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
- Viral gastroenteritis (viral infection of the stomach and intestines) is the usual cause
- Bacteria (e.g., Salmonella or Shigella) cause some diarrhea
- Giardia (a parasite) occasionally, especially in child care centers
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.
Definition of Diarrhea in Breastfed Infants
- The BMs 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 BMs (normally more than 6/day) are not much help. Breastfed babies may normally even pass some green BMs surrounded by a water ring (normal bile can come out green if GI transit time is rapid enough).
- During the first 1 to 2 months of life, the breastfed baby may normally pass a BM after each feeding. (However, if an infant's BMs 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 BMs 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.
When to Call Your Doctor for Diarrhea
Call 911 If…
- Your child is 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 AND over 105° F (40.6° C) by any route or axillary > 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.)
- 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)
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 and diarrhea is more than mild
- 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
- Loose stools are a chronic 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
- 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.
- 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).
- 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.
- 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.
- Solids
- Infants over 4 months old: Continue solids (e.g., rice cereal, strained bananas, mashed potatoes, etc).
- 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.
- 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 bananas, etc. Pretzels or salty crackers can help meet sodium needs.
- 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".
- 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.
- 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.
- 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.
- 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 "When to Call Your Doctor" symptoms.
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: 1/19/2009
Last Revised: 6/12/2008
Copyright 1994-2009 Barton D. Schmitt, M.D.