Diarrhea is one of the most common conditions that afflict children in the United States. Among children less than 5 years of age, 2–3.5 million will visit a doctor and more than 200,000 will require hospitalization due to the condition. Among children more severely affected are those under the age of 1 year.

Definition

Diarrhea is the sudden increase in the frequency and looseness of bowel movements. In children, bowel movements are extremely variable according to age and diet. It is not uncommon for a formula–fed 1–week old baby to have 3 firm bowel movements a day, while a breast–fed 1 week–old baby to have 8 loose bowel movements a day; yet both of them are having a normal stooling pattern. It is for this reason that a diagnosis of diarrhea can be tricky to establish in children, and it is always recommended to consult a physician.

Causes

Diarrhea is usually caused by viral infections (rotavirus, adenovirus, etc). Occasionally it is caused by bacterias (salmonella, shigella, etc) or parasites (Giardia, Entamoeba, etc). Diarrhea can also occur with excessive fruit juice consumption and food allergies.

Expected course

Diarrhea usually lasts from several days to a week. Many times diarrhea is self-limited and will go away without treatment. One of the main goals of therapy is to prevent dehydration, which is accomplished by providing plenty of oral fluids.

Symptoms

When diarrhea is present in a child, it can present with abdominal cramps, a sense of urgency to have a bowel movement, nausea and vomiting, fever, blood in stools, and dehydration. Signs of dehydration include decreased urination, no tears with crying, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.

Treatment

Children with mild diarrhea can continue to eat a normal diet with a few simple changes. Raw fruits and vegetables, spicy foods, and any other foods that increase loose stools should be avoided. Intake of juice should be decreased. Formula or milk should be continued. Special fluids usually are not necessary. In some cases, a child can become bloated or gassy after drinking cow’s milk or formula; in such cases it will be necessary to contact a physician in order to discuss a change of diet.

Children with moderate diarrhea will require special fluids called electrolyte solutions. These have been designed to replace water and salts lost during diarrhea.

A physician should be contacted immediately if

  • Any blood appears in the diarrhea
  • Signs of dehydration occur
  • More than 8 bowel movements occur in the last 8 hours
  • Persistent vomiting exists
  • Child starts acting very sick

Anytime diarrhea presents with fever (>38C or 100.4F), it is necessary to consult a physician. Also, “anti–diarrhea“ medications should only be administered if recommended by a physician.

Prevention

Diarrhea is very contagious. Hand washing after diaper changing or toilet use is very important in order to prevent everyone in the family from acquiring diarrhea. A natural preventive measure for young infants is breastfeeding. Also, it is important to provide the rotavirus vaccine to children less that 1 year of age. This vaccine protects against the virus, which is a very common cause of diarrhea in young children and is part of their regular immunization schedule.

By Julio E. Arias Viaud, MD Pediatrician