Diarrhea: Children (age 3 and older)

What is diarrhea?

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.

The main complication of diarrhea is dehydration from the loss of too much body fluid. Symptoms of dehydration are dry mouth, absence of tears, infrequent urination (for example, none in 12 hours), and a darker, concentrated urine. The main goal of diarrhea treatment is to prevent dehydration.

What is the 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 two days may cause green, watery bowel movements (called "starvation stools").

How long will it last?

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.

What Should I feed my child?

Increased fluids and dietary changes are the main treatment for diarrhea.

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

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 cerreal, 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.

Severe diarrhea

• Fluids - Encourage your child to drink lots of fluids to prevent dehydration. Offer water as the main fluid for the first 24 hours of watery diarrhea. On day 2, offer some milk as well as water. Avoid fruit juices because they all make diarrhea worse. If your child refuses to eat solid food, give your child milk rather than water.
• Foods - Keep giving your child food while he has diarrhea. The choice of food is important. Starchy foods are digested best. Examples of such foods are dried cereals, grains, bread, crackers, rice, noodles, mashed potatoes, carrots, applesauce, and bananas. Pretzels or saltine crackers can help meet your child's need for sodium. On the second day of the diarrhea, if your wants some protein, soft-boiled eggs or yogurt are usually easily digested.

How can I take care of my child?

• Common mistakes - 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. 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.
• 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.
• 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.

When Should I call my child's healthcare provider?

Call IMMEDIATELY if:

• There are signs of dehydration (no urine in more than 12 hours, very dry mouth, no tears).
• Any blood appears in the diarrhea.
• The diarrhea is severe (more than 8 BMs in the last 24 hours)
• The diarrhea is watery AND your child also vomits repeatedly.
• Your child starts acting very sick.

Call during office hours and schedule an appointment if:

• Mucus or pus appears in the BMs.
• A fever lasts more than 3 days.
• Mild diarrhea lasts more than 2 weeks.
• You have other concerns or questions.