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Diarrhea in Children

Overview

Diarrhea occurs when there is a sudden increase in the frequency of bowel movements, or the bowel movements are more watery and loose than normal. When the lining of your child's intestine is injured or inflamed, the result is diarrhea. Children who have diarrhea caused by a virus may also vomit or have a fever.

Diarrhea has many causes. While almost everyone has diarrhea now and then, it is usually not a cause for concern. There are some things it's important to know about this condition in children:

• Diarrhea is often the body's way of getting rid of the infection or irritant causing the diarrhea.
• If your child has diarrhea, watch him or her closely.
• Children can become dehydrated quickly if they lose too much fluid through diarrhea. Sometimes they cannot drink enough to replace lost fluids.

Every baby or child has different bowel habits.

• Your baby may have as many as 4 to 10 stools a day or as few as 1 every 3 days.
• Many breastfed babies will have a bowel movement with each feeding and sometimes between feedings.
• Nursing babies typically have runny stools.  
• It's normal for there to be some mucus in your baby's stool. 

Unless there is a change in your child's normal habits or you notice signs of dehydration, occasional loose or frequent stools are not a cause for concern.

Causes

Dietary changes

A child may develop diarrhea from a change in his or her diet. A baby or child's digestive tract may not tolerate large amounts of juice, fruit, or milk. Some causes may be:

• A food or milk allergy
• An increase in the amount of juice or fruit your child drinks or eats

Diarrhea caused by a change in your child's diet is not usually serious and will improve as you limit or stop the problem food.

Infection

Diarrhea is the body's way of quickly clearing any viruses, bacteria, or toxins such as botulism from the digestive tract. Viral infections cause most cases of diarrhea and will usually clear up. These infections include rotavirus, stomach flu (gastroenteritis), or food poisoning.

On rare occasions, diarrhea can be a symptom of a more serious condition, such as:

• A problem in the digestive tract, such as inflammatory bowel disease.
• Diseases that interfere with the normal digestion of food (malabsorption), such as cystic fibrosis or celiac disease.
• Parasitic infection such as Giardia lamblia. This parasite, as well as other viral and bacterial infections, may be spread by drinking untreated water or unpasteurized dairy products or by poor hand washing.

Medications

Some medications, especially antibiotics, can cause diarrhea. Giving plain yogurt (if your child tolerates milk) may also help.

Prevention

Avoid untreated water and unpasteurized milk because:

• Untreated water and unpasteurized milk are sources for viral, bacterial, and parasitic infections, such as Giardia lamblia.
• Untreated or unfiltered water from a lake or stream is also a source for infection.
• Even a small amount of untreated water, such as water used to brush teeth, can contain enough parasites, virus, and bacteria to cause diarrhea.

Diarrhea can spread because of poor hygiene. Therefore:

• Practice good hand washing with soap and warm water for 15 to 20 seconds.
• Be sure to wash your hands and your child's hands after each diaper change or trip to the bathroom.
• Teach your child to wash his or her hands after using the bathroom and before every meal.
• Do not place soiled diapers on surfaces that are used to prepare or serve food.
• If your child attends school or daycare, keep your child home until we have determined that the diarrhea is not infectious and cannot be passed to others.

Pro-biotics are not routinely recommended for the prevention of diarrhea. In some circumstances, they may be effective, but please consult with me before giving pro-biotics to your child.

Preventing Food Poisoning

Most cases of food poisoning at home can be prevented by taking a few precautions when preparing and storing food.

• Perishable foods, such as eggs, meats, poultry, fish, shellfish, milk, and milk products, should be treated with extra care.
• Take extra precautions if you have an impaired immune system or a chronic illness, or if you are preparing foods for other high-risk groups, such as young children or older people.

The U.S. Department of Agriculture recommends the following steps:

• Keep hot foods hot and cold foods cold.
• Do not eat meat, dressings, salads, or other foods that have been kept between 40° and 140°F for more than 2 hours.
• If there is a concern about whether or not your refrigerator is working properly, use a thermometer to check it. It should be between 34° and 40°F.
• Defrost meats in refrigerator or microwave, not on kitchen counter.
• Keep the kitchen clean.
• Wash your hands, cutting boards, and counter tops frequently.
• After handling raw meats, especially chicken, wash your hands and utensils before preparing.
• Cook hamburger until it is well done (inside is cooked). Cook chicken until juices run clear.
• Do not eat raw eggs or uncooked sauces made with raw eggs.
• Discard any cans or jars with bulging lids or leaks.
• When in doubt, throw it out.

