Tenafly Pediatrics

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