Diarrhea (Viral Gastroenteritis)

Diarrhea is the rapid increase in the frequency and looseness of bowel movements. The passage of a few loose or mushy stools is considered milk. Moderate diarrhea results in many watery stools. The frequency of the stool is a good indicator of how severe it is. A green stool can also points to very rapid passage and moderate to severe diarrhea.

The main complication and risk of diarrhea is dehydration from excessive loss of body fluids. Symptoms include dry mouth, the absence of tears (dry tears), sunken eyes, a decrease in urination (no urination or wet diaper in 8 hours), and a dark concentrated urine. It's the dehydration that you need to most worried about, and not the presence of diarrhea.

Diarrhea is most commonly caused by a viral infection of the intestines (viral gastroenteritis). Occasionally it is caused by a bacterial or parasitic intestinal infection. Food intake such as spoiled or improper foods, excessive fruit juice and sweet drinks and food allergies can also cause diarrhea. If the diarrhea only leads to a few stools, it may have been caused by the food your child ate.

Diarrhea usually lasts from several days to a week, regardless of the treatment. The main treatment is to prevent dehydration by giving enough oral fluids to keep up with the fluids lost in the diarrhea. Please be patient as the stools take time to return to normal. Wait until there are at least two loose stools before starting treatment as sometimes a single loose stool has no meaning. Dietary changes are the mainstay of home treatment for diarrhea. The optimal diet depends on your child's age and the severity of the diarrhea.

Mild diarrhea for child of any age.

• Continue a regular diet with a few simple changes.
• Continue full-strength formula or milk.
• Encourage an increased intake of these fluids and extra water.
• Decrease or avoid fruit juices as they may exacerbate symptoms.
• Dilute with water if you must use juice
• Avoid raw fruits and vegetables, beans, spicy foods, and any foods that cause loose stools.

Bottle-Fed Infants with Frequent Watery Diarrhea Oral Rehydration Solutions (ORS) for up to 24 Hours.

Children who have severe diarrhea require ORS to prevent dehydration. Pedialyte and lnfalyte are examples of over-the-counter ORS products that are available at most pharmacies or supermarkets. (ORS is not needed for diarrhea unless it's severe.) If your child doesn't like the flavor you can add a bit of Kool-Aid or other drink powder. Let your child take as much ORS as he/she will take. Prevention of dehydration is very important. Never restrict fluids when your child has diarrhea.

You may also cont to give full strength formula if your baby tolerates it. Avoid giving sport mix drinks like Gatorade due to the inadequate sodium content.)

A homemade ORS can be made with: 1/2 cup of dry infant rice cereal with 2 cups (16 ounces) of water and 1/4 level teaspoon of salt. Continue giving your baby ORS for at least 6 hours.

Switch back to formula when your baby becomes hungry, the diarrhea becomes less watery, and the child is making lots of urine between 6 & 24 hours.

Return to Formula

After taking ORS for 6 to 24 hours, your baby should become hungry. You can restart his/her regular formula. It is okay to do mixture of half strength formula and ORS as you transition to formula. Switching to soy formula can help if the diarrhea continues. Soy formula lacks the sugar in cow’s milk, lactose which may not be well tolerated when having diarrhea. Switching to lactose free cow’s milk formula can also help if your baby is taking cow’s milk formula. Continue the soy formula or lactose free formula until the diarrhea has resolved for 2-3 days.

If your baby's bowel movements are very watery, mix the formula with 1 or 2 ounces of extra water per bottle for 24 hours. Then after 24 hours go back to full-strength formula.

Adding Solids

Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 4 months old, has had diarrhea for over 24 hours, and wants to eat solid food, give her the following starchy foods until the diarrhea is gone: any cereal, mashed potatoes; applesauce, strained bananas, strained carrots, and other high-fiber foods. This is the part of the BRAT (bananas, rice, applesauce and toast) diet that is commonly recommended.

Breast-Fed Infants and Frequent, Watery Diarrhea

Breast-fed infants normally have loose watery stools which can sometimes be slightly green. Have a dirty diaper after each feed is considered normal for the first few months of life. For the breast-fed infant, an increase in the stooling frequency can be diagnosed as diarrhea. Infants may also act sick and feed poorly and develop a fever with the diarrhea.

Treatment

Continue breast-feeding but at a more frequent intervals. Breast-feeding should never be discontinued because of diarrhea. Give ORS if the urination decreases.

Older children (over 1 Year Old) with Frequent Watery Diarrhea

The choice of solids is the key factor-starchy foods are absorbed best. Give cereals (especially rice cereal), oatmeal, bread, noodles, mashed potatoes, carrots, applesauce, strained bananas, etc. Pretzels or salty crackers can help meet your child's sodium needs. The common acronym BRAT (Bananas, Rice, Applesauce, Toast) is used to remember this diet.

• Plain water or half-strength Kool-Aid.
• If not taking solids give ORS (Oral Rehydration Solution such as Pedialyte)
• Encourage a high fluid intake.
• Avoid all fruit juice or other drinks containing fructose .
• Avoid milk and milk products like cheese and creams for 2 to 3 days. Active culture yogurt is fine.
• ORS is rarely needed, unless diarrhea is very watery and urine production is decreased.

Common Mistakes

Using concentrated solution can cause serious complications for babies with diarrhea because they contain too much salt. Kool-Aid and soda pop should not be used as the only foods because they contain little or no salt. Clear fluids alone should only be used for up to 24 hours because the body needs more calories than they can provide. Likewise, a diluted formula should not be used for more than 24 hours. Never restrict fluids when treating diarrhea. There is no effective and safe druf for diarrhea. The best treatment is usually fluid and diet therapy.

Prevention.

Please wash your hands when changing diapers or when using the toilet. Diarrhea is very infectious and can spread quickly to other people.

Diaper Rash from Diarrhea.

Infants wearing diapers can have a red inflamed almost burned skin around the anus from the diarrhea stools. Try to wash it off quickly after each bowel movement. Apply a thick barrier layer of petroleum jelly or any common diaper cream.

Call our office IMMEDIATELY if

• Any blood seen in the diarrhea.
• Signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears, sunken eyes).
• Your child has severe diarrhea (more than eight bowel movements in the last 8 hours).
• The diarrhea is watery and your child also vomits the clear fluids three or more times.
• Your child starts acting very sick.
• Treating vomiting takes priority over diarrhea until no vomiting is seen for 8 hours.

Call during regular hours if

• A fever lasts more than 3 days.
• Mild diarrhea lasts more than 2 weeks.
• You have other concerns or questions.