Diarrhea  

This Care Guide Covers:

  • Diarrhea is the sudden increase in the number and looseness of stools
  • Diarrhea means 2 or more watery or very loose stools.  Reason: 1 loose stool can be normal with changes in diet.

If not, see these topics
When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Not moving
  • Too weak or dizzy to stand
  • You think your child has a life-threatening emergency
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Blood in the stool
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • Constant stomach pain lasts over 2 hours
  • Vomits clear liquids 3 or more times
  • Age under 1 month with 3 or more diarrhea stools
  • Severe diarrhea (10 or more watery stools in the last 24 hours)
  • Fever over 104° F (40° C)
  • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Moderate diarrhea (6 or more watery stools in the last 24 hours)
  • Stomach pains that do not go away after each diarrhea stool
  • Loss of bowel control in a toilet trained child occurs 3 or more times
  • Fever lasts more than 3 days
  • Close contact with person or animal who has bacterial diarrhea
  • Contact with reptile (snake, lizard, turtle) in past 14 days
  • Travel to country at risk for diarrhea within past month
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Diarrhea lasts over 2 weeks
  • Loose stools are a frequent problem
Parent Care at Home If
  • Mild diarrhea (probably caused by a virus)
Causes & Health Information

Causes

  • Virus (such as Rotavirus). An infection of the intestines from a virus is the most common cause.
  • Bacteria (such as Salmonella). Less common cause. Diarrhea often contains streaks of blood.
  • Food-poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
  • Giardia (a parasite). More likely in child care center outbreaks.

Diarrhea Scale

  • Mild: 2-5 watery stools per day
  • Moderate: 6-9 watery stools per day
  • Severe: 10 or more watery stools per day
  • The main risk of diarrhea is dehydration.
  • Loose or runny stools do not cause dehydration.
  • Frequent, watery stools can cause dehydration.

Dehydration: How to Know

  • Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. A weight loss of more than 3% is needed. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.
  • Dehydration is the most important complication of diarrhea.
  • These are signs of dehydration:
  • Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. 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 babies, a depressed or sunken soft spot
  • Slow blood refill test: Longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
  • Fussy, 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. They can also be very dizzy when trying to stand.

Diarrhea in Breastfed Babies: How to Tell

  • Diarrhea in a breastfed baby is sometimes hard to tell.
  • Normal breastfed stools are loose (often runny and seedy). Stools are yellow, but sometimes can be green. The green color is from bile. Runny stools can even be bordered by a water ring. These are all normal stools.
  • Breastfed babies often pass more than 6 stools per day. Until 2 months of age, they may pass a stool after each feeding. But, if stools suddenly increase in number and looseness, suspect diarrhea. If it lasts for 3 or more stools, the baby has diarrhea.
  • If the stools contain mucus, blood or smell bad, this points to diarrhea.
  • Other clues to diarrhea are poor eating, acting sick, or a fever.

Diarrhea in Formula-Fed Infants: How to Tell

  • Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.
  • The stools are yellow in color and thick like peanut butter.
  • Suspect diarrhea if the stools suddenly increase in number or looseness. If it lasts for 3 or more stools, the baby has diarrhea.
  • If the stools contain mucus, blood, or smells bad, this points to diarrhea.
  • Other clues to diarrhea are poor eating, acting sick or a fever.
  • After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They no longer appear to have mild diarrhea.

Return to School

  • Your child can go back to school after the stools are formed. The fever should also be gone. The older child can go back if the diarrhea is mild. The older child also needs to have good control over loose stools.
CARE ADVICE FOR DIARRHEA

  1. What You Should Know:
    • Most diarrhea is caused by a virus.
    • 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:  
    • Keep on a normal diet.  
    • Eat more starchy foods (such as cereal, crackers, rice).
    • Drink more fluids. Formula or milk are good choices for this illness.
    • Do not use fruit juices or soft drinks. Reason: They make diarrhea worse.
  3. Formula-Fed Babies WITH frequent, watery diarrhea: Start Oral Rehydration Solutions (ORS)
    • ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand. It can be bought in food or drug stores.
    • Start ORS for frequent, watery diarrhea. (Note: Formula is fine for mild diarrhea.)
    • Use ORS alone for 4 to 6 hours to prevent dehydration. Offer as much of it as your child will drink.
    • If you don't have ORS, use formula mixed normally until you can get some. Offer as much formula as your child will take.
    • Do not use Jello water, sports drinks, or fruit juice. Reason: They make diarrhea worse.
  4. Going Back to Formula:
    • Go back to formula by 6 hours at the latest. Reason: Your baby needs the calories.
    • Use formula mixed the normal way. Reason: It contains plenty of water.
    • Offer the formula more often than you normally do.
    • Lactose: Regular formula is fine for most diarrhea. Lactose-free formula (soy formula) are only needed for watery diarrhea lasting over 3 days.
    • Extra ORS: Also give 2-4 ounces (60-120 ml) of ORS after every large watery stool. (especially if the urine is dark).
  5. Solids:
    • Babies over 4 months old: Keep on baby foods. If diarrhea is bad, start with cereals.
    • Go back to a normal diet in 24 hours.
  6. Breastfed Infants WITH frequent, watery diarrhea:
    • Keep nursing, but more often.
    • Offer 2-4 ounces (60-120 mls) ORS (such as Pedialyte). Give after all large watery stools (especially if urine is dark). Do this in addition to breastfeeding.
    • Babies over 4 months old: Keep on baby foods. If diarrhea is bad, start with cereals.
  7. Older Children (over 1 year old) WITH frequent, watery diarrhea:
    • Fluids: Offer as much fluid as your child will drink. If taking solids, use water or half-strength Gatorade. If won't eat solids, give milk or formula.
    • Do not use fruit juices and soft drinks. Reason: They make diarrhea worse.
    • ORS (such as Pedialyte) is rarely needed. But, for bad diarrhea, also give 4-8 ounces (120-240ml) of ORS. Do this after all large watery stools (especially if the urine is dark).
    • Solids: Starchy foods are the best.  Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, or rice.  Pretzels or salty crackers can help meet salt needs.
    • Go back to a normal diet in 24 hours.
  8. Probiotics:
    • Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the GI tract.
    • YOGURT is the easiest source of probiotics. If over 12 months old, give 2 to 6 ounces (60 to 180 ml) of yogurt. Do this twice daily. (Note: Today, almost all yogurts are "active culture".)
    • Probiotic supplements can also be bought in health food stores.
  9. Diaper Rash:
    • Wash buttocks after each stool to prevent a bad diaper rash.
    • To protect the skin, use an ointment (such as petroleum jelly). Put it on the skin around the anus.
  10. Return to School:
    • Your child can go back to school after the stools are formed.
    • The fever should also be gone.
    • The older child can go back if the diarrhea is mild.
    • The older child also needs to have good control over loose stools.
  11. What to Expect:
    • Viral diarrhea lasts 5-14 days.
    • Severe diarrhea only occurs on the first 1 or 2 days. But, loose stools can last for 1 to 2 weeks.  
  12. Call Your Doctor If:
    • Signs of dehydration occur
    • Diarrhea lasts over 2 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.