Diarrhea

Symptom Definition

  • Diarrhea is the sudden increase in the frequency and looseness of bowel movements (BMs)
  • Mild diarrhea is the passage of a few loose or mushy BMs
  • Severe diarrhea is the passage of many watery BMs
  • Main cause: viral gastroenteritis (viral infection of the stomach and intestines)

See More Appropriate Topic

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

  • Signs of shock (very weak, limp, not moving, unresponsive, gray skin, etc.)

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Signs of dehydration (e.g. no urine in > 8 hours, no tears with crying and very dry mouth)
  • Blood in the stool
  • Fever > 104°F (4°C)
  • Age less then 12 weeks with fever > 100.4°F (38°C) rectally
  • Abdominal pain present > 2 hours
  • Vomiting clear liquids 3 or more times
  • Age < 1 month with 3 or more large diarrhea stools
  • Passes 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 9 and 4) If

  • You think your child needs to be seen
  • Mucus or pus in the stool for > 2 days
  • Loss of bowel control in a toilet trained child for > 2 days
  • Fever > 3 days
  • Close contact with someone 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 > 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

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:

  • Starting Oral Rehydration Solutions (ORS is a special fluid for diarrhea):
  • Start ORS (Infalyte, KaoLectrolyte or Pedialyte) it there is frequent, watery diarrhea (Note: formula is fine for average diarrhea)
  • Use ORS only for 4 to 6 hours to prevent Dehydration. Offer unlimited amounts of ORS
  • If ORS is not available, use unlimited amounts of formula until you can get ORS.  Avoid Jello, water, and sports drinks
  • Returning to Formula:
  • Get back to formula by 6 hours at the latest (Reason: child needs the calories)
  • Use full-strength formula (Reason: it contains adequate water)
  • Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (milk-based Lactofree or soy formula) are only needed for watery diarrhea persisting > 3 days
  • Extra ORS:you can also give 2-4 oz. of ORS for every large watery stool
  • Infants > 4 months old can also be given rice cereal, strained bananas, mashed potatoes, etc.

3. Breastfed Infants WITH frequent, watery diarrhea:

  • Continue breastfeeding at more frequent intervals. Add solids (see formula-fed above)
  • Offer ORS between feedings if urine production is decreased or dark

4. Older Children (over 1 year old) WITH frequent, watery diarrhea:

  • The choice of solids is the key factor--starchy foods are absorbed best. Give cereals (especially rice cereal), oatmeal, bread, crackers, noodles, mashed potatoes, carrots, applesauce, strained bananas, etc.  Pretzels or salty crackers can help meet sodium needs
  • Fluids: If your child takes solids: use water or 1/2 strength Gatorade.  If your child 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

5. Diaper Rash:  Wash buttocks after each BM 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 and is always worse on day 1 and 2.

8. Call Your Doctor If:

  • Signs of dehydration occur
  • Diarrhea persists > 2 weeks
  • Your child becomes worse or develops any of the “Call Your Doctor” symptoms