Diarrhea is a very common problem in children younger than age five. In developing or non-industrialized countries, multiple episodes of diarrhea can lead to serious problems such as malnutrition (poor nutrition). In the United States and Canada, young children have an average of two episodes of diarrhea per year.
Diarrhea is defined as an increase in the number of stools or the presence of looser stools than is normal for the individual, i.e. more than three bowel movements each day. Acute diarrhea is when diarrhea occurs for less than 3 weeks total. When diarrhea lasts longer than three weeks, it is considered to be chronic.
Diarrhea may be watery or contain blood. Stool may float which may indicate that there is increased fat present in the stool. Diarrhea may also be accompanied by:
Individuals with diarrhea are at risk for dehydration, which occurs when someone is unable to take in sufficient fluid orally to meet their daily requirements and compensate for losses in their stools. Signs of dehydration include:
Physicians can determine if someone is dehydrated and how severely they are dehydrated by examining them. Parents can monitor children for signs of dehydration.
Acute diarrhea may be due to infections with bacteria, viruses or parasites. Diarrhea is more common in children attending day care and is usually due to a virus. While cases of diarrhea due to infection are usually mild and go away on their own, it is important to avoid becoming dehydrated from loss of body fluid in diarrheal stools.
There are many causes of chronic diarrhea. Chronic diarrhea is due to a disease that causes inflammation of the bowel and/or malabsorption of nutrients.
Common causes of chronic diarrhea are shown below:
Risk factors for infectious causes of diarrhea include travel to foreign countries, swimming in lakes and ponds, attendance at day care, foster home and school as well as sick contacts at home. Recent antibiotic use can also put individuals at risk for developing diarrhea. Celiac disease and inflammatory bowel disease (IBD) have been associated with certain genes and families with first-degree relatives with these diseases are at greater risk.
Diarrhea due to acute infection (acute gastroenteritis) usually does not require tests. In some cases doctors will order blood tests to determine if a child is dehydrated. Collection of stool samples (stool cultures) can be done to identify the specific cause of the diarrhea in some children, especially if they have blood in stools. Stool cultures can take from 2 to 5 days before a result is available. Stool studies can also be done to look for parasites including Giardia. In many cases of acute infectious diarrhea, a precise cause will not be identified despite stool testing.
The diagnosis of chronic diarrhea usually requires confirmatory tests. Establishing the exact cause of chronic diarrhea may require several different tests, some of which are listed below:
Your physician can assist you in choosing the best treatment after determining the cause of your child’s diarrhea.
Ensure Adequate Hydration
Children with mild dehydration can be treated outside of the hospital with special oral rehydration solutions (ORS) that can be purchased at the pharmacy or grocery store. Oral rehydration solutions are the best way to rehydrate a child who is able to drink and is not vomiting. Although other drinks such as juices, colas and sports drinks are frequently used, they are not a good substitute for ORS, and can actually worsen the diarrhea. Patients with more severe diarrhea, vomiting and dehydration may require intravenous fluids (fluids given through a vein in the arm) in the hospital.
In a child who is otherwise healthy, it is very important to start feeding them their regular diet as soon as possible. Breast fed infants should be nursed normally during episodes of acute gastroenteritis. Formula fed infants can continue their regular diet and older children should be re-introduced to their regular diet as soon as possible. Older children may avoid dairy initially and try a bland diet consisting of bananas, apple sauce, rice, and toast.
Antibiotics may be prescribed for children with specific bacterial or parasitic illnesses, although in most cases antibiotics do not change how long the diarrhea lasts or its severity. Probiotics (commercially manufactured tablets or capsules that contain “good bacteria”) may be useful in decreasing the severity of symptoms in the presence of an imbalance of good and bad bacteria in the intestines. Medications that slow down bowel movements are not recommended in children with acute diarrhea although they may occasionally play a role in children with chronic diarrhea.
Careful hand washing should be practiced by all family members especially after diaper changes.
Marsha H. Kay, MD, FACG, The Cleveland Clinic, Cleveland, OH, and Anthony F. Porto, MD, MPH, Yale University/Greenwich Hospital, Greenwich, CT – Updated December 2012.
Marsha H. Kay, MD, The Cleveland Clinic, Cleveland, OH, and Vasundhara Tolia, MD, Children's Hospital of Michigan, Detroit, MI – Published September 2004.