Diarrhea

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DEFINITION

• Diarrhea is the sudden increase in the frequency and looseness of BMs (bowel movements, stools).
• Mild diarrhea is the passage of a few loose or mushy BMs.
• Severe diarrhea is the passage of many watery BMs.

Causes

• Usually viral gastroenteritis (viral infection of the stomach and intestines)
• Also, sometimes caused by bacteria (e.g. Salmonella or Shigella)

Return to School

• Your child can return to day 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.

See More Appropriate Topic (instead of this one) If

• The vomiting is worse than the diarrhea, see VOMITING.
• Blood present and no diarrhea, see STOOLS, BLOOD IN.

WHEN TO CALL YOUR DOCTOR

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

• Not moving or too weak to stand.

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.
• Fever above 105°F (40.6° C).
• Age under 12 weeks with fever above 100.4°F (38.0° C) rectally.
• Abdominal pain present over 2 hours.
• Vomiting clear liquids 3 or more times.
• Age under 1 month with 3 or more large diarrhea stools.
• Passed more than 8 diarrhea stools in the last 8 hours.
• Severe diarrhea while taking a medicine that could cause diarrhea (e.g., antibiotics).

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

• You think your child needs to be seen.
• Mucus or 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 and 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 Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Diarrhea persists over 2 weeks or is a recurrent problem.

Parent Care at Home If

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

HOME CARE ADVICE FOR DIARRHEA

1. Mild Diarrhea:  
   • Continue regular diet.  
   • Eat more starchy foods. (e.g., cereal, crackers, rice). 
   • Drink more fluids.  (EXCEPTION: avoid all fruit juices and soft drinks because they make diarrhea worse.)
2. Formula-Fed Infants (less than 1 year old) 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.
3. 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 oz. of ORS after every large watery stool.
4. Solids:
   • Infants over 4 months old:  Continue solids (e.g. rice cereal, strained bananas, mashed potatoes, etc).
5. Breastfed Infants WITH frequent, watery diarrhea:
   • Continue breastfeeding at more frequent intervals.  Continue solids as for formula-fed.
   • Offer 2-4 oz. ORS after every large watery stool (especially if urine is dark) in addition to breastfeedings.  
6. 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 is rarely needed, but for severe diarrhea, also give 4-8 oz. of ORS after every large watery stool.
   • Solids: Starchy foods are absorbed best.  Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, rice, carrots, applesauce, strained bananast, etc.  Pretzels or salty crackers can help meet sodium needs.
   • Yogurt: If over 12 months old, give 2-6 oz. of active culture yogurt twice a day. (Reason: restores healthy bacteria to GI tract.)
7. 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.
8. Contagiousness: Your child can return to day 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.
9. 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. 
10. 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.