(See the separate article on vomiting.)
What Is Diarrhea?
Older Children
- Diarrhea is the sudden increase in the number and looseness of stools
- Diarrhea means 2 or more watery stools. Reason: a few loose stools can be normal with changes in diet.
- Most diarrhea is caused by a viral infection of the intestines.
Breastfed Babies
Diarrhea in a breastfed baby is sometimes hard to tell. Normal breastfed stools are loose (often runny and seedy). Stools are yellow, but sometimes can be green. The green color is from bile. Runny stools can even be bordered by a water ring. These are all normal stools.
- Breastfed babies often pass more than 6 stools per day. Until 2 months of age, they may pass a stool after each feeding. But, if stools suddenly increase in number and looseness, suspect diarrhea. If it lasts for 3 or more stools, the baby has diarrhea.
- If the stools contain mucus, blood or smell bad, this points to diarrhea.
- Other clues to diarrhea are poor eating, acting sick, or a fever.
Formula-Fed Babies
Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age. The stools are yellow in color and thick like peanut butter.
- Suspect diarrhea if the stools suddenly increase in number or looseness. If it lasts for 3 or more stools, the baby has diarrhea.
- If the stools contain mucus, blood, or smell bad, this points to diarrhea.
- Other clues to diarrhea are poor eating, acting sick or a fever.
- After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They no longer appear to have mild diarrhea.
Is My Child's Amount of Diarrhea Considered Severe?
Diarrhea Scale
- Mild: 2-5 watery stools per day
- Moderate: 6-9 watery stools per day
- Severe: 10 or more watery stools per day
- The main risk of diarrhea is dehydration.
- Loose or runny stools do not cause dehydration.
- Frequent, watery stools can cause dehydration.
Most of the time mild diarrhea lasts from 3 to 6 days. Sometimes a child will have loose stools for several days more. As long as the child acts well and is drinking and eating enough, parents do not need to worry about loose stools.
How Do I Know if My Child Is Dehydrated?
Older Children
Dehydration means that the body has lost too much fluid. This can happen with vomiting or diarrhea. Mild diarrhea or mild vomiting does not cause this. These are signs of dehydration:
- Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw-colored, your child is not dehydrated.
- Dry tongue and inside of the mouth. If lips are dry but the tongue is moist, this does NOT signal dehydration.
- Dry eyes with decreased or absent tears
- Fussy, tired out, or acting ill. If your child is alert, happy, and playful, they are not dehydrated.
- A child with severe dehydration becomes too weak to stand. They can also be dizzy when trying to stand.
Babies
Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. Mild diarrhea or mild vomiting does not cause this. These are signs of dehydration:
- Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw-colored, your child is not dehydrated.
- Dry tongue and inside of the mouth. If lips are dry but the tongue is moist, this does NOT signal dehydration.
- Dry eyes with decreased or absent tears.
- In babies, a depressed or sunken soft spot.
- Slow blood refill test: Longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
- Fussy, tired out, or acting ill. If your child is alert, happy, and playful, they are NOT dehydrated.
What Causes Diarrhea?
- Virus (such as Rotavirus). An infection of the intestines from a virus is the most common cause. It’s called viral gastroenteritis.
- Bacteria (such as Salmonella). Less common cause. Diarrhea often contains streaks of blood.
- Food-poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
How Do I Prevent Spreading the Diarrhea Illness to Others?
Careful handwashing after using the toilet or changing diapers.
How Do I Care For My Child With Diarrhea?
- Most diarrhea is caused by a virus.
- Diarrhea is the body’s way of getting rid of the germs.
- Your job is to prevent dehydration.
- Here is some care advice that should help.
Mild Diarrhea:
- Keep on a normal diet.
- Drink more fluids (breastmilk or formula for babies)
- Do not give fruit juices or cow's milk. Reason: They can make diarrhea worse.
- Eat more starchy foods (such as cereal, crackers, rice).
Frequent, Watery Diarrhea:
Older Children
- Offer as much fluid as your child will drink.
- If also eating solid foods, water is fine. So is oral rehydration solution (such as Pedialyte), half-strength Gatorade, or half-strength apple juice.
- If not eating solid foods, use oral rehydration solution or half-strength Gatorade as the fluid.
- Caution: Do not use cow's milk, fruit juices, or soda. Reason: They make diarrhea worse.
Breastfed Babies
- Nurse your baby more often.
- Also, give some extra fluid if you think breast milk isn’t keeping up with the fluid losses. You can use formula or oral rehydration solution (see below).
- Solid foods: If on baby foods, continue them. Cereals are best.
-
Oral Rehydration Solutions (ORS) such as Pedialyte to Prevent Dehydration:
- ORS is a special fluid that can help your baby stay hydrated. You can use Pedialyte or the store brand. It can be bought in food stores or drug stores.
- When to use: Start ORS for frequent, watery diarrhea if you think your baby is getting dehydrated. That means passing less urine than normal. Increase fluids using ORS. Also, continue breastfeeding.
- Amount for babies: Give 2-4 ounces (60-120 ml) of ORS after every large watery stool.
