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Diarrhea in Children

What is diarrhea?

Diarrhea is when your stools are loose and watery. You may also need to go to the bathroom more often. Diarrhea in babies and children can be serious. It needs to be treated differently than you would treat diarrhea in adults.

Diarrhea is a common problem which generally lasts only a few days. Diarrhea can occur year round but may be more common in the winter. If diarrhea lasts longer it may mean you have a more serious problem.

Diarrhea may be either:

Short-term (acute). Diarrhea that lasts a few days up to one week and goes away. This may be caused by having food or water that was made unsafe by a bacterial infection. Or it may happen if you get sick from a virus, which is the most common cause of diarrhea.
Long-term (chronic). Diarrhea that lasts more than four weeks. This may be caused by another health problem such as irritable bowel syndrome. It can also be caused by an intestinal disease such as Crohn’s disease or celiac disease. Some infections such as parasites can cause chronic diarrhea. Certain food intolerances can also lead to chronic diarrhea.

What causes diarrhea in children?

Diarrhea may be caused by many things, including:

An infection from bacteria, viruses, or parasites.
Food poisoning
Medications, such as antibiotics
Food allergies
Milk or soy intolerance in infants
Enzyme deficiencies (such as lactose or fructose intolerance)
Toxic substances
A problem with how your stomach and bowels work (functional bowel disorder), such as irritable bowel syndrome
Metabolic conditions such as thyroid problems
An intestinal disease, such as inflammatory bowel disease
Celiac disease
Malabsorption syndromes
Leakage of loose stool around constipated stool in the rectum (encopresis)
Todder's diarrhea

Children who visit some foreign countries are at risk for traveler's diarrhea. This is caused by having food or water that is not safe because of bacteria, viruses, or parasites.

What are the symptoms of diarrhea?

Symptoms can occur a bit differently in each child. They can include:

Cramping
Belly (abdominal) pain
Swelling (bloating)
Upset stomach (nausea)
Urgent need to use the bathroom
Fever
Bloody stools
Loss of body fluids (dehydration)
Incontinence

Dehydration is a serious side effect of diarrhea - if you are concerned about dehydration, please call your healthcare provider right away. Symptoms include:

Feeling thirsty
Not urinating as often
Having dry skin as well as a dry mouth and nostrils (mucous membranes)
Feeling very tired
Feeling that you may pass out or faint (lightheaded)
Headaches
Fast heart rate
Sunken fontanelle (soft spot) on baby's head

How is the cause of diarrhea diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. If the healthcare provider feels that there is a more significant reason for diarrhea, they may order further testing. Tests may include:

Stool studies. A stool culture to check for abnormal bacteria or parasites in your child’s digestive tract. A small stool sample is taken and sent to a lab. Stool can also be sent to look for blood, fat, sugars or proteins.

Sigmoidoscopy. This test lets your healthcare provider check the inside of part of the large intestine. It helps to tell what is causing diarrhea. A short, flexible, lighted tube (sigmoidoscope) is put into the large intestine through the rectum. This tube blows air into the intestine to make it swell. This makes it easier to see inside. A biopsy can be taken if needed.

Colonoscopy. This test looks at the full length of the large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding. A long, flexible, lighted tube (colonoscope) is put into the rectum up into the colon. This tube lets the gastroenterologist see the lining of your colon and take out a tissue sample (biopsy) to test it. He or she can also treat some problems that may be found.

Imaging tests. These tests can see if there are anatomic abnormalities leading to diarrhea.

Food intolerance tests. These tests can help determine ability to digest certain enzymes. Such tests include Hydrogen Breath Testing.
Blood tests. These can look for metabolic problems like thyroid disease, anemia (low blood count), evidence of low vitamin levels suggesting poor absorption, and celiac disease, among other things.

How is diarrhea treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Dehydration is the major concern with diarrhea. In most cases, treatment includes replacing lost fluids. Antibiotics may be prescribed when specific bacterial infections are the cause.

Children should drink lots of fluids. This helps replace the lost body fluids. If your child is dehydrated, be sure to:

Offer drinks called glucose-electrolyte solutions. These fluids have the right balance of water, sugar, and salts. Some are available as popsicles.
Avoid juice or soda. They may make diarrhea worse.
Not give plain water to your baby
Not give too much plain water to kids of any age. It can be dangerous.
Keep breastfeeding your baby. Breastfed babies often have less diarrhea.
Keep feeding your baby formula, if you were already doing so

Acute diarrhea tends to stop after the body clears the infection or toxin that is causing the diarrhea. Viral infections and most bacterial infections do not require antibiotic treatment. Children with acute diarrhea should continue to eat as before provided the diarrhea is not severe and there is no vomiting. On occasion, milk or dairy products can make diarrhea worse. Infants under 3 months of age with diarrhea and vomiting are at high risk for dehydration. Fever should be treated to avoid increased body fluid loss. If your child is unable to keep enough fluid in to prevent dehydration, it is recommended that your child be brought to the hospital for further evaluation and treatment.

Chronic diarrhea treatment is based entirely on the cause. Sometimes a change in diet is sufficient whereas sometimes medications may be needed. Your healthcare provider will determine the best treatment for your child.

Complications of diarrhea

The greatest complication of diarrhea is dehydration. This is more likely with young children and those with a weakened immune system. Dehydration can be mild, moderate, or severe. Mild dehydration is the loss of fluid. Moderate or severe dehydration puts stress on the heart and lungs. In the worst cases it can lead to shock, which is life-threatening.

What can I do to prevent diarrhea?

Proper handwashing can reduce the spread of bacteria that may cause diarrhea.

A rotavirus vaccine can prevent diarrhea caused by rotaviruses. Ask your child's healthcare provider which vaccines are right for your child.

When you travel, make sure anything your child eats and drinks is safe. This is even more important if you travel to developing countries.

Travel safety tips for drinking and eating include:

Not drinking tap water or using it to brush teeth
Not using ice made from tap water
Not drinking unpasteurized milk (milk that has not gone through a process to kill certain bacteria)
Not eating raw fruits and vegetables unless you wash and peel them yourself
Not eating raw or undercooked meat or fish
Not eating food from street vendors or food trucks

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