Diarrhea

What is it?

Diarrhea means having too many loose or watery bowel movements. Diarrhea can be caused by bacteria, viruses, or ingredients in various foods. Viruses cause most diarrhea, but bacteria cause some of the more dangerous kinds of diarrhea. Diarrhea can also be caused by eating or drinking too much of certain kinds of sugary food or drinks, by over-use of laxatives, and by many antibiotics. Some infants and children have reactions to food components that cause them to have diarrhea.

Most parents are mainly worried about the number of bowel movements and the discomfort that comes with diarrhea. Your doctor is even more concerned about how much fluid your child might lose in the bowel movements. Diarrhea is not dangerous itself, but too much fluid loss produces dehydration. Dehydration happens when not enough water and minerals are left in the child’s circulation. Severe dehydration is rare in the industrialized world, but it can cause organ damage and even death if it is not treated.

Fortunately, the treatment of diarrhea is simple and easy. Most diarrhea in childhood goes away by itself after 2 to 5 days, and does not require any medication at all (in fact, some medications can make matters worse). The main point in treating a child with diarrhea is to keep up with fluids and prevent dehydration. If your doctor has sent your child home, it means that the doctor is confident that your child is not dehydrated now, and that you will be able to keep up with the necessary fluids. Here are a few things that you should do to make sure you are preventing dehydration:

• Avoid giving your child soft drinks of any kind. This includes avoiding ginger ale, soda pop, Kool Aid, HiC, and other drinks that contain a lot of sugar. If your child likes fruit juice, be sure to mix it half-and-half with water (for example, mix 2 ounces of juice with 2 ounces of water). This will keep the sugar level low enough so the diarrhea will not get worse.
• Do give your child an "oral rehydration solution" such as Pedialyte®, Infalyte®, or other electrolyte

  You'll find packets of Oral Rehydration Salts (pure rehydration) and Ceralyte® (rehydration plus reduced diarrhea) in our on-line Store.

  fluids recommended by your doctor. These fluids contain just the right mixture of simple sugar and minerals to help your child’s digestive system absorb as much water as possible.  You may wish to try a cereal-based solution such as Cera-Lyte(R) instead.  Cereal-based oral rehydration solutions do reduce the amount and duration of the diarrhea.
• Do continue to feed your child with whatever s/he normally eats, but avoid foods or snacks that contain a lot of sugar (such as Jell-O or pudding). Foods that help slow down diarrhea are rice, noodles, bread/toast, and other high-starch foods. Toddlers often especially like "Ramen" style noodles.
• Some infants and many toddlers do not like the taste of the "oral rehydration solutions." The most common reason for this is that they are not dehydrated enough to need them (the solutions taste a little salty). If your child is awake and alert, and not fussy or cranky, but refuses to drink the solution, s/he probably does not need it, and you can just use half-strength juice. Many children who refuse standard oral rehydration solutions will take a cereal-based solution such as Cera-Lyte.  If your child is lethargic, sleepy, or irritable, however, call your doctor for advice.

Diarrhea usually goes away in 2-5 days, but it can last up to 7 days. Call your doctor if your child has diarrhea for longer than 7 days.

Dehydration is the main thing to be concerned about. Signs of dehydration depend on the child’s age. In general, a child under one year of age is much more likely to develop dehydration than an older child. Here are the most common signs to look out for:

• Sticky or dry tongue or mouth (dry lips are normal, especially in winter)
• Sunken-appearing eyes
• A sunken fontanel (soft spot)
• Cool or cold hands and feet
• A generally pale appearance of the skin
• Decreased amounts of urine, or a very strong-smelling urine
• Unusual fussiness, irritability, or sleepiness

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant is difficult to awaken or seems unconscious, go directly to the emergency room.

• Vomiting: many infants and children with diarrhea also have vomiting. If vomiting occurs without diarrhea, always call your doctor. This could mean something other than a simple "stomach bug." If your child develops vomiting after a few hours or days of diarrhea, but none of the other signs of dehydration develop, it is usually safe to continue to give the oral liquids and even feedings. Do not stop breastfeeding or giving formula to a vomiting infant. Your doctor may advise you to wait to feed for an hour or so if the child is having a lot of vomiting, but don’t stop for longer than that. In older children, be sure to offer small sips of fluid between episodes of vomiting.
• Fever: many children develop a low fever (up to about 100.5ºF/38ºC) with diarrhea. If your child seems otherwise well and is over 3 months old, there should be little cause for concern. Fever higher than this, or any fever in a baby under 3 months, should be discussed with your child’s doctor.
• Diaper rash: infants and toddlers almost always develop a diaper rash just from having so many wet diapers. You can help to prevent diaper rash by "waterproofing" the diaper area with petroleum jelly (Vaseline® and others) or A&D Ointment®. Apply after every diaper change. Avoid using scented baby wipes if the skin becomes broken, because these may cause pain. If the diaper rash spreads, becomes scaly or very red, check with your doctor. Babies often develop a yeast infection in the diaper area, especially if they are also getting antibiotics.
• Blood in stool: you may see tiny streaks of blood in the stool if there is diaper rash. If there is blood along with strands of mucous, or more than just trace amounts of blood, be sure to call your doctor; some diarrhea caused by bacteria can cause bloody stools and need to be treated.
• Pain: Infants and children with diaper rash frequently cry during and after a bowel movement because of the broken skin in the area. A diaper change and some snuggling should make it better. If the child seems to have more severe abominal pain or has a swollen belly, or if s/he pulls his/her knees up while crying, check with your doctor right away.

There are some conditions that may start off as simply diarrhea, and then turn into something worse. Although these are rare, here are a few things to look out for:

• An unusual strain of a common bacteria called E. coli (or another bacterium called "Shigella") can cause breakdown of red blood cells and kidney damage. This condition is called "HUS." Victims have often eaten meat or poultry that was infected during processing. Symptoms include bloody diarrhea, decreased or absent urine, blood in the urine, and swelling of the face or body. Children with HUS need immediate medical care and may need to have kidney dialysis.
• Children between 1 and 4 years may develop a condition called intussusception ("in-tuh-suh-sep’-shun"), in which the intestinal tract "telescopes" in on itself. This does not usually involve diarrhea, but may cause the child to have red, jelly-like stools. The most common symptom is severe abdominal pain that comes and goes. Children are often "glassy-eyed" or "distant" in between episodes of pain. Call your doctor right away if your child develops these symptoms.
• A single-celled parasite called "Giardia" ("gee-are’-dee-uh") can cause big, soft or watery stools, gas, and abdominal pain. Giardia lives in lakes and streams and is carried by deer and other wild animals. Children often get Giardia after a camping or hiking trip from drinking improperly purified water. Giardia is rarely dangerous, but it will not usually go away without specific medical treatment.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.