No one enjoys having diarrhea. But it can be especially worrisome when your child has it. Was it something they ate? Or did they catch another round of the stomach bug that seems to be going around?
The cause of diarrhea in kids can vary in severity but many cases can be treated at home. We spoke with Nicole King, MD, a pediatrician with Banner - University Medicine, to learn more about the causes of diarrhea and how to treat it.
What is diarrhea in children?
Diarrhea is loose or watery stools (poops). It often comes with an increase in the need to go (frequency), typically three or more bowel movements a day. But Dr. King said what matters most is a noticeable change in your child’s usual stool pattern.
“Diarrhea can range from loose to watery stools and may also include mucus or blood,” she said. “Even if the number of stools isn’t high, a sudden change from your child’s normal pattern could be diarrhea.”
Babies, especially breastfed infants, naturally have soft stools. One loose stool alone is usually not diarrhea.
You can use tools like the Bristol Stool Form Scale (sometimes called the “Choose Your Poo” chart) to help classify the consistency of their poop.
Causes of diarrhea in children
“Some of the most common causes of diarrhea in all age groups are infections, caused either by viruses or bacterial infections,” Dr. King said.
Viral infections, often called the stomach flu, usually clear up within a few days. Bacterial infections can sometimes happen from contaminated food or water. These infections can be more serious and recovery takes longer.
Common causes by age:
- Infants: Formula sensitivity or food protein intolerance
- Toddlers: Diets high in simple carbohydrates, fructose and sorbitol from high intake of fruit juice
- Older children and teens: Lactose intolerance can develop, interfering with the intestines' ability to digest milk products
Other possible causes include:
- Food allergies
- Certain medications (especially antibiotics)
- Irritable bowel syndrome (IBS)
- Inflammatory bowel disease (IBD), such as Crohn’s or ulcerative colitis
When to consider testing
Diarrhea can be acute (short-term) or chronic (lasting longer than four weeks). Most short-lived cases do not need testing. However, your health care provider may order tests if:
- There is blood or mucus in the stool
- Diarrhea lasts longer than four weeks
- Your child has severe dehydration
- There are other symptoms, like weight loss, rash, joint pain or fatigue
“Testing may include a stool culture or a microscopic stool exam to look for parasites or blood tests to look for IBD, celiac or malabsorptive diseases,” Dr. King said.
Symptoms to watch for
Along with loose, watery stool, your child may experience:
- Belly cramping or pain
- Swelling (bloating)
- Nausea or vomiting
- Urgent need to go poop
- Fever
See your child’s health care provider if your child has:
- Chronic diarrhea
- Diarrhea with fatigue
- Diarrhea with mucus
- Diarrhea with rash or joint pain
Seek urgent care if your child has:
- Bloody diarrhea
- Diarrhea with a high fever (102°F or higher in infants or 103°F or higher in older children)
- Diarrhea with lethargy (decreased wakefulness)
- Diarrhea with severe belly pain
- Weight loss
- Signs of dehydration
Signs of dehydration to watch for
Dehydration is one of the biggest concerns when a child has diarrhea. Diarrhea makes your child lose water and electrolytes, which they need to stay healthy. Here are signs to watch for:
Infants and young children:
- Fewer than three wet diapers in 24 hours
- Dry lips or mouth, no tears when crying
- Sunken soft spot (fontanelle)
- Sunken eyes or cheeks
- Skin that tents (bunches up) when pinched
- Capillary refill of three seconds or more (the time it takes for the skin to return to pink after pressing)
Older children:
- Decreased urination
- Rapid heartbeat or breathing
- Dizziness or fatigue
- Dry lips or mouth
“A big red flag is altered mental status or lethargy (difficult to wake up),” Dr. King said. “Severe dehydration is a medical emergency. Go to the nearest emergency room or call 911.”
[Also read: 5 Tips to Prevent Dehydration When You Have Diarrhea or Vomiting.]
How to treat diarrhea at home
You can do a lot to help your child feel better. Most important is hydration but diet, hygiene and comfort also matter.
1. Keep your child hydrated
Oral rehydration solutions (ORS) such as Pedialyte are the safest way to replace fluids and electrolytes lost through loose, watery stools. Dr. King shared these tips for giving ORS:
- Infants or small children: Give five to 10 milliliters (mL) every five minutes if they cannot drink on their own
- Mild dehydration: Give 50 mL per kilogram (kg) of body weight (to determine your child’s weight in kilograms, divide their weight in pounds by 2.2)
- Moderate to severe dehydration: Give 100 mL per kg of body weight
- After each loose bowel movement: Add 10 mL per kg to replace lost fluids
Avoid fruit juice, sodas or sports drinks, which can make diarrhea worse. Gatorade, Kool-Aid and Coke contain too much sugar and not much salt.
[Also read: Hydration Tips to Ensure Your Child Drinks Enough Water.]
2. Continue to eat usual foods
“You do not need to restrict your child’s diet when they have diarrhea,” Dr. King said. “Let your child eat what they feel like, choosing foods that are gentle on the stomach.”
Easy-to-digest foods include:
- Rice, pasta and crackers
- Bananas and cooked vegetables
- Lean proteins like chicken or eggs
Breastfed babies: Keep breastfeeding; breast milk is ideal.
Formula-fed babies: Continue feeding formula unless your provider indicates otherwise.
3. Keep good hygiene
Diarrhea spreads easily. To prevent germs:
- Wash your hands well after diaper changes or bathroom use
- Clean toys and surfaces your child touches
- Keep your child home from school or daycare until diarrhea improves
4. Be careful with medications
“One serious mistake is treating children with anti-diarrhea medications,” Dr. King said. “These can be dangerous to children and cause more harm than help. Especially in infectious cases, it’s important to allow the infection to clear out on its own.”
For pain or fever, you can use children’s acetaminophen (Tylenol) or ibuprofen (Advil or Motrin), following the proper dose for age and weight.
Antibiotics are usually not needed, except in rare cases of specific bacterial infections like bloody diarrhea caused by certain bacteria.
Prevent diarrhea in the future
You can help prevent future episodes with these steps:
- Encourage regular handwashing for your family.
- Wash fruits and vegetables thoroughly.
- Keep your child up to date on vaccinations, like rotavirus.
- Make sure water is safe to drink, especially when traveling.
Takeaway
Diarrhea is common in children but it can become serious if your child becomes dehydrated or develops other concerning symptoms. With careful attention and supportive care, your child will likely feel better in a few days. Remember, contact your health care provider or a Banner Health specialist if you have questions or concerns.
