Diarrhea is the sudden increase in the frequency and looseness of stools
* The main risk of diarrhea is dehydration
* Loose or runny stools do not cause dehydration
* Frequent, watery stools can cause dehydration
* Viral gastroenteritis (viral infection of the stomach and intestines) is the usual cause
* Bacteria (eg, Salmonella, Shigella) cause some diarrhea. The main food-borne bacteria are Campylobacter, Salmonella, and Escherichia coli.
* Food Poisoning: Rapid onset of vomiting and diarrhea within hours after eating a food contaminated with toxins (eg, cream dishes that are not properly refrigerated). Symptoms usually resolve in fewer than 24 hours without a need for medical care.
* Giardia (a parasite) occasionally, especially in child care centres.
How to Recognize Dehydration:
* Dehydration means that the body has lost excessive fluids, usually from vomiting or diarrhea. An associated weight loss of more than 3% is required. In general, mild diarrhea, mild vomiting, or a mild decrease in fluid intake does not cause dehydration.
* Dehydration is the most important complication of diarrhea
* The following are signs of dehydration:
– Decreased urination (no urine in more than 8 hours) occurs early in the process of dehydration. So does a dark-yellow, concentrated yellow. If the urine is light straw coloured, 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 infants, a depressed or sunken soft spot
– Delayed capillary refill longer than 2 seconds. This refers to the return of a pink color to the thumbnail after you press it and make it pale. Ask your child’s doctor to teach you how to do this test.
– Irritable, tired out, or acting ill. If your child is alert, happy, and playful, he is not dehydrated.
– A child with severe dehydration becomes too weak to stand or very dizzy if he tries to stand.
Definition of Diarrhea in Breastfed Infants:
• The stools 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 stools (normally more than 6 a day) are not much help. Breastfed babies may normally even pass some green stools surrounded by a water ring (normal bile can come out green if intestinal transit time is rapid enough).
* During the first 1 to 2 months of life, the breastfed baby may normally pass a stool after each feeding. (However, if an infant’s stools 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 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 colour and peanut butter in consistency
* Formula-fed newborns have true diarrhea if the stools 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 odour.
* Other clues to diarrhea are poor eating, acting sick, or 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.
Return to School: Your child can return to child 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.
Not moving or too weak to stand
Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:
* Your child looks or acts very sick
* Signs of dehydration (eg, no urine longer than 8 hours, no tears with crying, very dry mouth)
* Blood in the stool
* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)
* Abdominal pain present longer than 2 hours
* Vomiting clear liquids 3 or more times
* Child is younger than 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 (eg, antibiotics)
* Fever above 104°F (40°C) and not improved 2 hours after fever medicine
* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)
Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:
* You think your child needs to be seen
* Pus in the stool present for more than 2 days
* 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 or 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 more than 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
* 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
2. Mild Diarrhea:
* Continue regular diet
* Eat more starchy foods (eg, cereal, crackers, rice)
* Drink more fluids. Formula or milk are good balanced fluids for diarrhea (EXCEPTION: Avoid all fruit juices and soft drinks because they make diarrhea worse)
3. Formula-Fed Infants With Frequent, Watery Diarrhea: Start Oral Rehydration Solution (ORS)
* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.
* Start ORS for frequent, watery diarrhea (Note: formula is fine for average diarrhea)
* Use ORS alone for 4-6 hours to prevent dehydration. Offer unlimited amounts.
* If ORS is not available, use formula prepared in the usual way (unlimited amounts) until you can get some.
* Avoid Jell-O water, sports drinks, and fruit juice
4. Returning to Formula:
* Go back to formula by 6 hours at the latest (Reason: child needs the calories)
* Use formula prepared in the usual way (Reason: it contains adequate water)
* Offer 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 more than 3 days.
* Extra ORS: Also give 2 to 4 oz (30 to 120 mL) of ORS after every large, watery stool
Infants Older Than 4 Months: Continue solids (eg, rice cereal, strained bananas, mashed potatoes).
6. Breastfed Infants With Frequent, Watery Diarrhea:
* Continue breastfeeding at more frequent intervals. Continue solids as for formula fed.
* Offer 2 to 4 oz (60 to 120 mL) ORS (eg, Pedialyte) after every large, watery stool (especially if urine is dark) in addition to breastfeeding.
7. Children Older Than 1 Year With Frequent, Watery Diarrhea:
* Fluids: Offer unlimited fluids. If taking solids, give water or half-strength Gatorade. If child refuses solids, give milk or formula.
* Avoid all fruit juices and soft drinks (Reason: make diarrhea worse)
* ORS (eg, Pedialyte) is rarely needed, but for severe diarrhea, also give 4 to 8 oz (120 to 240 mL) of ORS after every large, watery stool.
* Solids: Starchy foods are absorbed best. Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, or rice. Pretzels or salty crackers can help meet sodium needs.
* Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy bacteria in the gastrointestinal tract.
* Yogurt is the easiest source of probiotics. If your child is older than 12 months, give 2 to 6 oz (60 to 180 mL) of yogurt twice daily (Note: today, almost all yogurts are “active culture”)
* Probiotic supplements in granules, tablets, or capsules are also available in health food stores.
9. Diaper Rash: Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (eg, petroleum jelly) around the anus to protect the skin.
10. Contagiousness: Your child can return to child 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.
11. Expected Course: Viral diarrhea lasts 5 to 14 days. Severe diarrhea only occurs on the first 1 or 2 days, but loose stools can persist for 1 to 2 weeks.
12. Call Your Doctor If:
* Signs of dehydration occur
* Diarrhea persists more than 2 weeks
* Your child becomes worse
Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt