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Clinical Reference Systems: Pediatric Advisor 10.0
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Diarrhea

Description

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 dehydration.

Cause

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").

Expected Course

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 babies.)

Note: One loose bowel movement can mean nothing. Don't start dietary changes until your child has had several loose bowel movements.

  1. 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 worse.

      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.

  2. OLDER CHILDREN (over 1 year old) with frequent, watery diarrhea
    • Fluids

      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 digested.

  3. 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 fever.

      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 herbal teas.

    • Diet

      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 12 hours).

  4. 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.

  5. OLDER CHILDREN (over 1 year old) with mild diarrhea (loose BMs)

    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 noodles.
    • Drink more water. Avoid all fruit juices.
    • Eat or drink less milk and milk products for a few days.
    • Avoid beans or any other foods that cause loose bowel movements.

Home Care: Other Aspects

  1. 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 suggested here.

    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 dehydration.

    There is no effective, safe drug for diarrhea. Extra fluids and diet therapy work best.

  2. Prevention

    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 diarrhea.

  3. 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 helps.

  4. 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 bathtub.

  5. 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 without vomiting.

(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 8 hours).
  • 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.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems