Clinical Reference Systems: Pediatric Advisor 10.0
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. The best indicator of the
severity of the diarrhea is its frequency. Green bowel
movements are also a sign of severe diarrhea.
The main complication of diarrhea is dehydration from the
loss of too much body fluid. Symptoms of dehydration are a
dry mouth, the absence of tears, infrequent urination (for
example, none in 8 hours), and a darker, concentrated urine.
The main goal of diarrhea treatment is to prevent
Diarrhea is usually caused by a viral infection of the
lining of the intestines (gastroenteritis). Sometimes it is
caused by bacteria or parasites. Occasionally a food
allergy or drinking too much fruit juice may cause diarrhea.
If your child has just one or two loose bowel movements, the
cause is probably something unusual your child ate. A diet
of nothing but clear fluids for more than 2 days may cause
green, watery bowel movements (called "starvation stools").
Diarrhea usually lasts several days to a week, regardless of
the type of treatment. The main goal of treatment is to
prevent dehydration. Your child needs to drink enough
fluids to replace the fluids lost in the diarrhea. Don't
expect a quick return to solid bowel movements.
Home Care: Diet
Increased fluids and dietary changes are the main treatment
for diarrhea. Several diets are described below. The right
diet for your child depends on the severity of the diarrhea
and your child's age. Go directly to the section that
pertains to your child. (If you are breast-feeding your
child, please refer to the section for breast-feeding
Note: One loose bowel movement can mean nothing. Don't
start dietary changes until your child has had several loose
- FORMULA-FED INFANTS (less than 1 year old) with
frequent, watery diarrhea
- Oral glucose-electrolyte solutions for 4 to 6 hours
If your child has severe diarrhea and dark urine or
not much urine, buy Kao Lectrolyte or Pedialyte at
your pharmacy or supermarket. (These special
solutions are not needed for diarrhea that is not
severe.) If your child doesn't like the flavor, add
a bit of KOOL-Aid powder or 2 drops of Nutrasweet.
Give as much of the liquid as your baby wants. Give
at least 10 ml for every pound your child weighs each
hour. Diarrhea makes children thirsty, and your job
is to satisfy that thirst and prevent dehydration.
Never restrict fluids when your child has diarrhea.
Until you get one of these special solutions,
continue giving your baby full-strength formula in
unlimited amounts. Avoid giving your baby Jell-O
water mixtures or sports drinks (they do not contain
enough sodium). Fruit juice will make the diarrhea
If you aren't able to get an oral glucose-electrolyte
solution, ask your doctor about making a homemade
solution as follows: Mix 1/2 cup of dry infant rice
cereal with 2 cups (16 ounces) of water and 1/4 level
teaspoon of salt. Be careful not to add too much
salt (to avoid the risk of salt poisoning).
- Returning to formula
After being given clear fluids for 4 to 6 hours,
your baby will be hungry, so begin her full-strength
formula. Offer it more frequently than you normally
do. If the diarrhea continues to be severe, begin
with a soy formula. If you give cow's milk formula
and the diarrhea doesn't improve after 3 days, change
to a lactose-free formula (a soy formula or milk-
based Lactofree). Often there is less diarrhea with
soy formulas than with cow's milk formulas because
the soy formulas don't contain milk sugar (lactose).
If you start giving soy formula, plan to keep your
baby on the soy formula until the diarrhea is gone
for 3 days.
- Adding solids
Foods that contain a lot of starch are more easily
digested than other foods during diarrhea. If your
baby is over 4 months old and has had diarrhea for over
24 hours, give her the following starchy foods until
the diarrhea is gone: any cereal, applesauce,
strained bananas, strained carrots, mashed potatoes,
and other high-fiber foods.
- OLDER CHILDREN (over 1 year old) with frequent, watery
A child who is taking table foods doesn't need to get
calories from formula or milk. Give your child water
for the first 24 hours of watery diarrhea. (Most
toddlers don't need oral glucose-electrolyte
solutions such as Pedialyte unless the child is
dehydrated). On day 2, offer some milk as well as
water. Avoid fruit juices, because they usually make
diarrhea worse. If your child refuses solids, give
your child milk or formula rather than water.