Home Treatment for Diarrhea

Children, especially those younger than 6 months of age and those with other health risks, need special attention when they have diarrhea because they can quickly become dehydrated. To help prevent problems, carefully observe your child's appearance and how much fluid he or she is drinking.

Signs of dehydration include:

• No tears; a dry mouth and tongue
• Listlessness, lethargy, or extreme irritability
• Little or no urine for 8 hours or dark cola-colored urine
• Skin that is doughy or that does not bounce back when pinched
• A fast heartbeat or rapid breathing
• Difficulty waking up
• Refusal to drink or inability to take in enough liquid to replace lost fluids
• Sunken eyes or a sunken soft spot (on an infant's head)

For babies up to 1 year

• If your baby is breastfed, try to breastfeed more often throughout the day so lost fluids can be replaced. If your baby is formula-fed, offer your baby more bottles throughout the day.
• If signs of dehydration develop, give a children's oral electrolyte solution such as Pedialyte or Enfalyte*(sometimes called a rehydration solution). Give the electrolyte solution orally in addition to regular feedings. You can give the solution a little at a time in a dropper, spoon, or bottle. Do not give oral electrolyte solutions as the only source of fluids for more than 24 hours.
• Do not give your baby sports drinks, juice, or soda. These drinks contain too much sugar and not enough minerals (electrolytes) to replace the ones that are being lost.
• Offer your baby easily digestible foods (cereal, strained bananas, mashed potatoes) if he or she was eating solid food before.
• Protect the baby's diaper area with a thick diaper rash cream or ointment. You can also use zinc oxide cream.

For children 1 to 11 years

• Give ½ cup to 1 cup (4 to 8 oz) of a children's oral electrolyte solution or plain water (if child is eating food) each hour.
• Encourage your child to drink often to prevent dehydration.
• Do not give your child apple juice, chicken broth, sports drinks, soft drinks, or ginger ale. These drinks may make diarrhea worse.
• Your child can eat a variety of foods, as long as they don't make symptoms worse.
• Offer frequent small meals of easily digestible foods (such as cereal, starchy vegetables, toast, applesauce, rice, and eggs.). Avoid foods that are high in sugar or fat, or any foods that seem to make your child's diarrhea worse.
• Do not use an electrolyte solution as the only source of fluids and nutrients for more than 24 hours.

Sometimes, diarrhea will last for 4 to 6 days. As your child gets better, the stools will get smaller and happen less often.

*Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

Caring for Your Child Who Is Experiencing Diarrhea

• Do not withhold food from your child. Studies have shown that children who are fed easily digestible foods have shorter episodes of diarrhea.
• If your child drinks cow's milk, he or she can continue to drink it. Do not give boiled milk.
• Do not give your child prescription or nonprescription medicine to stop diarrhea unless we discuss it first.
• Protect the diaper area with zinc oxide or another cream. Diaper rash is common after diarrhea.
• Wash your hands and your child's hands thoroughly after each diaper change and before each feeding.
• Until we have assured you that your child's diarrhea is not infectious, your child should not attend school or daycare.

To clean diarrhea from hard surfaces, such as a toilet seat or bathroom floor, you can use a diluted chlorine bleach. To make the cleaning solution:

• Mix 5 tablespoons of 6 percent household bleach in 1 gallon of water.
• The solution needs to stay on the surface area for 10 minutes to be effective.
• Let the surface air dry if possible.
• Protect your hands with gloves while using the bleach solution.
• Wash your hands after you are done cleaning up.
• Soiled linens and clothing should be handled as little as possible and washed separately in a hot water cycle as soon as possible.

When to Call Us

If your child is experiencing diarrhea and also has:

• Bloody, tarry, or dark red diarrhea
• Urine that is bloody or brown in color
• A fever of 103°F or higher, or a lower fever for more than 2 days

If your child has signs of dehydration:

• No tears; a dry mouth and tongue
• Is listless, lethargic, or extremely irritable
• Little or no urine for 8 hours or dark cola-colored urine
• Skin that is doughy or that does not bounce back when pinched
• A fast heartbeat or rapid breathing
• A difficult time waking up
• Refusal to drink or inability to take in enough liquid to replace lost fluids
• Sunken eyes or a sunken soft spot on your baby's head

If your child is in pain and:

• Stomach pain is severe.
• Stomach pain is persistent, and there is frequent vomiting for more than 12 hours with little or no diarrhea.
• Stomach pain starts several hours before the vomiting and seems more severe than stomach cramps.
• Stomach pain seems to be in the child's lower right abdomen.

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.