Diarrhea

What is diarrhea?

Diarrhea is the sudden increase in the frequency and looseness of bowel movements (BMs). Mild diarrhea is the passage of a few loose or mushy BMs. Severe diarrhea is the passage of many watery BMs. The best indicator of the severity of the diarrhea is its frequency. Green bowel movements are also a sign of severe diarrhea.

The main complication of diarrhea is dehydration from the loss of too much body fluid. Symptoms of dehydration are a dry mouth, the absence of tears, infrequent urination (for example, none in 8 hours), and a darker, concentrated urine. The main goal of diarrhea treatment is to prevent dehydration.

What is the cause?

Diarrhea is usually caused by viruses that infect the lining of the stomach and intestines (gastroenteritis). Sometimes it is caused by bacteria or parasites. Occasionally a food allergy or drinking too much fruit juice may cause diarrhea. If your child has just one or two loose bowel movements, the cause is probably something unusual your child ate. A diet of nothing but clear fluids for more than 2 days may cause green, watery bowel movements (called "starvation stools").

Why was my child admitted to the hospital?

Your child's diagnosis: ________________________________________

Main complication: ___________________________________________

___ Needs IV fluids

___ Other reason: ___________________________________________

How long does it last?

Diarrhea usually lasts several days to a week, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink or receive enough fluids to replace the fluids lost in the diarrhea. Don't expect a quick return to solid bowel movements.

What are the requirements for discharge?

• _______________________________________________________
• _______________________________________________________
• _______________________________________________________

What should I feed my child?

Increased fluids and dietary changes are the main treatment for diarrhea. Several diets are described below. The right diet for your child depends on the severity of the diarrhea and your child's age. Go directly to the section that pertains to your child.

Note: One loose bowel movement can mean nothing. Don't start dietary changes unless your child has had several loose bowel movements.

BREAST-FED INFANTS

• Special considerations for breast-fed infants

  No matter how they look, the bowel movements of a breast-fed infant must be considered normal unless they contain mucus or blood or develop a bad odor. In fact, breast-fed babies may normally pass some green BMs or BMs with a water ring.

  The frequency of bowel movements is also not much help in deciding whether your breast-fed baby has diarrhea. During the first 2 or 3 months of life, the breast-fed baby may normally have one BM after each feeding. However, if your baby's BMs abruptly increase in number, your baby probably has diarrhea. Other clues are poor eating, acting sick, and a fever.

  Occasionally a mother's diet may cause a breast-fed baby to have more frequent or looser bowel movements. If you suspect this, take any foods you suspect might be causing a problem out of your diet and see what happens. Check with your doctor if you are concerned that a medication you are taking may be giving your baby diarrhea.

• Diet

  Continue breast-feeding but at more frequent intervals. Add solids as described below for formula-fed infants. Don't stop breast-feeding your baby because your baby has diarrhea. For severe (watery and frequent) diarrhea, offer Kao Lectrolyte or Pedialyte between breast-feedings for 6 to 24 hours only if your baby is urinating less frequently than normal.

  You may have to stop breast-feeding temporarily if your baby is too exhausted to nurse and needs intravenous (IV) fluids for severe diarrhea and dehydration. Pump your breasts to maintain milk flow until you can breast-feed again (usually within 12 hours).

FORMULA-FED INFANTS (less than 1 year old)

• Oral glucose-electrolyte solutions for 4 to 6 hours

  If your child has severe diarrhea and also has dark urine or not very much urine, buy an oral electrolyte solution (for example, Kao Lectrolyte or Pedialyte) at your pharmacy or supermarket. (These special solutions are not needed when diarrhea is not severe.) If your child doesn't like the flavor, add a bit of KOOL-Aid powder or 2 drops of NutraSweet. Give as much of the special liquid as your baby wants (at least 10 ml for each pound your child weighs per hour). Diarrhea makes children thirsty, and your job is to satisfy that thirst and prevent dehydration. Never restrict fluids when your child has diarrhea.

