Diarrhea

What is diarrhea?

Diarrhea is when your child has frequent, watery stool. There are many different causes of diarrhea. In children, it is most often caused by a virus that infects the lining of the intestines. Other causes include bacterial infection, parasitic infection, food poisoning or medications such as antibiotics. Diarrhea caused by antibiotics is known as antibiotic-associated diarrhea. Diarrhea is also caused by medical conditions that affect how food is absorbed from the intestines.

Signs and symptoms of severe diarrhea

Severe diarrhea can be harmful because it causes dehydration. Dehydration is a loss of fluid in the body. Infants can lose too much fluid very quickly. Other signs may include:

  • dry mouth
  • fewer tears when crying
  • sunken eyes
  • not urinating (peeing) as often as usual
  • dark urine
  • sunken fontanelle (the “soft spot” on the top of the baby’s head) in babies less than a year old
  • low energy

Diarrhea can last up to one week

Diarrhea can last from one to seven days. During this time, give your child plenty of fluids to prevent dehydration. Your child should continue eating to keep healthy. 

How to take care of your child with diarrhea at home

Diarrhea in breastfed babies

During the first few months of life, it is normal for many breastfed babies to have bowel movements with very loose stool. Your baby may be having diarrhea if they have a sudden increase in the number of bowel movements. Other signs of diarrhea include stool that contains mucus or blood. Stool with a very bad smell may also be a sign of diarrhea.  If you think your baby has diarrhea, continue breastfeeding, but offer the feedings more frequently. Do not stop breastfeeding when your baby has diarrhea.

If the diarrhea is very severe or you notice signs of dehydration, you may give your child an oral rehydration solution, such as Pedialyte. Give Pedialyte after or between feedings. The oral rehydration solution should NOT take the place of breast milk. 

If your baby is not taking the breast well, then use a dropper to give either expressed breast milk or oral rehydration solution. Give your baby 1 teaspoon (5 mL) of expressed breast milk or oral rehydration solution every 3 minutes. Increase the amount as tolerated. When your baby has not vomited for 4 hours, try breastfeeding again.

If you need to stop breastfeeding for any reason, make sure to pump your breasts until you can start breastfeeding again. Do not give other types of liquids, such as juice, rice water, sports drinks, tea or homemade drinks to your baby. 

If your baby eats solid foods and has diarrhea, continue with their regular diet.  If your baby is vomiting, give breast milk or oral rehydration solution as described above. When the vomiting has stopped for 4 hours, you may give your baby simple foods. These include foods that are low in sugar and easy to digest, such as cereal or mashed bananas. Babies should be able to go back to their regular diet the next day. 

Diarrhea in formula-fed babies

Formula-fed babies should continue to take their usual formula while they have diarrhea. Do not dilute the formula.

If your baby is not vomiting, give as much formula as your baby needs. Offer feedings more often than usual.

If your baby is vomiting the formula, then use an oral rehydration solution such as Pedialyte or Pediatric Electrolyte. Give your baby 1 teaspoon (5 mL) of oral rehydration solution every 2 to 3 minutes. Continue until your baby is able to tolerate larger amounts without vomiting. Try to give at least 2 to 3 teaspoons for every pound (20 mL for each kilogram) your baby weighs, every hour that they are awake. If your baby has gone 2 hours without vomiting, go back to using formula. Make sure to continue giving small amounts of solution more often.

If your baby continues throwing up their usual formula for more than a day, talk to your doctor. Do not give other types of liquids, such as juice, rice water, sports drinks, tea or homemade solutions.

Diarrhea in babies who eat solid foods

If your baby eats solid foods and has diarrhea, continue with their regular diet.  If your baby is vomiting, give formula or oral rehydration solution as described above. When the vomiting has stopped for at least 4 hours, you may give your baby simple foods. These include foods that are low in sugar and are easy to digest, such as cereal or mashed bananas. Babies should be able to go back to their regular diet the next day.

Diarrhea in toddlers

If the diarrhea is mild, you can limit your child’s intake of juice, ginger ale and other soft drinks. These drinks contain sugars that make the diarrhea worse. Drinks with caffeine, such as colas, also make diarrhea worse.

If the diarrhea is frequent and very watery, give your child plenty of fluids. If your child is showing signs of dehydration, you can give them an oral rehydration solution (such as Pedialyte, Enfalyte or Pediatric Electrolyte). Many children do not like to drink oral rehydration solution because it tastes salty. Children may prefer the solution if it is chilled. Some children enjoy oral rehydration popsicles. You can purchase these at grocery stores and pharmacies.

You may also try adding flavor to the oral rehydration solution by mixing juice with the commercial rehydration solution. Use 1 part juice to 2 parts rehydration solution. If oral rehydration solution is not an option, give your child an electrolyte sports drink like Gatorade. Speak to your doctor before giving these treatments to your child.

