Symptom Definition
- Diarrhea is the sudden increase in the frequency and looseness of bowel movements (BMs)
- Mild diarrhea is the passage of a few loose or mushy BMs
- Severe diarrhea is the passage of many watery BMs
- Main cause: viral gastroenteritis (viral infection of the stomach and intestines)
See More Appropriate Topic
- If the vomiting is worse than the diarrhea, see VOMITING
- If blood present and no diarrhea, see STOOLS, BLOOD IN
Call 911 Now (your child may need an ambulance) If
- Signs of shock (very weak, limp, not moving, unresponsive, gray skin, etc.)
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Signs of dehydration (e.g. no urine in > 8 hours, no tears with crying and very dry mouth)
- Blood in the stool
- Fever > 104°F (4°C)
- Age less than 12 weeks with fever > 100.4°F (38°C) rectally
- Abdominal pain present > 2 hours
- Vomiting clear liquids 3 or more times
- Age < 1 month with 3 or more large diarrhea stools
- Passes more than 8 diarrhea stools in the last 8 hours
- Severe diarrhea while taking a medicine that could cause diarrhea (e.g. antibiotics)
Call Your Doctor within 24 Hours (between 9 and 4) If
- You think your child needs to be seen
- Mucus or pus in the stool for > 2 days
- Loss of bowel control in a toilet trained child for > 2 days
- Fever > 3 days
- Close contact with someone who has bacterial diarrhea
- Contact with reptile (snake, lizard, turtle) in previous 14 days
Call Your Doctor during Weekday Office Hours If
- You have other questions or concerns
- Diarrhea persists > 2 weeks or is a recurrent problem
Parent Care at Home If
- Mild diarrhea, probably viral gastroenteritis and you don’t think your child needs to be seen
Home Care Advice for Diarrhea
1. Mild Diarrhea: Continue regular diet. Eat more starchy foods. Drink more fluids (Exception: avoid all fruit juices and soft drinks because they make diarrhea worse)
2. Formula-Fed Infants (less than 1 year old) WITH frequent, watery diarrhea:
- Starting Oral Rehydration Solutions (ORS is a special fluid for diarrhea):
- Start ORS (Infalyte, KaoLectrolyte or Pedialyte) it there is frequent, watery diarrhea (Note: formula is fine for average diarrhea)
- Use ORS only for 4 to 6 hours to prevent Dehydration. Offer unlimited amounts of ORS
- If ORS is not available, use unlimited amounts of formula until you can get ORS. Avoid Jello, water, and sports drinks
- Returning to Formula:
- Get back to formula by 6 hours at the latest (Reason: child needs the calories)
- Use full-strength formula (Reason: it contains adequate water)
- Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (milk-based Lactofree or soy formula) are only needed for watery diarrhea persisting > 3 days
- Extra ORS:you can also give 2-4 oz. of ORS for every large watery stool
- Infants > 4 months old can also be given rice cereal, strained bananas, mashed potatoes, etc.
3. Breastfed Infants WITH frequent, watery diarrhea:
- Continue breastfeeding at more frequent intervals. Add solids (see formula-fed above)
- Offer ORS between feedings if urine production is decreased or dark
4. Older Children (over 1 year old) WITH frequent, watery diarrhea:
- The choice of solids is the key factor--starchy foods are absorbed best. Give cereals (especially rice cereal), oatmeal, bread, crackers, noodles, mashed potatoes, carrots, applesauce, strained bananas, etc. Pretzels or salty crackers can help meet sodium needs
- Fluids: If your child takes solids: use water or 1/2 strength Gatorade. If your child refuses solids: give milk or formula
- Avoid all fruit juices and soft drinks (Reason: make diarrhea worse)
- ORS is rarely needed, but for severe diarrhea, also give 4-8 oz. of ORS for every large watery stool
5. Diaper Rash: Wash buttocks after each BM to prevent a bad diaper rash. Consider applying a protective ointment (e.g. petroleum jelly) around the anus to protect the skin.
6. Contagiousness: Your child can return to day care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.
7. Expected Course: Viral diarrhea lasts 5-7 days and is always worse on day 1 and 2.
8. Call Your Doctor If:
- Signs of dehydration occur
- Diarrhea persists > 2 weeks
- Your child becomes worse or develops any of the “Call Your Doctor” symptoms