Pediatric Diarrhea

Diarrhea is when bowel movements (stools) are loose and watery. Your child may also need to go to the bathroom more often.

Diarrhea is a common problem. It may last one or two days and go away on its own. If diarrhea lasts more than two days, your child may have a more serious problem.

Diarrhea may be either:

• Short-term (acute). Diarrhea that lasts one or two days and goes away. This may be caused by food or water that was contaminated by bacteria (bacterial infection). Or it may happen if your child gets sick from a virus.
• Long-term (chronic). Diarrhea that lasts for a few 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 ulcerative colitis, Crohn’s disease or celiac disease. Giardia may also cause chronic diarrhea.

Diarrhea may be caused by many things, including:

• Bacterial infection
• Viral infection
• Trouble digesting certain things (food intolerance)
• An immune system response to certain foods (food allergy)
• Parasites that enter the body through food or water
• Reaction to medicines
• An intestinal disease, such as inflammatory bowel disease
• A problem with how the stomach and bowels work (functional bowel disorder), such as irritable bowel syndrome
• Surgery on the stomach or gallbladder

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

Severe diarrhea may mean a child has a serious disease. Talk with your child's healthcare provider if symptoms don’t go away. Also talk with the provider if symptoms stop your child from doing daily activities. It may be hard to find out what is causing your child’s 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

The symptoms of diarrhea may look like other health problems. Severe diarrhea may be a sign of a serious disease. Make sure your child sees their healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. Your child may have lab tests to check blood and urine.

Other tests may include:

• A stool culture. This checks for abnormal bacteria or parasites in your child’s digestive tract. A small stool sample is taken and sent to a lab to be looked at
• A stool evaluation. This checks the stool for blood or fat,
• Blood tests. These are done to rule out certain diseases.
• Imaging tests. These can rule out structural problems.
• Other tests. Tests may be done to check for food intolerance or allergies.
• A sigmoidoscopy or colonoscopy. These are done to check the inside of part or all of your child’s large intestine.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on the cause and 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 bacterial infections are the cause.

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

• Offer drinks called glucose-electrolyte solutions. These fluids have the right balance of water, sugar and salts. Some are available as ice pops.
• Stay away from commercial sports drinks. These don't have the right balance for a child with severe diarrhea and dehydration.
• Don't give juice or soda. They may make diarrhea worse.
• Don't give plain water to your baby.
• Don't 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.

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.

Correct handwashing can reduce the spread of bacteria that may cause diarrhea. Alcohol-based sanitizers are also helpful.

A rotavirus vaccine can prevent diarrhea and vomiting caused by rotaviruses. Rotavirus is a viral infection of the digestive tract. It can cause dehydration. 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 hasn't 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

Talk with your child's healthcare provider before traveling.

Call your child's healthcare provider if your child is a baby younger than 6 months old or has any of these symptoms:

• Belly pain
• Blood in the stool
• Frequent vomiting
• Doesn’t want to drink liquids
• High fever
• Dry, sticky mouth
• Weight loss
• Urinates less frequently (wets fewer than six diapers per day)
• Frequent diarrhea
• Extreme thirst
• No tears when crying
• Sunken soft spot (fontanelle) on baby’s head