  Until you get one of these special solutions, continue giving your baby full-strength formula in unlimited amounts. Avoid giving your baby Jell-O water mixtures or sports drinks (they do not contain enough sodium). Fruit juice will make the diarrhea worse.

  If you aren't able to get an oral glucose-electrolyte solution, ask your provider about making and using a homemade solution as follows: Mix 1/2 cup of dry infant rice cereal with 2 cups (16 ounces) of water and 1/4 level teaspoon of salt. Be careful not to add too much salt (to avoid the risk of salt poisoning).

• Returning to formula

  After being given clear fluids for 4 to 6 hours, your baby will be hungry, so begin giving her full-strength formula. Offer it more frequently than you normally do. If the diarrhea continues to be severe, begin with a soy formula. If you give cow's milk formula and the diarrhea doesn't improve after 3 days, change to a lactose-free formula (a soy formula or milk-based Lactofree). If you start giving soy formula, plan to keep your baby on the soy formula until the diarrhea is gone for 3 days.

• Adding solids

  Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 4 months old and has had diarrhea for over 24 hours, give her the following starchy foods until the diarrhea is gone: any cereal, applesauce, strained bananas, strained carrots, mashed potatoes, and other high-fiber foods.

OLDER CHILDREN (over 1 year old)

• Fluids

  Give your child only water to drink for the first 24 hours of watery diarrhea. (Most toddlers don't need oral glucose-electrolyte solutions such as Pedialyte unless they are dehydrated). On day 2, offer some milk as well as water. Avoid fruit juices because they all make the diarrhea worse.

  Caution: If your child refuses solids, give your child milk or formula rather than water.

• Table foods

  Keep giving your child table foods while he has diarrhea. The choice of food is important. Starchy foods are digested best. Examples of such foods are cereal (especially rice cereal), grains, bread, crackers, rice, noodles, mashed potatoes, carrots, applesauce, and bananas. Pretzels or salty crackers can help meet your child's need for sodium. On the second day of the diarrhea, if your child wants some protein, soft-boiled eggs are usually easily digested.

How can I take care of my child?

• Common mistakes

  Using boiled skim milk or any concentrated solution can cause serious complications for babies with diarrhea because it contains too much salt. KOOL-Aid, soda pop, or water should not be used as the only food because they contain little or no salt. Use only the fluids suggested in the paragraphs appropriate for your child's age.

  Clear fluids alone should be used for only 4 to 6 hours because the body needs more calories than clear fluids can provide. Likewise, a diluted formula is not needed because regular formula contains enough water.

  The most dangerous myth is that the intestine should be "put to rest." Restricting fluids can cause dehydration.

  There is no effective, safe drug for diarrhea. Extra fluids and diet therapy work best.

• Prevention

  Diarrhea is very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea.

• Diaper rash from diarrhea

  The skin near your baby's anus can become irritated by the diarrhea. Wash the area near the anus after each bowel movement and then protect it with a thick layer of petroleum jelly or other ointment. This protection is especially needed during the night and during naps. Changing the diaper soon after bowel movements also helps.

• Overflow diarrhea in a child not toilet-trained

  For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery BM. Use disposable superabsorbent diapers to cut down on cleanup time. Use the diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

• Vomiting with diarrhea

  If your child has vomited more than twice, follow the treatment for vomiting instead of this treatment for diarrhea until your child has gone 8 hours without vomiting.

• Medicines

  For pain or fever over 102°F (39°C) give _____________________________

  ____________________________________________________________

• Additional instructions

  ________________________________________________________________

  ________________________________________________________________

  ________________________________________________________________

When does my child need to be seen again?

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call the doctor if you have any concerns.

When should I call my child's health care provider?

Call IMMEDIATELY if:

• There are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears).
• Any blood appears in the diarrhea.
• The diarrhea is severe (more than 8 BMs in the last 8 hours).
• The diarrhea is watery AND your child also vomits the clear fluids three or more times.
• Your child starts acting very sick.

Call during office hours if:

• Mucus or pus appears in the BMs.
• A fever (over 100°F, or 37.8°C) lasts more than 3 days.
• Mild diarrhea lasts more than 2 weeks.
• You have other concerns or questions.