Topic Overview
Every baby or child has different bowel habits. Your baby may have as many as 4 to 10 stools a day or as few as 1 every 3 days. Many breast-fed babies will have a bowel movement with each feeding and sometimes between feedings. During infancy, normal stool may be runny or pasty, especially if the baby is breast-fed. The presence of mucus in the stool is not uncommon. Unless there is a change in your baby's normal habits, loose and frequent stools are not considered to be diarrhea.
Diarrhea occurs when there is an increase in the frequency of bowel movements or bowel movements are more watery and loose than normal. Diarrhea has many causes.
Dietary changes
A child may develop diarrhea from a change in his or her diet. A baby's or child's digestive tract may not tolerate large amounts of juice, fruit, or even milk. Diarrhea may be caused by an increase in the amount of juice or fruit a child drinks or eats. Diarrhea that is caused by a change in the child's diet is not usually serious.
Infection
Diarrhea is often caused by a viral or bacterial infection, such as rotavirus, stomach flu (gastroenteritis), or food poisoning. Diarrhea is the body's way of quickly clearing any viruses, bacteria, or toxins such as botulism, from the digestive tract. Most cases of diarrhea are caused by a viral infection and will usually clear up in a few days.
Diarrhea may also be caused by a parasitic infection, such as Giardia lamblia. This parasite, as well as other viral and bacterial infections, may be spread by drinking untreated water, unpasteurized dairy products, or by poor hand-washing.
Other causes
On rare occasions, diarrhea can be a symptom of a more serious condition, such as:
- A problem in the digestive tract, such as inflammatory bowel disease.
- Diseases that interfere with the normal digestion of food (malabsorption), such as cystic fibrosis or celiac disease.
Children, especially those younger than 6 months of age and those with other health risks, need special attention when they have diarrhea because they can quickly become dehydrated. Careful observation of your child's appearance and how much fluid he or she is drinking can help prevent problems.
Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.
Emergencies
Does your child have any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.
Check Your Symptoms
If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.
Review health risks that may increase the seriousness of your child's symptoms.
Does your child have severe diarrhea?
See significance of severe diarrhea if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
Severe diarrhea occurs when a child has large, loose stools every 1 to 2 hours. |
Call your child's health professional immediately if you answer "Yes" to the following question.
Has your baby younger than 3 months of age had severe diarrhea for longer than 4 hours?
Call your child's health professional today if you answer "Yes" to any of the following questions.
Has your baby age 3 months through 6 months had severe diarrhea for longer than 8 hours?
Has your child age 7 months through 11 years had severe diarrhea for longer than 12 hours?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Are your child's stools black or bloody?
See significance of black or bloody stools if you need information to help you answer the question below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
Certain foods and medicines also can change the look of your child's stool. Taking medication containing bismuth subsalicylate (such as Pepto-Bismol) or iron tablets can make the stool black, and eating lots of beets may turn the stool red. Some food colorings also can change the color of your child's stool. Eating foods with black or dark blue food coloring can turn your child's stool black. |
Call your child's health professional immediately if you answer "Yes" to the following question.
| Note: |
Do not allow your child to eat until you have talked with your child's doctor. You may give your child sips of water or oral rehydration solution (ORS). |
Does your child have black or bloody diarrhea, but does not have signs of shock?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Does your child have diarrhea with cramping abdominal pain?
See significance of cramping abdominal pain if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
To help you determine your child's level of pain, see evaluating pain in a child. |
Call your child's health professional immediately if you answer "Yes" to any of the following questions.
| Note: |
Do not allow your child to eat until you have talked with your child's doctor. You may give your child sips of water or oral rehydration solution (ORS). |
Does your child have severe abdominal pain?
Does your child's diarrhea look like currant jelly?
Call your child's health professional today if you answer "Yes" to the following question.
Does your child have moderate abdominal pain?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Has your child had mild abdominal pain for longer than 24 hours?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Does your child have diarrhea and localized abdominal pain?
See significance of localized abdominal pain if you need information to help you answer the question below.
Review health risks that may increase the seriousness of your child's symptoms.
Call your child's health professional immediately if you answer "Yes" to the following question.
| Note: |
Do not allow your child to eat until you have talked with your child's doctor. You may give your child sips of water or oral rehydration solution (ORS). |
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
See significance of fever if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
If you need information on how to take a temperature, see the topic Body Temperature. |
Call your child's health professional immediately if you answer "Yes" to any of the following questions.
Does your baby younger than 3 months of age have a rectal temperature of 100.4° (38°) or higher?
Do you suspect your baby younger than 3 months of age has a fever but you are unable to measure your child's temperature?
Does your child have a rectal temperature of 105° (41°) or higher?
Do you suspect a high fever but you are unable to measure your child's temperature?
Call your child's health professional today if you answer "Yes" to any of the following questions.
Does your child have a rectal temperature of 104° (40°) or higher?
Has your child had a rectal temperature of 102° (39°) to 104° (40°) for longer than 12 hours?
Do you suspect a moderate fever but you are unable to measure your child's temperature?
