DIARRHEA

DEFINITION

Diagnostic Findings of Diarrhea

Diarrhea is the sudden increase in the frequency and looseness of bowel movements.  Mild diarrhea is the passage of a few loose or mushy stools.  The best indicator of the severity of the diarrhea is its frequency.  A green stool also points to very rapid  passage but by itself is not alarming.  The main complication of diarrhea is dehydration from excessive loss of body fluids.  Symptoms are a dry mouth, the absence of tears, a reduction in urine production (for example, none in 8 hours) and a darker concentrated urine.  It's dehydration you need to worry about, not  diarrhea.

Cause

Expected Course

HOME CARE

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Diet for Mild Diarrhea (Mushy Stools) in Children Less than 2 Years Old.

Give extra fluids by mixing your baby's formula or milk with two ounces of extra water per bottle.

If your baby is on solids, offer only the ABC's (that is, Applesauce, strained Bananas, and strained Carrots), rice, potatoes and offer high-fiber foods for the next few days.  Fiber is helpful for both diarrhea and constipation.

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Diet for Moderate Diarrhea (Watery or Frequent Stools) in Children less than 1 Year Old.

Clear fluids (Oral Electrolyte Solutions) for 24 Hours.

Have your baby take one of the following special clear fluids (oral electrolyte solutions) for the first 24 hours: Pedialyte™, Resol™, or Ricelyte™.  These are available without a prescription in most pharmacies and supermarkets.  Until you obtain the special solution, half strength Gatorade™ or another sports drink will do.  As a last resort, Jell-O ™water can be used.  Jell-O water must be mixed  (one package per quart of water or twice as much water as usual).  Don't use any red-colored Jell-O™ water because it can look like blood.  Give your baby as much of the liquid as he wants. Diarrhea makes children thirsty and your job is to prevent dehydration.

Soy Formula.

After being on clear liquids for 6 to 24 hours your baby will be hungry, so begin his regular formula.  If the diarrhea is severe, begin a soy formula.  Change to a soy formula if the diarrhea doesn't improve after 3 days on regular formula.  There is often less diarrhea with soy formulas than with cow's milk formulas because they don't contain milk sugar (lactose).  Mix the formula with 1 or 2 ounces of extra water per bottle until the stools are no longer watery.  Plan on keeping your baby on soy formula until the diarrhea is gone for 3 days.

Solids.

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Diet for Moderate Diarrhea (Watery or Frequent Stools, 6 to 8 a day) in Children 1 to 2 Years Old.

Babies 1 to 2 years old don't need formula or milk of any kind for the first  24 hours.  During this period Pedialyte™ or Kool-Aid™ can be used.  Gradually phase in the following solids.

Day 1:     Clear fluids and Popsicles.  If your toddler is hungry, add some foods from the Day 2 list.

Day 2:      Saltine crackers, toast with honey, rice, mashed potatoes, carrots, applesauce, bland soups, or any other high-fiber food.

Day 3:      Lean meats, soft-boiled eggs, noodles, soft cooked fruits and vegetables, and active cultured yogurt.

 Note:  Milk and dairy products can be restarted when diarrhea starts improving.  Stop it once again if  the     diarrhea dramatically increases with milk.    Avoid cheeses, which contain 80% of the lactose found in milk, until Day 8.  By contrast , the lactose in active-cultured yogurt will be digested by the Lactobacillus organisms.

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Diet for Mild or Moderate Diarrhea in Children Over 2 Years Old.

For the child who is toilet trained for bowel movements, the approach to diarrhea is the same as what any adult would do; namely, eat a regular diet with a few simple changes.

— Increase the intake of foods containing starch since these are easily absorbed during diarrhea.  Examples are bread, crackers, rice, mashed potatoes, and noodles.

— Increase the intake of water or clear fluids (those you can see through).

— Reduce or eliminate the intake of milk and milk products (Exception: active-culture yogurt is fine.)

— Avoid raw fruits and vegetables, beans, spices, and any other foods that cause loose BM's.

— Resume normal diet 1 day after the diarrhea is gone, which is usually in 3 or 4 days.

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Diet for Breast-Feeding Babies with Diarrhea

Definition/Special Considerations.

No matter how it looks the stool of the breast-fed infant must be considered normal unless it contains mucus or blood.  In fact, breast-fed babies can normally pass some green stools or stools with a watery ring.  Frequency of movements is also not much help.  During the first 2 or 3 months of life, the breast-fed baby may normally have one stool after each feeding.  The presence of something in the mother's diet such as coffee, cola or herbal teas may cause rapid passage of the baby's stool .  Diarrhea can be diagnosed if your baby's stools abruptly increase in number.

Diet.

If your breast-fed baby has diarrhea, treatment is straightforward.  Breast-feeding should never be discontinued because of mild to moderate diarrhea.  The only treatment necessary is to offer extra water between breast feedings.  Breast-feeding may have to be temporarily discontinued if you baby requires intravenous fluids for severe diarrhea and dehydration.  Pump your breasts to maintain milk flow until you can breast-feed again (usually within 12 hours).

HOME CARE: OTHER ASPECTS

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Common Mistakes:

Using boiled skim milk or  any concentrated solution can cause serious complications for babies with diarrhea because they contain too much salt.  Kool-Aid™ and soda pop should not be used as the only foods because they contain little or no salt.  Use only the fluids mentioned.  Clear fluids alone should only be used for 6 to 24 hours because the body needs more calories than they can provide.  Likewise, a diluted formula should not be used for more than 24 hours.  The most dangerous myth is that the intestine should be "put to rest"; restricting fluids can cause dehydration.  Keep in mind that there is no effective, safe drug for diarrhea and that extra water and diet therapy work best.

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Prevention:

Diarrhea is very contagious.  Hand washing after diaper changing or using the toilet is crucial for keeping everyone in the family from getting diarrhea.

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Diaper Rash from Diarrhea:

The skin near your baby's anus can become "burned" from the diarrhea stools.  Wash it off after each BM and then protect it with a thick layer of petroleum jelly or other ointment.  The protection is especially needed during the night and during naps.  Changing the diaper quickly after BM's is also helpful.

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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 disposable super absorbent diapers temporarily to cut down on cleanup time.  Use the ones with the snug leg bands or cover the others with a pair of plastic pants.  Wash your child under running water in the bathtub.  Someday he will be toilet trained.

CALL OUR OFFICE

Immediately if:

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Your child does not urinate in more than 8 hours.

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Crying produces no tears.

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The mouth becomes dry rather than moist.

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Any blood appears in the diarrhea.

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Severe abdominal cramps occur.

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The diarrhea becomes severe (such as a bowel movements every hour for more than 8 hours.

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The diarrhea is watery and  your child vomits clear fluids more than three times.

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Your child becomes dizzy with standing.

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Your child starts acting very sick.

During Regular Office Hours if:

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Mucus or pus appears in the stools.

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The diarrhea causes loss of bowel control.

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A fever (over 100° F (37.8° C) has been present for more than 72 hours.

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The diarrhea does not improve after 48 hours on the special diet.

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Mild diarrhea lasts more than 1 week.

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You have other concerns or questions.