If your child is vomiting​, avoid giving them solid foods.  Make sure to give your child plenty of liquids. Give your child 1 or 2 teaspoons of liquid every 5 minutes. Increase the amount as tolerated. If your child has not vomited for over 4 hours, then start giving them solid food again.

Many children are able to digest simple, starchy foods more easily when they have had vomiting or diarrhea. Examples of these foods include cereals, bread, crackers, rice, noodles, potatoes and bananas. Your child should keep eating solid foods while they have diarrhea. Good nutrition will help their recovery.

Diarrhea in children age 3 years and older

If the diarrhea is mild, limit intake of juice, ginger ale and other soft drinks. These drinks contain sugars that make the diarrhea worse. Drinks with caffeine, such as colas, also make diarrhea worse.

If the diarrhea is frequent and very watery, give your child plenty of fluids. Most children over the age of 3 years can be given regular fluids or sports drinks when they have diarrhea.  If your child is showing signs of dehydration, you can give them an oral rehydration solution (such as Pedialyte, Enfalyte or Pediatric Electrolyte). Many children do not like to drink oral rehydration solution because it tastes salty. Children may prefer the solution if it is chilled. Some children enjoy oral rehydration popsicles. You can purchase these at grocery stores and pharmacies.

You may also try adding flavor to the oral rehydration solution by mixing it with juice. Use 1 part juice to 2 parts rehydration solution. If oral rehydration solution is not an option, give your child an electrolyte sports drink like Gatorade.

If your child is vomiting, avoid giving them solid foods. Make sure to give your child plenty of liquids.  Give your child 1 or 2 teaspoons of liquid every 5 minutes. Increase the amount as tolerated. If your child has not vomited for over 4 hours, then start giving them solid food again.

Many children can digest simple, starchy foods more easily when they have had vomiting or diarrhea. Examples of these foods include cereals, bread, crackers, rice, noodles, potatoes and bananas. Your child should keep eating solid foods while they have diarrhea. Good nutrition is an important step in their recovery.

Infectious diarrhea spreads easily

Diarrhea caused by viruses and other infections is very contagious. Wash yours and your child’s hands well with soap and water after every trip to the bathroom or diaper change. 

Treating diaper rash

Diarrhea can be very irritating to the skin of the diaper area. Apply creams or ointments to your child’s skin to reduce diaper rash. Use petroleum jelly (Vaseline) and zinc-containing creams such as Penaten and Ihle’s Paste. Clean your child’s skin immediately after each bowel movement. Then, apply a very thick layer of protective cream.

Do not give medicine for diarrhea unless your doctor says to do so

There are no proven safe and effective medications for diarrhea caused by viruses. In fact, antibiotics can make diarrhea worse. They can interfere with healthy bacteria that live in the gut.

There are many problems with prescription and over-the-counter medications for diarrhea. Some medicine can cause excessive sleepiness, worsen cramping or cause other problems. Others may be unsafe for children.

Do not give your child a medicine for diarrhea without talking to your doctor. In general, the best treatment for diarrhea is to prevent dehydration by giving your child plenty of fluids.

When to see a doctor

Make an appointment with your child's regular doctor if:

  • your child is showing mild signs of dehydration but can drink some fluids
  • your child has been vomiting more than 48 hours
  • your child is less than 3 months of age
  • your child has fever and is greater than 3 months of age
  • your child has mucus in the diarrhea
  • your child has severe diarrhea (more than 8 times per day) for more than 2 days
  • your child has mild diarrhea for more than 2 weeks

Go to the nearest Emergency Department or call 911 if:

  • your child is showing signs of dehydration and is not able to drink fluids
  • your child has vomit or diarrhea that is green or bloody
  • your child has severe abdominal (belly) pain that is getting worse and is not relieved by passing stool
  • your child appears to be very sick
  • your child has a fever and/or diarrhea that does not go away, and is less than 3 months of age

Key points

  • Diarrhea is frequent bowel movements and loose or watery stool.
  • Diarrhea can cause dehydration which can be dangerous.
  • Signs of dehydration include dry mouth, sunken eyes, not peeing often and low energy.
  • When your child has diarrhea, continue with their regular diet. Give plenty of fluids. 
  • If your child is a baby check with the doctor about giving certain fluids.
  • Talk to your doctor before giving your child an oral rehydration solution to prevent dehydration.
  • Talk to your doctor if your child is not able to drink fluids, has blood in their stool, or has pain that does not go away. Talk to your doctor if your child seems to be getting sicker.

Elly Berger, BA, MD, FRCPC, FAAP, MHPE

7/10/2013




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