Diarrhea

Definition

  • The frequency and consistency of stools in children varies with age. Diarrhea is a sudden increase in frequency and looseness of the stool.

Tidbits

  • 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 enough milk.
  • 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 stools.
  • 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 hospitalization.
  • 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.

Call the Doctor immediately if:

  • 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

Call during office hours if:

  • The child is on medicine that may be causing diarrhea or recently completed a course of antibiotics
  • 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

 

Home Treatment

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 breast-feeding.

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 ointments.

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.

Abdominal Pain
Acting Sick
Asthma/Wheezing
Chickenpox
Colds
Constipation
Cough
Croup
Dehydration
Diaper Rash
Diarrhea
Difficulty Breathing
Ear Infection
Eye Infection

Febrile Seizures
Fever
Head Injuries
Head Lice
Normal Temp
Pinworms
Sore Throat
Swimmer's Ear
Vomiting

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