Does your child have a recurrent or ongoing fever without an obvious cause after traveling outside your own country in the last 6 weeks?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Has your child had a rectal temperature of 100.4° (38°) to 102° (39°) for longer than 24 hours?
Do you suspect your child has a mild fever for longer than 24 hours, but you are unable to measure your child's temperature?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Does your child have diarrhea and signs of mild to moderate dehydration?
See significance of dehydration if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
| Note: |
Be sure to review the Home Treatment section in this topic for tips on how to prevent and correct dehydration. |
Call your child's health professional immediately if you answer "Yes" to the following question.
Does your child have signs of moderate dehydration, and he or she is unable to drink enough liquid to replace lost fluids?
Call your child's health professional today if you answer "Yes" to any of the following questions.
Does your child have signs of moderate dehydration?
Does your child have signs of mild dehydration, and he or she is unable to drink enough liquid to replace lost fluids?
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Does your child have signs of mild dehydration for longer than 24 hours?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Has your child had ongoing diarrhea or diarrhea that comes and goes?
See significance of ongoing diarrhea if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
Call your child's health professional today if you answer "Yes" to the following question.
Is your child having more frequent episodes of diarrhea than he or she had in the past?
Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.
Has your child had diarrhea off and on for longer than 2 months?
Has your baby's or child's ongoing diarrhea been evaluated by a doctor, but it is not following the expected course?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Has your child had mild to moderate diarrhea (less than 6 stools in 12 hours)?
See significance of mild to moderate diarrhea if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.
Has your baby younger than 3 months of age had diarrhea for longer than 24 hours?
Has your baby age 3 months through 6 months had diarrhea for longer than 24 to 48 hours?
Has your child age 7 months through 11 years had diarrhea for longer than 4 to 7 days?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Do you think your child's diarrhea may be caused by a medication?
See significance of medications if you need information to help you answer the questions below.
Review health risks that may increase the seriousness of your child's symptoms.
Call your child's health professional today if you answer "Yes" to any of the following questions.
Did your child's diarrhea start after an increase in a dose of medication or after taking a new medication?
| Note: |
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Did your child's diarrhea start after starting treatment with an antibiotic?
Did your child's diarrhea start within 2 weeks of stopping treatment with an antibiotic?
If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.
Other Symptoms to Watch For
Does your child have any of the following symptoms?
- Nausea or vomiting: Go to the topic Vomiting, Age 3 and Younger or Nausea and Vomiting, Age 4 and Older.
- Ongoing (chronic) abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger.
| Note: |
If your baby younger than 3 months of age is becoming increasingly fussy during the evening, but there has been little or no diarrhea (there may be loose stools), you may be able to talk to your doctor over the telephone about colic. For more information, see the topic Colic. |
If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.
Home Treatment
As soon as you notice your child has diarrhea, it is important to take action to prevent dehydration. Oral rehydration solutions (ORSs) are used to prevent or correct dehydration in young children. ORSs contain the right mix of salt, sugar, potassium, and other minerals to help replace body fluids lost from diarrhea. It may be wise to keep some ORS on hand so that if your child develops diarrhea, you can start replacing lost fluids immediately. ORS will help prevent dehydration, but it will not stop the diarrhea.
The amount of ORS your child needs depends on the severity of his or her dehydration. The more severe the dehydration, the more ORS you will need to give your child.
Newborns and babies through 1 year of age
Don't wait until signs of dehydration develop to replace lost fluids.
- If you breast-feed your baby, continue at more frequent intervals to replace lost fluids. Give an oral rehydration solution (ORS) between feedings only if signs of dehydration develop.
- If you use a bottle to feed your baby, increase the frequency of feedings to make up for lost fluids. The amount of extra fluid your baby needs depends on your baby's size and the severity of his or her diarrhea. For example, a newborn may need as little as 1 fl oz (30 mL) at each extra feeding while a 12 month old baby may need as much as 3 fl oz (89 mL) at each extra feeding. Give an ORS between feedings only if signs of dehydration develop.
- If signs of mild or moderate dehydration develop, the amount of breast milk, formula, or ORS your baby needs depends on his or her weight and the degree of dehydration present. You can give the ORS in a dropper, spoon, or bottle. Continue to give the ORS until your baby's stools return to normal.
- If your baby has started eating cereal, you may replace lost fluids with cereal. Offer the cereal mixture after each diarrhea stool. You may also offer any other foods that your child has had before.
Children 1 year through 11 years of age
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Oral rehydration solution (ORS), half-strength orange juice, or plain water (if the child is eating food) may be used to replace fluids lost from diarrhea.
- Offer your child 0.5 cups (118 mL) to 1 cup (237 mL) of fluids after each diarrhea stool.
- Allow your child to drink as much fluid as he or she wants.
- If diarrhea is persistent or if your child is dehydrated, using an ORS as the main source of replacement fluids is the safest approach.
- The amount of ORS your child needs depends on his or her weight and the degree of dehydration present.
- Keep giving the ORS until your child's stools return to normal.
