Diarrhea

Diarrhea is a sudden increase in the frequency and looseness of bowel movements.  Mild diarrhea is the passage of a few loose or mushy stools.  Moderate diarrhea is many watery stools.  The best indicator of the severity of the diarrhea is its frequency.  The main complication of diarrhea is dehydration from excessive loss of body fluids.  Symptoms of dehydration are a dry mouth, the absence of tears, a reduction in urine production, and darker, concentrated urine.  Diarrhea is usually caused by a viral infection of the intestines but rarely is caused by bacteria or parasites.  Diarrhea can be due to excessive fruit juice or to a food allergy.  If only one or two loose stools are passed, the cause was probably something unusual your child ate.  Diarrhea usually lasts from several days to a week, regardless of the treatment, and the main goal of therapy is to prevent dehydration by giving enough oral fluids to keep up with the fluids lost.  Don’t expect a quick return to solid stools.

Home Care:  Diet 

Dietary changes are the basis of home treatment for diarrhea.  The optimal diet depends on your
child’s age and the severity of the diarrhea.  Go directly to the part that pertains to your child.

Mild Diarrhea and Child of Any Age:

• Continue full strength formula or milk.
• Avoid the intake of fruit juices.
• Avoid raw fruits and vegetables, beans, spicy foods, and any foods that cause loose stools.

Bottle-Fed Infants and Frequent, Watery Diarrhea: 

Children with severe diarrhea need ORS to prevent dehydration.  Examples are Infalyte, Kao-Lectrolyte, or Pedialyte.  These over-the-counter products are available in all pharmacies or supermarkets.  Give as much ORS as your baby wants.  Diarrhea makes children thirsty, and you
should never restrict fluid intake, in order to prevent dehydration. Until you get one of these solutions, continue giving your baby full strength formula in unlimited amounts.  Avoid giving your baby Jell-O water or sports drinks.   Continue giving your baby ORS for at least 6 hours.  Between 6
and 24 hours, switch back to formula when your baby becomes hungry, the diarrhea becomes less
watery, and the child is making lots of urine.
Returning to Formula:  After being given ORS for 6 to 24 hours, your baby will be hungry, so begin her regular formula.  If the diarrhea continues to be severe, begin with a soy or lactose-free formula.  If you give cow’s milk formula and the diarrhea doesn’t improve after 3 days, change to a lactose-free formula.  If you start giving soy formula, plan to keep your baby on the soy formula until the diarrhea is gone for 3 days.  If you baby’s bowel movements are very watery, mix the formula with 1 or 2 ounces of extra water per bottle for 24 hours.  Then go back to full strength formula.
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, has diarrhea for over 24 hours, and wants to eat solid food, give her the following starchy foods until the diarrhea is gone:  any cereal, mashed potatoes, applesauce, strained bananas, strained carrots, and other high-fiber foods. Yogurt is also an excellent food for babies with diarrhea as it gives them all the good bacteria (probiotics) that help restore the gut’s natural balance.

Breast-Fed Infants and Frequent, Watery Diarrhea:
Definition of Diarrhea.  No matter how it looks, the stool of breast-fed infant is considered normal unless it contains mucus, blood or develops a bad odor.  In fact, breast-fed babies can normally pass some green stools or stools with a water ring around them.  Frequency of movements is also not much help.  During the first 2 or 3 months of life, the breast-fed baby may normally have as many stools as one after each feeding.  The presence of something in the mother’s diet that causes rapid passage should always be considered in these babies.  Diarrhea can be diagnosed if your baby’s stools abruptly increase in number, or if your baby feeds poorly, acts sick or has a fever.
Treatment: 

• Continue breast-feeding, but at more frequent intervals.
• If urine production is decreased, offer ORS between breast-feedings for 6 to 24 hours.

Older Children (over 1 year) and Frequent, Watery Diarrhea:

• The choice of solids is the key factor – starchy foods are absorbed best.  Give cereals, oatmeal,bread, noodles, mashed potatoes, carrots, applesauce, strained bananas, etc.  Pretzels or salty crackers can help meet your child’s sodium needs.
• For fluids, use water or if still nursing, breast milk.  If solids are not being consumed, offer ORS, and encourage high fluid intake.
• Avoid all fruit juice or other drinks containing fructose because they usually make diarrhea worse.
• Avoid milk for 2 or 3 days, because lactose is not very easily absorbed.  Active culture yogurt is an excellent choice.

Other Aspects of Home Care:

Probiotics:  Recent studies have shown the use of a probiotic called lactobacillus GG to be safe and effective in the treatment of diarrhea, especially Rotavirus.  Probiotics occur in yogurt “with active cultures” and a commercially available product called Lactinex Granules is available at your pharmacy.  One packet of this product sprinkled on whatever your child is willing to eat 2-3 times per day will shorten the duration of symptoms.

Common Mistakes:  Using boiled skim milk or any concentrated solution can cause serious
complications for babies because they contain too much salt.  Kool-Aid and soda pop should not be
used as the only foods because they contain little or no salt.  Use only the fluids mentioned.  Clear
fluids alone should only be used for 6 to 24 hours because the body needs more calories than they can provide.  Likewise, a diluted formula should not be used for more than 24 hours.  The most dangerous myth is that the intestine should be “put to rest”; restricting fluids can cause dehydration.  Keep in mind that there is no effective, safe drug for diarrhea and that extra water and diet therapy work best.
Prevention:   Diarrhea is very contagious.  Hand washing after diaper changing or using the toilet is crucial for keeping everyone in the family from getting diarrhea.
Diaper Rash from Diarrhea:  The skin near your baby’s anus can become “burned” from the diarrhea stools.  Wash it off 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 quickly after a bowel movement 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 stool.  Use disposable superabsorbent diapers temporarily to cut down on cleanup time.  Use the ones with snug leg bands or cover the others with a pair of plastic pants.  Wash your child under running water in the bathtub.

Call our Office IMMEDIATELY if . . . 

• Any blood appears in the diarrhea.
• Signs of dehydration occur (no urine in more than 8 hours).
• Your child has severe diarrhea (more than 8 bowel movements 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 or listless.
• Note:  If your child has vomited more than once, treatment of the vomiting has priority over the treatment of the diarrhea until your child has gone 8 hours without vomiting.

Call our office during regular hours if . . . 

• A fever lasts more than 3 days.
• Mild diarrhea lasts more than 2 weeks.
• You have other questions or concerns.