Diarrhea (0-12 Months)

• Sudden increase in the number and looseness of stools
• Diarrhea means 3 or more watery or very loose stools.  Reason: 1 or 2 loose stools can be normal with changes in diet.

Causes of Acute Diarrhea

• Virus (such as Rotavirus). An infection of the intestines from a virus is the most common cause.
• Bacteria (such as Salmonella). Less common cause. Diarrhea often contains streaks of blood.
• Giardia (a parasite). More likely in child care center outbreaks.
• Antibiotic Diarrhea. Many antibiotics cause mild diarrhea. This is not an allergic reaction. Keep giving the antibiotic. Call your doctor if any serious symptoms occur.
• Serious Causes. Most bacterial diarrhea goes away on its own. A few can cause a severe large bowel infection (such as Shigella colitis). C. difficile is a serious cause that can occur after being on strong antibiotics.
• Serious Complication: Dehydration. This is the health problem where the body has lost too much fluid. (See below for more on this).

Causes of Recurrent Diarrhea

• Cow's Milk Allergy. Can cause loose, slimy stools in babies. Can be blood-streaked. Starts within the first 2 months of life. Need to avoid cow's milk formulas.
• Lactose Intolerance. Lactose is the sugar in milk. Many people cannot absorb lactose. The gut bacteria convert the lactose to gas. The main symptoms are a lot of gas, loose stools and stomach bloating. Onset usually at age 4 or 5. This most often runs in the family (genetic).

Diarrhea Scale

• Mild: 3-5 watery stools per day
• Moderate: 6-9 watery stools per day
• Severe: 10 or more watery stools per day
• The main risk of diarrhea is dehydration.
• Loose or runny stools do not cause dehydration.
• Frequent, watery stools can cause dehydration.

Dehydration: How to Know

• Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. A weight loss of more than 3% is needed. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.
• Dehydration is the most important complication of diarrhea. Dehydration is a reason to see your doctor right away.
• These are signs of dehydration:
  • Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.
  • Dry tongue and inside of the mouth. Dry lips are not helpful.
  • Dry eyes with decreased or absent tears
  • In babies, a depressed or sunken soft spot
  • Slow blood refill test: longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
  • Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.

Diarrhea in Breastfed Babies: How to Tell

• Diarrhea in a breastfed baby is sometimes hard to tell.
• Normal breastfed stools are loose (often runny and seedy). Stools are yellow, but sometimes can be green. The green color is from bile. Runny stools can even be bordered by a water ring. These are all normal stools.
• Breastfed babies often pass more than 6 stools per day. Until 2 months of age, they may pass a stool after each feeding. But, if stools suddenly increase in number and looseness, suspect diarrhea. If it lasts for 3 or more stools, the baby has diarrhea.
• If the stools contain mucus, blood or smell bad, this points to diarrhea.
• Other clues to diarrhea are poor eating, acting sick, or a fever.

Diarrhea in Formula-Fed Infants: How to Tell

• Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.
• The stools are yellow in color and thick like peanut butter.
• Suspect diarrhea if the stools suddenly increase in number or looseness. If it lasts for 3 or more stools, the baby has diarrhea.
• If the stools contain mucus, blood, or smells bad, this points to diarrhea.
• Other clues to diarrhea are poor eating, acting sick or a fever.
• After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They no longer appear to have mild diarrhea.

Call 911 Now

• Not moving
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Blood in the stool
• Constant stomach pain lasts more than 2 hours
• Vomits 3 or more times
• Age less than 1 month with 3 or more diarrhea stools in past 24 hours
• Severe diarrhea. 10 or more watery stools in the last 24 hours.
• Fever higher than 104° F (40° C)
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Weak immune system. Examples are sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Moderate diarrhea. 6 or more watery stools in the last 24 hours.
• Stomach pains that do not go away after each diarrhea stool
• Fever lasts more than 3 days
• Close contact with person or animal who has bacterial diarrhea
• Contact with reptile (snake, lizard, turtle) in past 14 days
• Travel to country at risk for diarrhea within past month
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Diarrhea lasts more than 2 weeks
• Loose stools are a frequent problem
• You have other questions or concerns

Self Care at Home

• Mild diarrhea (probably caused by a virus)

Care Advice for Diarrhea

What You Should Know About Diarrhea:

• Most diarrhea is caused by a virus.
• Bacterial infections as a cause of diarrhea are not common.
• Diarrhea is the body's way of getting rid of the germs.
• The main risk of diarrhea is dehydration. Dehydration means the body has lost too much fluid.
• Most children with diarrhea don't need to see their doctor.
• Here are some tips on how to keep ahead of the fluid losses.

Mild Diarrhea:

• Most kids with diarrhea can eat a normal diet.
• Drink more fluids to prevent dehydration. Formula or breastmilk are good choices for diarrhea.
• Do not use fruit juices. Reason: they can make diarrhea worse.
• Solid foods: if on solid foods, eat more starchy foods (such as cereal, crackers, rice, pasta). Reason: they are easy to digest.

Formula-Fed Babies with Frequent, Watery Diarrhea:

• Keep giving formula but feed more often. Offer as much formula as your child will take.
• Mix formula the normal way. Reason: the formula contains plenty of water and doesn't need more.
• Solid foods: if on baby foods, continue them. Cereals are best.

Breastfed Babies with Frequent, Watery Diarrhea:

• Give your baby breastmilk more often.
• Also, give extra fluid if breast milk isn't keeping up with the fluid losses. You can use formula or ORS (Pedialyte).
• Solid foods: if on baby foods, continue them. Cereals are best.

Oral Rehydration Solutions (ORS), such as Pedialyte:

• ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand. It can be bought in food stores or drug stores.
• When to use: start ORS for frequent, watery diarrhea if you think your child is getting dehydrated. That means passing less urine than normal. Increase fluids using ORS. Continue giving breastmilk, formula or regular milk.
• Amount: for babies, give 2-4 ounces (60-120 mL) of ORS after every large watery stool.
• Caution: do not give ORS as the only fluid for more than 6 hours. Reason: your child will need calories and cry in hunger.

Probiotics:

• Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the gut (stomach).
• Probiotics may be helpful in reducing the number of diarrhea stools.
• Yogurt is the easiest source of probiotics.
• If your child is taking solids (4 to 6 months of age), give 1 to 2 ounces (30 - 60 mL) of plain yogurt twice daily.
• Yogurts that are lactose-free may be even more helpful.

Fever Medicine:

• For fevers higher than 102° F (39° C), give an acetaminophen product (such as Tylenol).
• Another choice is an ibuprofen product (such as Advil). Caution: avoid ibuprofen until 6 months or older.
• Note: Fevers less than 102° F (39° C) are important for fighting infections.
• For all fevers: keep your child well hydrated. Give lots of cold fluids.

Diaper Rash - Prevention:

• Wash buttocks after each stool to prevent a bad diaper rash.
• To protect the skin, use an ointment (such as Vaseline or Desitin). Put it on the skin around the anus.

Return to Child Care:

• Your child can go back to child care after stools are back to normal.
• The fever should also be gone.

What to Expect:

• Viral diarrhea lasts 5-14 days.
• Severe diarrhea only occurs on the first 1 or 2 days. But, loose stools can last for 1 to 2 weeks.

Call Your Doctor If:

• Blood in the diarrhea
• Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
• Diarrhea lasts over 2 weeks
• You think your child needs to be seen
• Your child becomes worse