Diarrhea

Symptoms

DEFINITION

• Diarrhea is the sudden increase in the frequency and looseness of stools
• The main risk of diarrhea is dehydration
• Loose or runny stools do not cause dehydration
• Frequent, watery stools can cause dehydration

Causes

• Viral gastroenteritis (viral infection of the stomach and intestines) is the usual cause
• Bacteria (e.g., Salmonella or Shigella) cause some diarrhea.
• The main food-borne bacteria are Campylobacter, Salmonella and E.coli.
• Food-poisoning: Rapid onset of vomiting and diarrhea within hours after eating a food contaminated with toxins (e.g. cream dishes that are not properly refrigerated). The symptoms usually resolve in less than 24 hours without a need for medical care. 
• Giardia (a parasite) occasionally, especially in child care centers

Dehydration: How to Recognize

• Dehydration means that the body has lost excessive fluids, usually from vomiting and/or diarrhea. An associated weight loss of more than 3% is required. In general, mild diarrhea, mild vomiting or a mild decrease in fluid intake does not cause dehydration.
• Dehydration is the most important complication of diarrhea.

The following are signs of dehydration:

• Decreased urination (no urine in more than 8 hours) occurs early in the process of dehydration. So does a dark yellow, concentrated yellow. If the urine is light straw colored, your child is not dehydrated.
• Dry tongue and inside of the mouth. Dry lips are not helpful.
• Dry eyes with decreased or absent tears
• In infants, a depressed or sunken soft spot
• Delayed capillary refill longer than 2 seconds. This refers to the return of a pink color to the thumbnail after you press it and make it pale. Ask your doctor to teach you how to do this test.
• Irritable, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
• A child with severe dehydration becomes too weak to stand or very dizzy if tries to stand.

Definition of Diarrhea in Breastfed Infants

• The stools of a breastfed infant are normal unless they contain mucus or blood or develop a new bad odor.
• The looseness (normally runny and seedy), color (normally yellow) and frequency of stools (normally more than 6/day) are not much help.  Breastfed babies may normally even pass some green stools surrounded by a water ring (normal bile can come out green if intestinal transit time is rapid enough). 
• During the first 1 to 2 months of life, the breastfed baby may normally pass a stool after each feeding.  (However, if an infant's stools abruptly increase in number and looseness and persist for 3 or more stools, the baby probably has diarrhea.) 
• Other clues to diarrhea are poor eating, acting sick, or a fever.

Definition of Diarrhea in Formula-Fed Infants

• Formula-fed babies pass 1 to 8 stools per day during the first week, then 1 to 4 per day until 2 months of age. 
• The stools are yellow in color and peanut butter in consistency. 
• Formula-fed newborns have true diarrhea if the stools abruptly increase in number or looseness and persist for 3 or more stools, become watery or very runny, contain mucus or blood or develop a new bad odor. 
• Other clues to diarrhea are poor eating, acting sick or a fever. 
• After 2 months of age, most infants pass 1 or 2 stools per day (or 1 every other day) and no longer appear to have mild diarrhea.

Return to School

• Your child can return to child care or school after the stools are formed and the fever is gone.  The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

See More Appropriate Topic (instead of this one) If

• Vomiting is present along with diarrhea, see VOMITING WITH DIARRHEA .
• Blood present and no diarrhea, see STOOLS, BLOOD IN.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE FOR DIARRHEA

1. Reassurance:
   • Most diarrhea is caused by a viral infection of the intestines.
   • Diarrhea is the body's way of getting rid of the germs.
   • Here are some tips on how to keep ahead of the fluid losses.
2. Mild Diarrhea:  
   • Continue regular diet.  
   • Eat more starchy foods (e.g., cereal, crackers, rice).
   • Drink more fluids. Formula or milk are good balanced fluids for diarrhea. (EXCEPTION: avoid all fruit juices and soft drinks because they make diarrhea worse).
3. Formula-Fed Infants WITH frequent, watery diarrhea: Start Oral Rehydration Solutions (ORS)
   • ORS (e.g., Pedialyte or the store brand) is a special electrolyte solution that can prevent dehydration. It's readily available in supermarkets and drug stores.
   • Start ORS for frequent, watery diarrhea (Note: Formula is fine for average diarrhea).
   • Use ORS alone for 4 to 6 hours to prevent dehydration. Offer unlimited amounts.
   • If ORS not available, use formula prepared in the usual way (unlimited amounts) until you can get some.
   • Avoid Jello water, sports drinks, or fruit juice.
4. Returning to Formula
   • Go back to formula by 6 hours at the latest. (Reason: needs the calories)
   • Use formula prepared in the usual way. (Reason: It contains adequate water).
   • Offer the formula more frequently than you normally do.
   • Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (soy formula) are only needed for watery diarrhea persisting over 3 days.
   • Extra ORS: also give 2-4 ounces (60-120 ml) of ORS after every large watery stool.
5. Solids
   • Infants over 4 months old: Continue solids (e.g., rice cereal, strained bananas, mashed potatoes, etc).
6. Breastfed Infants WITH frequent, watery diarrhea:
   • Continue breastfeeding at more frequent intervals.  Continue solids as for formula-fed.
   • Offer 2-4 (60-120 ml) ORS (e.g., Pedialyte) after every large watery stool (especially if urine is dark) in addition to breastfeedings.
7. Older Children (over 1 year old) WITH frequent, watery diarrhea:
   • Fluids: Offer unlimited fluids. If taking solids, give water or half-strength Gatorade. If refuses solids, give milk or formula.
   • Avoid all fruit juices and soft drinks. (Reason: makes diarrhea worse)
   • ORS (e.g., Pedialyte) is rarely needed, but for severe diarrhea, also give 4-8 ounces (120-240 ml) of ORS after every large watery stool.
   • Solids: Starchy foods are absorbed best.  Give dried cereals, oatmeal, bread, crackers, noodles, mashed potatoes, rice, etc.  Pretzels or salty crackers can help meet sodium needs.
8. Probiotics:
   • Probiotics contain healthy bacteria (Lactobacilli) that can replace unhealthy bacteria in the GI tract.
   • YOGURT is the easiest source of probiotics. If over 12 months old, give 2 to 6 oz (60 to 180 ml) of yogurt twice daily. (Note: Today, almost all yogurts are "active culture".)
   • Probiotic supplements in granules, tablets or capsules are also available in health food stores.
9. Diaper Rash: Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (e.g., petroleum jelly) around the anus to protect the skin.
10. Contagiousness: Your child can return to child care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.
11. Expected Course: Viral diarrhea lasts 5-14 days. Severe diarrhea only occurs on the first 1 or 2 days, but loose stools can persist for 1 to 2 weeks.
12. Call Your Doctor If:
    • Signs of dehydration occur
    • Diarrhea persists over 2 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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Source: LMS Inc.

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