DIARRHEA

Symptom Definition

  • Diarrhea is the sudden increase in the frequency and looseness of BMs (bowel movements, stools).
  • Mild diarrhea is the passage of a few loose or mushy BMs.
  • Severe diarrhea is the passage of many watery BMs.

Cause

  • Usually viral gastroenteritis (viral infection of the stomach and intestines).

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WHEN TO CALL YOUR DOCTOR FOR DIARRHEA

Call 911 Now (your child may need an ambulance) If:

  • Not moving or too weak to stand.

Call Your Doctor Now (night or day) If:

  • Your child looks or acts very sick.
  • Signs of dehydration (e.g. no urine in over 8 hours, no tears with crying and very dry mouth).
  • Blood in the stool.
  • Fever above 104°F (40° C).
  • Age less than 12 weeks with fever above 100.4°F (38° C) rectally.
  • Abdominal pain present more than 2 hours.
  • Vomiting clear liquids 3 or more times.
  • Age less than 1 month with 3 or more large diarrhea stools.
  • Passed more than 8 diarrhea stools in the last 8 hours.
  • Severe diarrhea while taking a medicine that could cause diarrhea (e.g., antibiotics).

Call Your Doctor Within 24 Hours (between 9am and 4pm) If:

  • You think your child needs to be seen.
  • Mucus or pus in the stool for more than 2 days.
  • Loss of bowel control in a toilet trained child occurs 3 or more times.
  • Fever longer than 3 days.
  • Close contact with person and animal who has bacterial diarrhea.
  • Contact with reptile (snake, lizard, turtle) in previous 14 days.

Call Your Doctor During Weekday Office Hours If:

  • You have other questions or concerns
  • Diarrhea persists more than 2 weeks or is a recurrent problem.

Parent Care at Home If:

  • Mild diarrhea, probably viral gastroenteritis and you don't think your child needs to be seen.
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HOME CARE ADVICE FOR DIARRHEA

  1. Mild Diarrhea:  Continue regular diet.  Eat more starchy foods.  Drink more fluids.  (Exception: avoid all fruit juices and soft drinks because they make diarrhea worse.)
  2. Formula-Fed Infants (less than 1 year old) WITH frequent, watery diarrhea:  Start Oral Rehydration Solutions (ORS) (special fluid for diarrhea).
    • ORS (eg, Pedialyte or the store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drug stores
    • Start ORS (Infalyte, KaoLectrolyte or Pedialyte) for frequent, watery diarrhea (note: formula is fine for average diarrhea).
    • Use ORS alone for 4 to 6 hours to prevent dehydration.  Offer unlimited amounts.
    • If ORS not available, use full sterngth formula (unlimited amounts) until you can get some.  Avoid Jello water, sports drinks, or fruit juice.

    Returning to Formula

    • Get back to formula by 6 hours at the latest (reason: needs the calories).
    • Use full-strength formula (reason: it contains adequate water).
    • Offer the 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 longer than 3 days.
    • Extra ORS: also give 2-4 oz. of ORS for every large watery stool.
    • Solids: Infants older than 4 months old continue solid ( eg: rice cereal, strained bananas, mashed potatoes, etc).
  3. Breastfed Infants WITH frequent, watery diarrhea:
    • Continue breastfeeding at more frequent intervals.  Continue solids as for formula-fed.
    • Offer 2-4 oz. ORS between feedings for each large stool (especially if urine is dark)
  4. Older Children (over 1 year old) WITH frequent, watery diarrhea:
    • Offer unlimited FLUIDS: If taking solids, give water or 1/4 strength Kool-Aid or 1/2 strength Gatorade. If refuses solids, give milk or formula.
    • Avoid all fruit juices and soft drinks (reason: make diarrhea worse).
    • ORS is rarely needed, but for severe diarrhea, also give 4-8 oz. of ORS for every large watery stool.
    • Solids: continue solid starchy foods are absorbed best.  Give dried cereals oatmeal, bread, crackers, noodles, mashed potatoes, rice, carrots, applesauce, strained bananas, yogurt, etc.  Pretzels or salty crackers can help meet sodium needs.
    • Yogurt: If > 12 months old, give 2-6 oz. of active culture yogurt twice a day. (Reason: restores healthy bacteria to GI tract.)
  5. Diaper Rash:  Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (e.g. petroleum jelly) around the anus to protect the skin.
  6. Contagiousness:  Your child can return to day 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.
  7. Expected Course:  Viral diarrhea lasts 5-7 days.  Always worse on day 1 and 2.
  8. Call Your Doctor If:
    • Signs of dehydration occur.
    • Diarrhea persists longer than 2 weeks.
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2003

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