transit time is rapid enough). 

  • During the first 1 to 2 months of life, the breastfed baby may normally pass a stool after each feeding.  (However, if an infant's stools abruptly increase in number and looseness and persist for 3 or more stools, the baby probably has diarrhea.) 

  • Other clues to diarrhea are poor eating, acting sick, or a fever.

Definition of Diarrhea in Formula-Fed Infants

  • Formula-fed babies pass 1 to 8 stools per day during the first week, then 1 to 4 per day until 2 months of age. 

  • The stools are yellow in color and peanut butter in consistency. 

  • Formula-fed newborns have true diarrhea if the stools abruptly increase in number or looseness and persist for 3 or more stools, become watery or very runny, contain mucus or blood or develop a new bad odor. 

  • Other clues to diarrhea are poor eating, acting sick or a fever. 

  • After 2 months of age, most infants pass 1 or 2 stools per day (or 1 every other day) and no longer appear to have mild diarrhea.

Return to School

  • Your child can return to child care or school after the stools are formed and the fever is gone.  The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

If not, see these topics

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When to Call Your Doctor

call 911

Call 911 Now (your child may need an ambulance) If

  • Not moving or too weak to stand

call now

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick

  • Signs of dehydration (e.g., no urine over 8 hours, no tears with crying and very dry mouth)

  • Blood in the stool

  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc)

  • Abdominal pain present over 2 hours

  • Vomiting clear liquids 3 or more times

  • Age under 1 month with 3 or more diarrhea stools (mucus, bad odor, increased looseness)

  • Passed more than 8 diarrhea stools in the last 8 hours

  • Severe diarrhea while taking a medicine that could cause diarrhea (e.g., antibiotics)

  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine

  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)

  • You think your child needs to be seen urgently

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen, but not urgently

  • Pus in the stool present for over 2 days

  • Loss of bowel control in a toilet trained child occurs 3 or more times

  • Fever present for more than 3 days

  • Close contact with person or animal who has bacterial diarrhea

  • Contact with reptile (snake, lizard, turtle) in previous 14 days

  • Travel to country at risk for bacterial diarrhea within past month

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Diarrhea persists over 2 weeks

  • Loose stools are a chronic problem

home care

Parent Care at Home If

  • Mild diarrhea (probably viral gastroenteritis) and you don't think your child needs to be seen

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HOME CARE ADVICE FOR DIARRHEA

  1. Reassurance:

    • Most diarrhea is caused by a viral infection of the intestines.

    • Diarrhea is the body's way of getting rid of the germs.

    • Here are some tips on how to keep ahead of the fluid losses.

  2. Mild Diarrhea:  

    • Continue regular diet.  

    • Eat more starchy foods (e.g., cereal, crackers, rice).

    • Drink more fluids. Formula or milk are good balanced fluids for diarrhea. (EXCEPTION: avoid all fruit juices and soft drinks because they make diarrhea worse).

  3. Formula-Fed Infants WITH frequent, watery diarrhea: Start Oral Rehydration Solutions (ORS)

    • ORS (e.g., Pedialyte or the store brand) is a special electrolyte solution that can prevent dehydration. It's readily available in supermarkets and drug stores.

    • Start ORS for frequent, watery diarrhea (Note: Formula is fine for average diarrhea).

    • Use ORS alone for 4 to 6 hours to prevent dehydration. Offer unlimited amounts.

    • If ORS not available, use formula prepared in the usual way (unlimited amounts) until you can get some.

    • Avoid Jello water, sports drinks, or fruit juice.

  4. Returning to Formula

    • Go back to formula by 6 hours at the latest. (Reason: needs the calories)

    • Use formula prepared in the usual way. (Reason: It contains adequate water).

    • Offer the formula more frequently than you normally do.

    • Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (soy formula) are only needed for watery diarrhea persisting over 3 days.

    • Extra ORS: also give 2-4 ounces (60-120 mls) of ORS after every large watery stool.

  5. Solids

    • Infants over 4 months old: Continue solids (e.g., rice cereal, strained bananas, mashed potatoes, etc).

  6. Breastfed Infants WITH frequent, watery diarrhea:

    • Continue breastfeeding at more frequent intervals.  Continue solids as for formula-fed.

    • Offer 2-4 ounces (60-120 mls) ORS (e.g., Pedialyte) after every large watery stool (especially if urine is dark) in addition to breastfeedings.

  7. Older Children (over 1 year old) WITH frequent, watery diarrhea:

    • Fluids: Offer unlimited fluids. If taking solids, give water or half-strength Gatorade. If refuses solids, give milk or formula.

    • Avoid all fruit juices and soft drinks. (Reason: makes diarrhea worse)

    • ORS (e.g., Pedialyte) is rarely needed, but for severe diarrhea, also give 4-8 ounces (120-240ml) of ORS after every large watery stool.

    • Solids: Starchy foods are absorbed best.  Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, rice, etc.  Pretzels or salty crackers can help meet sodium needs.

  8. Probiotics:

    • Probiotics contain healthy bacteria (Lactobacilli) that can replace unhealthy bacteria in the GI tract.

    • YOGURT is the easiest source of probiotics. If over 12 months old, give 2 to 6 oz (60 to 180 ml) of yogurt twice daily. (Note: Today, almost all yogurts are "active culture".)

    • Probiotic supplements in granules, tablets or capsules are also available in health food stores.

  9. Diaper Rash: Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (e.g., petroleum jelly) around the anus to protect the skin.

  10. Contagiousness: Your child can return to child care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

  11. Expected Course: Viral diarrhea lasts 5-14 days. Severe diarrhea only occurs on the first 1 or 2 days, but loose stools can persist for 1 to 2 weeks.

  12. Call Your Doctor If:

    • Signs of dehydration occur

    • Diarrhea persists over 2 weeks

    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Online Medical Reviewer: Louise Akin, RN, BSN
Online Medical Reviewer: Daphne Pierce-Smith, RN, MSN, FNP, CCRC
Last Review Date: 2/21/2012
© 2000-2014 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.