- Caution: Do not give ORS as the only fluid for more than 6 hours. Reason: Your baby will need calories and cry in hunger.
Formula-Fed Babies
- Keep giving formula, but feed more often. Offer as much formula as your baby will take.
- Mix formula the normal way. Reason: It contains plenty of water and doesn’t need more.
- Solid foods: If on baby foods, continue them. Cereals are best.
-
Oral Rehydration Solutions (ORS) such as Pedialyte to Prevent Dehydration:
- ORS is a special fluid that can help your baby stay hydrated. You can use Pedialyte or the store brand. It can be bought in food stores or drug stores.
- When to use: Start ORS for frequent, watery diarrhea if you think your baby is getting dehydrated. That means passing less urine than normal. Increase fluids using ORS. Also, continue giving formula.
- Amount for babies: Give 2-4 ounces (60-120 ml) of ORS after every large watery stool.
- Caution: Do not give ORS as the only fluid for more than 6 hours. Reason: Your baby will need calories and cry in hunger.
-
Going Back to Formula:
- Go back to formula by 6 hours at the latest. Reason: Your baby needs the calories.
- Use formula mixed the normal way. Reason: It contains plenty of water.
- Offer the formula more often than you normally do.
- Soy formula: Regular formula is fine for most diarrhea. Lactose-free formula (soy formula) is only needed for watery diarrhea lasting over 3 days.
- Extra ORS: Also give 2-4 ounces (60-120 ml) of ORS after every large watery stool. (Especially if the urine is dark).
Solid Foods:
- Babies over 6 months old: Keep on baby foods. If diarrhea is bad, start with cereals.
- Older children:
- Starchy foods are the best. Reason: easy to digest.
- Give dried cereals, oatmeal, bread, crackers, pasta, mashed potatoes, or rice. Pretzels or salty crackers can help meet salt needs.
- Go back to a normal diet in 24 hours.
Probiotics and Yogurt:
- Probiotics are healthy bacteria (such as Lactobacilli). They may replace harmful bacteria in the gut.
- Probiotics may be helpful in reducing the number of diarrhea stools.
- Yogurt is the easiest source of probiotics. Give 2 to 6 ounces (60 to 180 ml) of yogurt. Do this twice daily. (Note: look for “probiotic” yogurts)
- Probiotic supplements can also be bought in health food stores.
Diaper Rash:
- Wash buttocks after each stool to prevent a bad diaper rash. It may be necessary to get up once during the night to change the diaper.
- To protect the skin, use an ointment (such as petroleum jelly). Put it on the skin around the anus.
What to Expect:
- Viral diarrhea lasts 5-14 days.
- Severe diarrhea only occurs on the first 1 or 2 days. But, loose stools can last for 1 to 2 weeks.
Return to Child Care or Preschool:
- The younger child can go back after the stools are formed.
- The toilet-trained child can go back if the diarrhea is mild. The older child also needs to have good control over loose stools.
- The fever should also be gone.
Contact Your Healthcare Team If:
- Blood in the diarrhea
- Signs of dehydration occur (see above)
- Diarrhea lasts over 2 weeks
- You think your child needs to be seen
- Your child becomes worse
Frequently Asked Questions:
What are electrolyte solutions?
Most children with mild diarrhea do not need electrolyte solutions. Electrolyte solutions are very helpful for the home management of moderately severe diarrhea.
Electrolyte solutions are special fluids that have been designed to replace water and salts lost during diarrhea. Soft drinks (soda, pop), soups, juices, sports drinks, and boiled milk have the wrong amounts of sugar and salt and may make your child sicker.
Do not try to prepare your own electrolyte solutions at home. Use only commercially available fluids—store brand and name brand work the same. Your child’s doctor or pharmacist can tell you what products are available.
DeleteShould a child with diarrhea fast (not eat)?
Fasting is not a treatment for diarrhea. However, some children may benefit from reducing their intake of solid food if they are vomiting. It is appropriate to continue to offer small amounts of fluids, particularly electrolyte solutions, in these cases. As children recover from their illness, it is fine to let them eat as much or as little of their usual diet as they want.
DeleteWhat about the BRAT diet?
The bananas, rice, applesauce, toast (BRAT) diet, once recommended while recovering from diarrhea, is no longer considered useful. Because BRAT diet foods are low in fiber, protein, and fat, the diet lacks enough nutrition to help a child’s gastrointestinal tract recover. Some pediatricians believe that it may actually make symptoms last longer. The AAP now recommends that children resume eating a normal, well-balanced diet appropriate for their age within 24 hours of getting sick. That diet should include a mix of fruits, vegetables, meat, yogurt, and complex carbohydrates.
DeleteWhat about antidiarrheal medicines?
Over-the-counter antidiarrheal medicines are not recommended for children. Always check with your child’s doctor before giving your child any medicine for diarrhea.
Also, do not give your child homemade remedies. Because diarrhea is so common, many different home remedies have been tried through the years. Some of these homemade remedies may not be effective and some may actually make things worse.
DeleteAdapted from AAP Pediatric Education materials.
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