Diarrhea is a very common complaint in children and there are many causes – some are serious and others are completely harmless.  Diarrhea is often considered an increased frequency of stools, however it is better described as an excess loss of fluids and electrolytes from the intestines.  Infants normally have frequent soupy, yellow or green, seedy stools.  The normal number of stools per day depends on the age, diet and habits of the child.  For an infant, several stools per day may be normal and a breastfed infant may go several days without stooling.  Older children may have 3 stools per day or 1 stool every 3 days.  When diarrhea is caused by an infection and there is vomiting also, it is called gastroenterititis.

  

What causes diarrhea?

Acute

• Bacterial infection – Clostridium difficile, E. coli, Salmonella, Shigella, Campylobacter, others
• Viral infection – Rotavirus, Adenovirus, others
• Parasites – Giardiasis, others
• Infection (systemic)
• Medicines
• Osmotic (example – too much juice or water)
• Food poisoning
• Poisons

Chronic (more than 14 days)

• Post infectious
• Milk intolerance
• Toddlers diarrhea
• Celiac disease
• Inflammatory bowel disease
• Infections (Giardiasis)
• Irritable bowel syndrome

What are the symptoms of diarrhea?

• Increased frequency of stools
• Watery, loose stools
• Smelly stools (more than usual)
• Abdominal cramping

Red Flags (seek medical care immediately)

• Severe or persistent diarrhea
• Infants and young children with diarrhea
• Ill-appearing child
• Rash
• High fever
• Not drinking fluids
• Decreased urine output
• Excessive sleepiness, confusion or unusual behavior
• Blood in stools        

How is the cause of diarrhea diagnosed?

Acute diarrhea is most often caused by an infection and is often associated with fever, vomiting, and malaise (not feeling well).  Diarrhea caused by a virus will most often improve in less than a week.  Doctors usually don’t need to perform any blood, stool or x-ray tests if the child is not dehydrated and the symptoms are not severe.  When done, blood tests may help your doctor determine if the child has a serious infection or has lost too much water or electrolytes.  Stool studies can help determine if infectious diarrhea is due to a virus, bacteria or parasite.  If diarrhea is chronic, tests may be done to look for inflammatory bowel disease or conditions that affect the intestines ability to absorb food or water.

How is diarrhea treated in children?

Replacing lost water and electrolytes is the most important treatment.  Young children should receive fluids with appropriate electrolytes such as Infalyte® or Pedialyte®.  Juices and sodas contain high concentrations of sugars that may make diarrhea worse.  Breastfeeding infants should continue breastfeeding if they are able.  If the child can not drink enough fluids, then she may need intravenous fluids.  A bland diet may help.  Antibiotics are usually not helpful (and may make diarrhea worse).  Medicines to slow or stop diarrhea are usually not recommended (and may make the child worse).  Generally, infectious diarrhea improves on its own once the infection resolves.

Can diarrhea be prevented?

The risk of developing diarrhea from an infection can be reduced by frequent hand washing, good hygiene and a healthy lifestyle.  Medicines or foods known to cause diarrhea can be avoided.  Raw foods should be appropriately cleaned or cooked.