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James D. Briggs M.D.

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Diarrhea: Infants

What is diarrhea?

Diarrhea is the sudden increase in the frequency and looseness of stools. Mild diarrhea is the passage of a few loose or mushy stools. Severe diarrhea is the passage of many watery stools. 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 fluid from the body. Symptoms of dehydration are a dry mouth, the absence of tears, infrequent urination (for example, none in 8 hours), and a darker, concentrated urine. With severe dehydration, the eyes may appear sunken, the soft spot on the head may be sunken or depressed, and the skin may have a doughy feel when pinched. 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 stools, the cause is probably something your child ate. A diet of nothing but clear fluids (such as Pedialyte) for more than 2 days may cause green, watery stools (called "starvation stools").

How long will it last?

Diarrhea caused by a viral infection usually lasts several days to 2 weeks, 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 stools.

Formula-fed Infants:

What should I feed my child?

Increased fluids and dietary changes are the main treatment for diarrhea. Note: One loose stool can mean nothing. Don't start dietary changes until your child has had several loose stools.

Mild diarrhea (loose stools)

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, strained bananas, and strained carrots. Avoid all fruit juices because they make diarrhea worse.

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 Pedialyte or the store brand at your pharmacy or supermarket. (These special solutions are not needed for diarrhea that is not severe.) Give as much of the special liquid as your baby wants (at least 2 teaspoons or 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 fruit juice because it will make the diarrhea worse. Do not give sports drinks, Kool-Aid, Jello water, or soda pop.

• Returning to formula

After being given electrolyte fluids for 4 to 6 hours, your baby will be hungry, so begin her full-strength formula. Offer it more often than you normally do. If the diarrhea continues to be severe and doesn't improve after 3 days, change to a lactose-free formula (such as Enfamil Lacto-free or Similac Sensitive). Often there is less diarrhea with these formulas than with standard cow's milk formulas because the lactose (milk sugar) is not digested in children with severe diarrhea. If you need to start a lactose-free formula, plan to keep your baby on it until the diarrhea is gone for at least 3 days. In the case of severe diarrhea, it is okay to start the lactose-free formula earlier—you don’t have to wait 3 days. Soy formulas are also lactose-free, but I don’t usually recommend them for diarrhea because they don’t taste as good and because a few babies will develop an allergy to soy (showing up as worsening diarrhea and bloody stools).

• Continuing solids

Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 5 or 6 months old and is already eating solids, continue the solid foods. Good choices are cereals and other high-fiber foods. Strained carrots and mashed potatoes are also good.

How can I take care of my child?

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

• Common mistakes

Using boiled skim milk can cause serious complications for babies with diarrhea because it contains too much salt. Use only the fluids suggested here.

Do not dilute your baby's formula or give only clear fluids. This will not provide your baby with enough calories.

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 can be 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.

• 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 stool and then protect it with a thick layer of petroleum jelly or other ointment. Use running water or put the baby in a bath, instead of using baby wipes.This protection is especially needed during the night and during naps. Changing the diaper quickly after stools also helps.

• 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 stool. Use diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

• Vomiting with diarrhea

If your child has vomited more than twice, follow your doctor's recommended treatment for vomiting instead of this treatment for diarrhea until your child has gone 8 hours without vomiting. A good approach is for your child to take one swallow of fluid at a time every 5 minutes. (See information on vomiting.)

Breast-fed Infants:

Is it diarrhea?

No matter how they look, the stools of a breast-fed infant must be considered normal unless they contain mucus or blood or develop a bad odor. In fact, during the first months, breast-fed babies normally pass very loose stools, some green stools, or even stools with a water ring.

The frequency of stools is also not much help in deciding whether your breast-fed baby has diarrhea. Breast-fed babies during the first 2 months pass from 4 stools per day to 1 after each feeding. The stools are normally liquid. However, if your baby's stools abruptly increase in number, your baby probably has diarrhea. Other clues are poor eating, acting sick, and a fever.

What should I feed my child?

Increased fluids and dietary changes are the main treatment for diarrhea. One loose stool can mean nothing. Don't start dietary changes until your child has had several loose stools.

• Breast-feeding

If your breast-fed baby has diarrhea, treatment is straightforward. Continue breast-feeding but at more frequent intervals. Don't stop breast-feeding your baby because your baby has diarrhea. For severe (watery and frequent) diarrhea, offer Pedialyte or other electrolyte solutions between breast-feedings.

You may have to stop breast-feeding temporarily if your baby is too exhausted to nurse and needs intravenous (IV) fluids for dehydration. This would be very unusual. Pump your breasts to maintain milk flow until you can breast-feed again (usually within 12 hours).

• Continuing solids

Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 6 months old and is already eating solids, continue with solid foods. Good choices are: any cereal, strained carrots, mashed potatoes, and other high-fiber foods.

• Mother's diet

Remember that something in the mother's diet may cause a breast-fed baby to have more frequent or looser stools--for example, coffee, cola, or herbal teas. If you suspect this, take it out of your diet and see what happens. Do not take stimulant laxatives, such as X-lax or castoria, while breast-feeding, as these can cause diarrhea in the baby.

How can I take care of my child?

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

• Common mistakes

Using boiled skim milk can cause serious complications for babies with diarrhea because it contains too much salt. Use only the fluids suggested here.

Do not dilute your baby's formula or give only clear fluids. This will not provide your baby with enough calories.

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 can be 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.

• 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 stool and then protect it with a thick layer of petroleum jelly or other ointment. Use running water or put the baby in a bath, instead of using baby wipes.This protection is especially needed during the night and during naps. Changing the diaper quickly after stools also helps.

• 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 stool. Use diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

• Vomiting with diarrhea

If your baby vomits once, make no changes.

If your baby vomits twice, continue breast-feeding but nurse on only one side for 10 minutes every 1 to 2 hours.

If your baby vomits 3 or more times, nurse for 4 to 5 minutes every 30 to 60 minutes. As soon as 8 hours have passed without vomiting, return to normal nursing on both sides. If the vomiting continues, give a glucose-electrolye solution such as Pedialyte or Infalyte. Spoon or syringe feed 2-3 teaspoons (10-15 mL) of Pedialyte every 5-10 minutes while the baby is awake. Gradually increase the amount of Pedialyte per feeding. After a few hours, try breastfeeding again. Call the doctor if your baby is not able to keep down any breast milk after 18-24 hours.

When should I call my child's healthcare provider?

Call IMMEDIATELY if:

• There are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears, or doughy skin).

• Any blood appears in the diarrhea.

• The diarrhea is severe (more than 8 stools in the last 8 hours).

• Your child starts acting very sick.

Call during office hours if:

• Mucus or pus appears in the stools.

• A fever lasts more than 3 days.

• Mild diarrhea lasts more than 2 weeks.

• Frequent vomiting lasts more than 24 hours.

• You have other concerns or questions.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books and modified by James D. Briggs, M.D. 7/12/2011

Published by RelayHealth. Last Modified: 8/13/2009. Last Reviewed: 6/15/2009.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

© 2010 RelayHealth and/or its affiliates. All Rights Reserved.

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