Diagnostic Findings
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 and moderate to severe diarrhea.
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 the presence of diarrhea.
Diarrhea is usually caused by a viral infection of the
intestines (gastroenteritis).
Occasionally it is caused by bacteria or parasites. Diarrhea can be due to excessive fruit juice
or to a food allergy. If only one or
two loose stools are passed, the cause was probably something unusual your
child ate.
Diarrhea usually lasts from several days to a week,
regardless of the treatment. The main
goal of therapy is to prevent dehydration by giving enough oral fluids to keep
up with the fluids lost in the diarrhea.
Don’t expect a quick return to solid stools. Since one loose stool can mean nothing, don’t start dietary
changes until there have been at least two.
Dietary changes are the mainstay of home treatment for
diarrhea. The optimal diet depends on
your child’s age and the severity of the diarrhea. Go directly to the part that pertains to your child.
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 1 or 2 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 other high-fiber
foods for the next few days. Fiber is
helpful for both diarrhea and constipation.
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 this
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 fluids 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 later 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. The
foods most easily absorbed are composed of starch. If your baby wants solids, offer applesauce, strained bananas,
strained carrots, mashed potatoes, and rice cereal with water.
Diet for Moderate Diarrhea (Watery or Frequent Stools) 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 week. During this
week water or Kool-Aid can be used for fluids (avoid fruit juice). Gradually phase in the following special
solids:
Day 1: Clear fluids and Popsicles. If your toddler is hungry, add some food
from day 2 list.
Day 2: Saltine crackers, toast with honey, rice,
mashed potatoes, carrots, applesauce, bland soups, or other high fiber foods.
Day 3: Lean meats, soft-boiled eggs, noodles, soft
cooked fruits and vegetables, and active culture yogurt.
Day 6: Regular diet but no milk products.
Day 8: Milk and milk products can gradually be added.
Note: Avoid
cheeses, which contain 80% of the lactose found in milk, until day 8. By contrast, the lactose in active culture
yogurt will be digested by the Lactobacillus organisms.
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 an 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 breads, cracker, 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
bowel movements.
-Resume
normal diet 1 day after the diarrhea is gone, which is usually in 3 or 4 days.
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 water 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 that causes rapid passage should always be considered in these babies (for
example, coffee, cola, or herbal teas). 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 your 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).
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.
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.
The skin near your baby’s anus can become “burned” from
the diarrhea stools. Wash it off after
each bowel movement and then protect it with a thick layer of petroleum jelly
or other ointment. This protection is
especially needed during the night and during naps. Changing the diaper quickly after bowel movements also helps.
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 suber-absorbant diapers temporarily to cut down on
cleanup time. Use the ones with the
snug legs 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.
v Your child does not urinate
in more than 8 hours
v Crying produces no tears
v The mouth becomes dry rather
than moist
v Any blood appears in the
diarrhea
v Severe abdominal cramps
occur
v The diarrhea becomes severe
(such as a bowel movement every hour for more than 8 hours)
v The diarrhea is watery and
your child vomits clear fluids three or more times
v Your child becomes dizzy
with standing
v Your child starts acting
very sick
NOTE: If your child had vomited more than once, treatment
of the vomiting has priority over the treatment of diarrhea until your child
has gone 8 hours without vomiting.
During regular hours if:
v
Mucus
or pus appears in the stools
v
The
diarrhea causes loss of bowel control
v
A
fever (over 100 degrees [37.8 degrees Celsius]) has been present for more than
72 hours
v
The
diarrhea does not improve after 48 hours on the special diet
v
Mild
diarrhea lasts more than 1 week
v You have other concerns or questions