- The frequency and consistency of stools in children varies with age. Diarrhea is a
sudden increase in frequency and looseness of the stool.
- The main concern with diarrhea is if the child is becoming dehydrated or is acting
sick or if the diarrhea is lasting more than 1 to 2 weeks. A child with two or three
watery stools who is happy and drinking well is not a concern.
- Breast-fed babies have watery stools with some mustard consistency
curd-like material on top. They may also pass some intermittent green stools. They may
have up to 10 to 12 stools per day. If a breast-fed baby is fussy and having persistent
green and more watery stools than normal, this may indicate an infection. A brand new
nursing baby should have 4 to 12 stools per day once mother's milk is "in". If
the baby is only having one or two stools per day, this may mean your baby is not getting
- The majority of diarrheal illnesses are caused by a virus. If there is
blood or mucous in the stools, bacteria may be
a source for the diarrhea. Parasites may also cause diarrhea. Stool
cultures will often be obtained if the diarrhea is present more than one week, if there is
a history of exposure to some bacteria or parasite, or if there is blood or mucous in the
- Diarrhea may also be caused by excess fruit juices, food allergy/intolerance or
medications (especially antibiotics).
- Alert your doctor if you have done any unusual travel, there is a
possibility of food poisoning, there are other contacts
with diarrhea, or the child has been on recent antibiotics.
- Diarrhea due to viruses may last up to a week or sometimes longer. At times, there can
be fluctuation between diarrhea and almost normal stools for a few days.
- "Red currant jelly" stools are a sign of intussusception and
require an immediate call to the physician. See intussusception under vomiting.
- When a child is drinking red colored liquids, the stools may be reddish. If you are not
sure if this is blood or red fluids, your doctor can test this chemically in the office.
Stop giving red fluids and the problem should go away.
- Food poisoning is classically caused by a bacteria called
Staphylococcus aureus. Food, especially dairy and meat products left at room temperature
become contaminated with this bacteria. There is sudden onset, within 1 to 6 hours, of
alot of diarrhea, abdominal cramps and nausea or vomiting. The symptoms improve within 8
to 24 hours. There are other forms of food poisoning like E.coli O157
from undercooked meats where the child may become very ill and have severe, bloody
diarrhea. These children need immediate medical evaluation and may need
- Children are contagious with diarrhea caused by viruses for a day or
two before the onset of diarrhea, and as long as they have diarrhea. Hand washing is key
to reduce passing it on to others.
- Severity of diarrhea varies with the age group. A younger infant will
take less diarrhea production to get dehydrated. Remember that breast-fed infants are
different and have alot more stool production. Keep in mind that other fluid losses like
vomiting and sweating from a fever will add to further fluid loss and increase the risks
of dehydration. These are rough guidelines for severity of diarrhea:
- Mild diarrhea is present if the child is having 3 to 4 stools in 24
hours that are not particularly large in volume.
- Moderate diarrhea is present if the child is having 5 to 6 stools in 24
hours that are of medium volume (not leaking out of the diaper in massive amounts).
- Severe diarrhea is present if the child is having 7 to 8 or greater
stools of large volume that are running down the legs and require a total clothing change.
If the child is having 3 to 4 very large stools, this is probably more moderate
diarrhea and so the volume of each stool is important.
- Signs of severe dehydration
- Bloody diarrhea, especially if more than just specks of blood
- Red, "currant jelly stools"
- Severe, constant abdominal pain
- Listless, lethargic, difficult to arouse or acting sick
- The child is on medicine that may be causing diarrhea or recently completed a course of
- Moderate or severe diarrhea without signs of dehydration
- Mucous or pus in the stool
- Fever for more than 3 days
- Diarrhea for more than 1 week that is mild
- Known ill contacts to bacterial or parasitic cause of diarrhea
- Concerns about food allergy, food poisoning
- Infants under 3 or 4 months
- Home dietary treatment is not helping after 24 hours
Dehydration. When diarrhea and vomiting occur together, the treatment of vomiting takes priority. A child with both of these symptoms,
must be watched closely for dehydration.
Breast-fed infants (under 1 year). Most infants being breast-fed, may continue
to nurse. They often have milder cases of diarrhea. Try to nurse more frequently. Diarrhea
is present if there is an abrupt increase in stools and stools are more watery than
normal. The baby may be offered extra fluids in the form of Pedialyte or Infalyte in
between nursing. If diarrhea is severe, discuss with your doctor before discontinuing
Bottle-fed infants (under 1 year). If diarrhea is mild, formula
or milk should be diluted with extra water or Pedialyte to make the formula 1/4 or 1/2
strength for a few feedings and then may be gradually increased in strength as the baby
tolerates over 2 or 3 days. They may also be supplemented with extra fluids such as
Pedialyte or Infalyte. If diarrhea is moderate, start with Pedialyte or
Infalyte for 2 to 3 feedings, then go to 1/4 to 1/2 strength formula. Do not use Pedialyte
alone for more than 24 hours without discussing with your doctor. Soy formulas or
lactose-free formulas are often used instead of milk-based formulas temporarily to treat
the diarrhea. There presently is one formula for infants with diarrhea called Isomil DF.
This may be used as a temporary formula and when the child is better, you may return to
using the child's usual formula. Avoid fruit juices or jello water. They often aggravate
the diarrhea because of the high sugar content and they don't contain the right balance of
salts to correct losses of salt in diarrhea. Also do not give water alone for rehydration,
because it lacks salt and sugar that the child needs.
Children over 1 year. Pedialyte may be used for fluids, but some children do not
like the taste. Gatorade or other "sports" drinks are another alternative.
Again, avoid fruit juices. Also avoid all dairy products when the child is having
diarrhea. If the child is drinking well and tolerating some solids dairy is not necessary.
Solids. For infants and children on solids, foods such as bananas,
rice or rice cereal, applesauce, toast
or crackers (the BRAT diet) are helpful. Other foods that won't aggravate
the diarrhea include: plain noodles, bland soups, lean meats, potatoes, plain cooked
vegetables. Do not be concerned if your child is not very hungry for solids, if they are
drinking well and staying well-hydrated.
Diaper rash from diarrhea. This is common with
diarrhea and is best treated with ointments such as petroleum jelly or other diaper
Medications. Never use any medications to treat diarrhea unless
your doctor has specifically ordered it. In general, they may not help and may be
dangerous in young children.