- Cereal may also be used to replace lost fluids. Offer 0.5 cups (118 mL) to 1 cup (237 mL) of the cereal mixture after each diarrhea stool.
- Give your child frequent small meals, at least 6 a day, while he or she is having diarrhea.
- The best foods for your child are easily digestible foods, such as rice cereal, pasta, breads, cooked beans, mashed potatoes, cooked carrots, applesauce, and bananas.
- Pretzels or salty crackers can help your child replace the salt lost from diarrhea.
- Foods containing large amounts of sugar or fat should be avoided.
General tips
- Avoid giving your child apple juice, chicken broth, soda pop, sports drinks (such as Gatorade, All Sport, or Powerade), ginger ale, or tea. These drinks do not contain the right mixture of minerals and sugar to replace lost fluids and may make the diarrhea worse.
- Do not offer soda pop , juice, ice cream, or candy because they contain a lot of sugar and lack the calories and minerals your child needs.
- You may use plain water to replace lost fluids if your child is over the age of 1 year and is eating food.
- Do not withhold food from your child. Studies have shown that children who are fed easily digestible foods have shorter episodes of diarrhea.
- If your child drinks cow's milk, he or she may continue to drink it.
- Do not give your child prescription or nonprescription medicine to stop diarrhea unless you are told to do so by your child's doctor.
- Protect the diaper area with zinc oxide or another cream. Diaper rash is common after diarrhea. For more information, see the topic Diaper Rash.
- Wash your hands and your child's hands thoroughly after each diaper change and before each feeding.
- Until your doctor has assured you that your child's diarrhea is not infectious, your child should not attend school or day care.
Symptoms to Watch For During Home Treatment
Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment.
- Diarrhea gets worse despite home treatment.
- Increasing abdominal pain develops.
- Blood in diarrhea develops.
- Signs of dehydration develop.
- Diarrhea and a fever lasts longer than 2 days.
- Symptoms become more severe or frequent.
Prevention
Do not allow your child to drink untreated or unfiltered water from a lake or stream or unpasteurized milk. Untreated water and unpasteurized milk are sources for viral, bacterial, and parasitic infections, such as Giardia lamblia. Avoid having your child brush his or her teeth with untreated water. Even a small amount of untreated water can contain enough parasites, virus, and bacteria to cause diarrhea.
Diarrhea can spread because of poor hygiene.
- Practice good hand-washing.
- Be sure to wash your hands and your child's hands after each diaper change or trip to the bathroom.
- Teach your child to wash his or her hands after using the bathroom and before every meal.
- Do not place soiled diapers on surfaces that are used to prepare or serve food.
- If your child attends school or day care, keep your child home until your doctor has determined that his or her diarrhea cannot be passed to others (is not infectious).
Food poisoning is a common cause of diarrhea in children and adults. Most cases of food poisoning at home may be prevented by taking a few precautions when preparing and storing food. Perishable foods, such as eggs, meats, poultry, fish, shellfish, milk, and milk products, should be treated with extra care. Also, precautions should be taken if you are pregnant, you have an impaired immune system or a chronic illness, or you are preparing foods for other high-risk groups, such as young children or older people.
The U.S. Department of Agriculture recommends the following steps to prevent food poisoning:
- Prepare foods safely.
- Shop safely.
- Cook foods safely.
- Store foods safely.
- Follow labels on food packaging.
- Serve foods safely.
- When in doubt, throw it out.
Many counties in the United States have extension services listed in the phone book. These services can answer your question about safe home canning and food preparation.
When you travel in wilderness areas or to other countries of the world, it is common to get diarrhea from food or water because the methods of food preparation are different. For information on how to prevent traveler's diarrhea, see traveler's diarrhea.
A new vaccine (RotaTeq) has recently been licensed to prevent rotavirus infection. This vaccine helps protect babies and young children from getting a rotavirus infection, which can cause diarrhea and dehydration. Talk to your child's doctor about this vaccine for your child.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment
You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:
- How long has your child had diarrhea?
- How many times per day does your child have diarrhea?
- Describe your child's diarrhea:
- What color is it?
- Is it mushy or watery?
- Does it contain blood or mucus?
- Have you noticed an unusual odor?
- Does your child have other symptoms such as fever, vomiting, or abdominal pain?
- Has your child taken any new prescription or nonprescription medications?
- Do you regularly give your child laxatives or stool softeners?
- Has your child been eating new or different foods?
- Has your child been exposed to other children or adults who have diarrhea?
- Has your child drunk untreated lake, stream or well water?
- Has your child recently visited a foreign country where clean water or proper food preparation was not available?
- Has your child been exposed to farm animals?
- Does your child have a history of chronic disease such as cystic fibrosis or celiac disease?
- Does your child have any health risks?
Credits
| Author | Jan Nissl, RN, BS |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Tracy Landauer |
| Primary Medical Reviewer | Michael J. Sexton, MD - Pediatrics |
| Specialist Medical Reviewer | Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics |
| Last Updated | June 23, 2006 |
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