Should Your Child See a Doctor?
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.
See Other Care Guide If
- Vomiting also along with loose stools. See VOMITING WITH DIARRHEA.
- Blood in the stool, but no loose stools. See STOOLS, BLOOD IN.
- Color of stool not normal, but no loose stools. See STOOLS, UNUSUAL COLOR.
Causes of Acute Diarrhea
- 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.
- Traveler's Diarrhea. Caused by germs in food or drink. Suspect this if it follows recent foreign travel.
- Serious Causes. Most bacterial diarrhea goes away on its own. A few can cause a severe large bowel infection (such as Shigella colitis). C. difficile is a serious cause that can occur after being on strong antibiotics.
- Serious Complication: Dehydration. This is the health problem where the body has lost too much fluid. (See below for more on this).
Causes of Recurrent Diarrhea
- Cow's Milk Allergy. Can cause loose, slimy stools in babies. Can be blood-streaked. Starts within the first 2 months of life. Need to avoid cow's milk formulas.
- Toddler's Diarrhea. Toddlers who pass 3 to 6 sloppy stools per day. Stools may run out of the diaper. Symptoms begin at age 1. Symptoms resolve at age 3 or 4, after toilet trained. Harmless and no impact on growth. Fruit juice makes it worse. The cause is rapid transit time from stomach to anus. May develop irritable bowel syndrome (IBS) in adult years.
- Lactose Intolerance. Lactose is the sugar in milk. Many people cannot absorb lactose. The gut bacteria convert the lactose to gas. The main symptoms are a lot of gas, loose stools and stomach bloating. Onset usually at age 4 or 5. This most often runs in the family (genetic).
- 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.
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
- Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
- Blood in the stool
- 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.)
- Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Call Your Doctor Within 24 Hours If
- 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
- You think your child needs to be seen, but the problem is not urgent
Call Your Doctor During Weekday Office Hours If
- Diarrhea lasts over 2 weeks
- Loose stools are a frequent problem
- You have other questions or concerns
Parent Care at Home If
- Mild diarrhea (probably caused by a virus)
Care Advice for Diarrhea
- What You Should Know About Diarrhea:
Mild Diarrhea - Normal Diet:
- Most diarrhea is caused by a virus.
- Bacterial infections as a cause of diarrhea are not common.
- 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.
Formula-Fed Babies With Frequent, Watery Diarrhea: Start Oral Rehydration Solutions (ORS)
- Keep on a normal diet.
- Eat more starchy foods (such as cereal, crackers, rice).
- Drink more fluids. Formula and/or milk are good choices for this illness.
- Do not use fruit juices or soft drinks. Reason: They make diarrhea worse.
Going Back to Formula:
- 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.
Solids (Baby Foods):
- 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) is 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).
Breastfed Infants With Frequent, Watery Diarrhea - Feed More Often:
- 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.
Older Children (Age over 1 year old) With Frequent, Watery Diarrhea - Offer More Fluids:
- 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 6 months old: Keep on baby foods. If diarrhea is bad, start with cereals.
- 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.
- Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the GI tract.
- Age over 12 months old: Yogurt is the easiest source of probiotics. 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.
Diaper Rash - Prevention:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil). See Dose Tables.
- Note: Fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: Keep your child well hydrated. Give lots of cold fluids.
Return to School:
- Wash buttocks after each stool to prevent a bad diaper rash.
- To protect the skin, use an ointment (such as Vaseline or Desitin). Put it on the skin around the anus.
What to Expect:
- 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.
Call Your Doctor If:
- 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.
- Signs of dehydration occur
- Diarrhea lasts over 2 weeks
- Your child becomes worse
Remember! Contact your doctor if your child develops any of the "When to Call" symptoms.
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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: Barton D. Schmitt, M.D.
Last Reviewed: 1/2/2014
Last Revised: 4/4/2014 11:37:07 AM
Content Set: Child Symptom Checker
Version Year: 2014
Copyright 1994-2014 Barton D. Schmitt, M.D.