Diarrhea

There is nothing — and I mean nothing — good about loose, discolored, smelly stools. But as a parent, you’re almost certainly going to have to deal with them.

Invariably it happens when you’re out and about with your baby, with limited wipes and needing to get somewhere fast, and then… Boom! Out the diaper, up the back, all over the onesie… We can’t help you in those situations, but we can help by providing some good info and suggestions about what to know and what to do when it strikes.

Causes

There are many causes of diarrhea. While it’s most commonly caused by viral infections, it can also be related to bacteria, dietary intolerances, allergies, medication, medical illness, and other causes.

Viral diarrhea is very contagious. The viruses are spread easily — most commonly from infectious particles being transmitted from one individual to another, frequently by what is described as the Fecal-Oral route. That’s right: microscopic bits of poop with nasty little viruses get into your child’s mouth and are ingested. (Yuck. But it happens.)  This route, which can often occur during diaper changes, is a big reason day care workers and nurses can easily contact the virus. A person can also pick up a virus from a doorknob, a toy, or a shared drink. So yes, Moms and Dads, hand washing is really important!

Diarrhea caused by viruses affects people of all ages and is characterized by bowel movements that are loose or watery and more frequent than typical (this can range from 3 to 15+ times per day). The color can vary, most commonly: yellow, brown, or green. It’s not uncommon to have associated fever, abdominal pain, decreased appetite, and even vomiting.

Risks

Typically the greatest risk of diarrhea (and vomiting) is dehydration. Huge amounts of our body’s water and salts (electrolytes) can be lost when a person is having multiple watery stools per day. Episodes can come and go within a day, but can also persist for a week or more. If a child is infected with a virus, is having multiple loose stools, and doesn’t want to eat or drink much, they could easily become dehydrated. (For more on Dehydration, see my Doctor’s Note on the subject.)

Treatment

Viral diarrhea commonly presents as a mild to moderate illness. There is usually little treatment required; we just have to wait out the illness.  Care is supportive and targeted at the symptoms. To prevent dehydration, encouraging frequent attempts at taking fluid is imperative.

Parents have a few different ways to gauge a child’s hydration status, but a fairly reassuring sign is if your child urinates at least 3-4 times in a 24-hour span. Breastfed infants should continue to nurse or take pumped breastmilk, which protects against diarrhea and can help make it less severe if contracted. Formula can usually be continued in formula-fed infants. Electrolyte-balanced drinks like pedialyte are usually not necessary as long as adequate fluid (milk and water) persists. You should also avoid juices and high sugar drinks, because they can actually increase stool output.

Acetaminophen or ibuprofen can be given for discomfort or fever.  Some children like a warm water bottle — yes, just like grandma recommended! — on their tummies to make them feel better.

Probiotics, also described as “normal flora,” or “good germs,” are some of the regular bacteria that live in our intestines. They help us digest and process the contents of our digestive tract, and they help keep harmful and pathogenic bacteria crowded out. Diarrheal illnesses can upset the balance of normal flora. There are growing numbers of studies to show the benefit of probiotics, but the difficulty is that there is no clear guidance on which normal bacteria or how much of these bacteria is helpful to promote good digestive health or help recover from diarrhea. They are generally considered safe and are included in things like acidophilus milk and yogurts. They also come in supplement forms: capsules, powders, tablets and liquids.  If you’re onsidering probiotic supplements, it’s best to discuss them with your health care provider.

Both the American Academy of Pediatrics and the Centers for Disease Control and Prevention now recommended that you continue your child’s regular diet (including milk or formula) as tolerated. An old-time response to diarrhea was the institution of the BRAT (Bananas, Rice, Applesauce, and Toast) diet, because these foods have natural binders and so help make stools less loose. They are by no means a cure for diarrhea, but they can be added or increased in your child’s diet if they’ve well-tolerated once they’re introduced.

There are medicines on the market (Kaopectate and Immodium, to name just two) that are indicated for diarrhea, but they should NOT be used in children without the recommendation of a health care provider, because they could worsen the illness or cause additional, even more serious conditions.

When to Call the Office

Give us a call if…

  • Your child is less than 1 year old
  • Your child has a serious existing medical condition

Or, if your child…

  • Urinates fewer than 3 times in 24 hours
  • Has dry mouth
  • Seems lethargic
  • Produces more than 10 stools in a day
  • Produces red or black stools
  • Looks ill
  • Has an appearance or behavior that concern you.

A Last Reminder

If you have questions or concerns at any time,y ou can always call the office to ask questions or to discuss your concerns with our staff.

Dr. Todd Wolynn is the President & CEO of Kids Plus Pediatrics.