Everything You Want to Know About

Diarrhea

 

Published by the Children's Clinic of Ocean Springs

Pediatrician Dr. George D. Fain, M.D.

Office Telephone (228) 875-1184 or 1185 -- 24 hours

 

DEFINITION

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. Moderate diarrhea gives many watery 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.

 

CAUSE

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 usual your child ate.

 

EXPECTED COURSE

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.

 

HOME CARE

DIET

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 ABCs (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, Pediapops, or Ricelyte. If your baby is less than two months old, clear liquids should be used only 12 hours. These are available without a prescription in most pharmacies and supermarkets. Mixing Pedialyte with Sugar-free Jell-O will improve the flavor. Until you obtain this special solution, Gatorade or another sports drink mixed with an equal amount of water will do. As a last resort, Jell-O water can be used. Regular Jell-O water must be mixed (one package per quart of water, or twice as much water as usual). Do not use any red-colored Jell-O water because it can look like blood. Give your baby as much of the liquid as he wants unless he is vomiting. Then give the fluids in one to two ounce increments every 30 to 60 minutes while awake. 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 lactose free formula or a soy formula. Ross Pharmaceutical Company makes a formula called ISOMIL DF. This is a good formula to thicken up stools. Another good soy formula is Prosobee by Mead Johnson. 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 for no more that 24 hours. Plan on keeping your baby on soy formula or Lacto-Free 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, electrolyte solutions, or Kool-Aid can be used for fluids (avoid fruit juice). Gradually phase in the following special solids:

 

 

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 any adult would do; namely, eat a regular diet with a few simple changes.

 

DIET FOR BREAST-FEEDING BABIES WITH DIARRHEA

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 straight forward. 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).

 

HOME CARE: OTHER ASPECTS

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 and too much sugar. 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.

 

Diaper Rash from Diarrhea

The skin near your baby's anus can become "burned" from the diarrhea stools. Wash it off with mild soap and water after each BM 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 BMs 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 disposable suberabsorbent diapers temporarily to cut down on cleanup time. Use the ones with 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 (228-875-1184) IMMEDIATELY IF

 

NOTE: If your child has vomited more than once, treatment of the vomiting has priority over the treatment of diarrhea until your child has gone 8 hours without vomiting.

 

CALL DURING REGULAR HOURS IF

 

Instructions for Pediatric Patients by Barton D. Schmitt, M.D., Pediatrician.

Adapted from YOUR CHILD'S HEALTH.

Copyright (C) 1991 by Barton D. Schmitt, M.D.

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