Diarrhea

When To Call

Call 911 Now

• Not moving
• Too weak or dizzy to stand
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Blood in the stool
• Constant stomach pain lasts more than 2 hours
• Vomits clear liquids 3 or more times
• Age less than 1 month with 3 or more diarrhea stools in past 24 hours
• Severe diarrhea. 10 or more watery stools in the last 24 hours.
• Fever higher than 104° F (40° C)
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Moderate diarrhea. 6 or more watery stools in the last 24 hours.
• Stomach pains that do not go away after each diarrhea stool
• Loss of bowel control in a toilet trained child occurs 3 or more times
• Fever lasts more than 3 days
• Close contact with person or animal who has bacterial diarrhea
• Contact with reptile (snake, lizard, turtle) in past 14 days
• Travel to country at risk for diarrhea within past month
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Diarrhea lasts more than 2 weeks
• Loose stools are a frequent problem
• You have other questions or concerns

Self Care at Home

• Mild diarrhea (probably caused by a virus)
• Diarrhea disease: how to prevent

Care Advice

Treatment for Mild Diarrhea

What You Should Know About Diarrhea:

• Most diarrhea is caused by a virus.
• Bacterial infections as a cause of diarrhea are not common.
• Diarrhea is the body's way of getting rid of the germs.
• The main risk of diarrhea is dehydration. Dehydration means the body has lost too much fluid.
• Most children with diarrhea don't need to see their doctor.
• Note: 1 or 2 loose stools can be normal with changes in diet. Diarrheal illness means 3 or more watery stools per day.
• Here are some tips on how to keep ahead of the fluid losses.

Mild Diarrhea:

• Most kids with diarrhea can eat a normal diet.
• Drink more fluids to prevent dehydration. Formula, breastmilk and/or regular milk are good choices for diarrhea.
• Do not use fruit juices or full-strength sports drinks. Reason: they can make diarrhea worse.
• Solid foods: eat more starchy foods (such as cereal, crackers, rice, pasta). Reason: they are easy to digest.

Formula-Fed Babies with Frequent, Watery Diarrhea:

• Keep giving formula but feed more often. Offer as much formula as your child will take.
• Mix formula the normal way. Reason: the formula contains plenty of water and doesn't need more.
• Solid foods: if on baby foods, continue them. Cereals are best.

Breastfed Babies with Frequent, Watery Diarrhea:

• Give your baby breastmilk more often.
• Also, give extra fluid if breast milk isn't keeping up with the fluid losses. You can use formula or ORS (Pedialyte).
• Solid foods: if on baby foods, continue them. Cereals are best.

Older Children (age more than 1 year old) with Frequent, Watery Diarrhea:

• Offer as much fluid as your child will drink. If also eating solid foods, water is fine. So is half-strength Gatorade or half-strength apple juice.
• If won't eat solid foods, give milk or formula as the fluid.
• Caution: do not use most fruit juices, full-strength sports drinks or soft drinks. Reason: they can make diarrhea worse.
• Solid foods: starchy foods are easy to digest and best. Offer cereals, bread, crackers, rice, pasta or mashed potatoes. Pretzels or salty crackers will help add some salt to meals. Some salt is good.

Oral Rehydration Solutions (ORS), such as Pedialyte:

• ORS is a special fluid that can help your child 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 child is getting dehydrated. That means passing less urine than normal. Increase fluids using ORS. Continue giving breastmilk, formula or regular milk.
• Amount: for babies, give 2-4 ounces (60-120 mL) of ORS after every large watery stool.
• For children over 1 year old, give 4-8 ounces (120-240 mL) of ORS after every large watery stool. Children rarely need ORS after age 3.
• Caution: do not give ORS as the only fluid for more than 6 hours. Reason: your child will need calories and cry in hunger.

Probiotics:

• Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the gut (stomach).
• Probiotics may be helpful in reducing the number of diarrhea stools.
• Yogurt is the easiest source of probiotics.
• If your child is taking solids (4 to 6 months of age), give 1 to 2 ounces (30 - 60 mL) of plain yogurt twice daily.
• If older than 12 months, give 2 to 6 ounces (60 to 180 mL) of yogurt twice daily. Note: today, almost all yogurts are "active culture."
• Yogurts that are lactose-free may be even more helpful.

Fever Medicine:

• For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil).
• Note: fevers less than 102° F (39° C) are important for fighting infections.
• For all fevers: keep your child well hydrated. Give lots of cold fluids.

Diaper Rash - Prevention:

• Wash buttocks after each stool to prevent a bad diaper rash.
• To protect the skin, use an ointment (such as Vaseline or Desitin). Put it on the skin around the anus.

Return to School:

• Your child can go back to school after the stools are formed.
• The fever should also be gone.
• The older child can go back if the diarrhea is mild.
• The toilet trained child also needs to have good control over loose stools.

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.

Call Your Doctor If:

• Blood in the diarrhea
• Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
• Diarrhea lasts over 2 weeks
• You think your child needs to be seen
• Your child becomes worse

Preventing Diarrhea Disease

Safety Tips in All Countries:

• Hand washing is the key to preventing the spread of infections.
• Always wash the hands before eating, feeding or handling young children or cooking.
• Always wash the hands after any contact with vomit or stools.
• Wash the hands after using the toilet or changing diapers. Help young children wash their hands after using the toilet.
• Cook all poultry fully. Never serve chicken that is still pink inside. Reason: undercooked poultry is a common cause of diarrhea in developed countries.

Extra Safety Tips in Developing Countries:

• Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
• Eat foods that have been fully cooked and that are still hot.
• Dry foods such as bread are usually safe.
• Avoid salads and raw vegetables. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
• Avoid all undercooked meat and fish.
• Avoid buying foods and drinks from street vendors. Reason: this is a common cause of traveler's diarrhea.
• Formula for babies: breastfeed if possible. If not, use premixed formula. If you prepare your own, mix the formula with bottled or boiled water.
• Feeding babies: wash bottles, nipples, spoons and dishes with soap and water. Then sterilize them in boiling water for 5 minutes if possible.
• Brush your teeth with bottled or boiled water.

Call Your Doctor If:

• You have other questions or concerns

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