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 > 104oF (4oC)
Age < 12 weeks with fever > 100.4oF (38oC) 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
Mild diarrhea, probably viral gastroenteritis and you don’t think your child needs to be seen
Home Care Advice for Diarrhea
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)
Formula-Fed Infants (less than 1 year old) WITH frequent, watery diarrhea Starting Oral Rehydration Solutions (ORS) (special fluid for diarrhea)
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 formula (unlimited amounts) until you can get some. Avoid Jello water and sports drinks.
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)
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: also give 2-4 oz. of ORS for every large watery stool.
nfants > 4 months old: also give rice cereal, strained bananas, mashed potatoes, etc.
Breastfed Infants WITH frequent, watery diarrhea
Continue breastfeeding at more frequent intervals. Add solids as for formula-fed.
Offer ORS between feedings if urine production is decreased or dark.
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 takes solids, use water or ˝ strength regular Kool-Aid.
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.
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.
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.
Expected Course: Viral diarrhea lasts 5-7 days. Always worse on day 1 and 2.
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