- Table foods
Keep giving your child table foods while he has
diarrhea. The choice of food is important. Starchy
foods are digested best. Examples of such foods are
cereal (especially rice cereal), grains, bread,
crackers, rice, noodles, mashed potatoes, carrots,
applesauce and bananas. Pretzels or salty crackers
can help meet your child's need for sodium. On the
second day of the diarrhea, if your child wants some
protein, soft-boiled eggs are usually easily
- BREAST-FED INFANTS with frequent, watery diarrhea
- Definition/special considerations
No matter how they look, the bowel movements of a
breast-fed infant must be considered normal unless
they contain mucus or blood or develop a bad odor.
In fact, breast-fed babies may normally pass some
green BMs or BMs with a water ring.
The frequency of bowel movements is also not much
help in deciding whether your breast-fed baby has
diarrhea. During the first 2 or 3 months of life,
the breast-fed baby may normally have one BM after
each feeding. However, if your baby's BMs abruptly
increase in number, your baby probably has diarrhea.
Other clues are poor eating, acting sick, and a
Remember that something in the mother's diet may
cause a breast-fed baby to have more frequent or
looser bowel movements--for example, coffee, cola, or
If your breast-fed baby has diarrhea, treatment is
straightforward. Continue breast-feeding but at more
frequent intervals. Add solids as described above
for formula-fed infants. Don't stop breast-feeding your
baby because your baby has diarrhea. For severe
(watery and frequent) diarrhea, offer Kao Lectrolyte
or Pedialyte between breast-feedings for 6 to
24 hours only if your baby is urinating less
frequently than normal.
You may have to stop breast-feeding temporarily if
your baby is too exhausted to nurse and needs
intravenous (IV) fluids for severe diarrhea and
dehydration. Pump your breasts to maintain milk flow
until you can breast-feed again (usually within
- FORMULA-FED INFANTS (less than 1 year old) with mild
diarrhea (loose BMs)
Continue a regular diet with a few simple changes. Give
full-strength formula--as much as your baby wants. If
your baby eats solid foods, offer more rice cereal,
mashed potatoes, applesauce, strained bananas, and
strained carrots. Avoid all fruit juices because they
make diarrhea worse.
- OLDER CHILDREN (over 1 year old) with mild diarrhea
Follow a regular diet with a few simple changes:
- Eat more foods containing starch. Starchy foods are
easily digested during diarrhea. Examples are
cereal, breads, crackers, rice, mashed potatoes, and
- Drink more water. Avoid all fruit juices.
- Eat or drink less milk and milk products for a few
- Avoid beans or any other foods that cause loose bowel
Home Care: Other Aspects
- Common mistakes
Using boiled skim milk or any concentrated solution can
cause serious complications for babies with diarrhea
because it contains too much salt. KOOL-Aid, soda pop,
or water should not be used as the only food because
they contain little or no salt. Use only the fluids
Clear fluids alone should be used for only 4 to 6 hours
because the body needs more calories than clear fluids
can provide. Likewise, a diluted formula is not needed
because regular formula contains enough water.
The most dangerous myth is that the intestine should be
"put to rest." Restricting fluids can cause
There is no effective, safe drug for diarrhea. Extra
fluids and diet therapy work best.
Diarrhea is very contagious. Always wash your hands
after changing diapers or using the toilet. This is
crucial for keeping everyone in the family from getting
- Diaper rash from diarrhea
The skin near your baby's anus can become irritated by
the diarrhea. Wash the area near the anus after each
bowel movement and then protect it with a thick layer of
petroleum jelly or other ointment. This protection is
especially needed during the night and during naps.
Changing the diaper quickly after bowel movements also
- Overflow diarrhea in a child not toilet-trained
For children in diapers, diarrhea can be a mess. Place
a cotton washcloth inside the diaper to trap some of the
more watery BM. Use disposable superabsorbent diapers
to cut down on cleanup time. Use the diapers with snug
leg bands or cover the diapers with a pair of plastic
pants. Wash your child under running water in the
- Vomiting with diarrhea
If your child has vomited more than twice, follow the
recommended treatment for vomiting instead of this
treatment for diarrhea until your child has gone 8 hours
(For further information see Vomiting .)
Call Your Physician Immediately If:
- There are signs of dehydration (no urine in more than
8 hours, very dry mouth, no tears).
- Any blood appears in the diarrhea.
- The diarrhea is severe (more than 8 BMs in the last
- The diarrhea is watery AND your child also vomits the
clear fluids three or more times.
- Your child starts acting very sick.
Call Your Physician During Office Hours If:
- Mucus or pus appears in the BMs.
- A fever (over 100ƒF, or 37.8ƒC) lasts more than 3 days.
- Mild diarrhea lasts more than 2 weeks.
- You have other concerns or questions.