Monica Madavariya
Diarrhea - Patient Education
What is diarrhea?
Diarrhea is the passage of watery stools. Diarrhea often occurs with fever, nausea, vomiting, cramps, and dehydration.

What causes diarrhea?
Infection from viruses like rotavirus, bacteria like salmonella and, rarely, parasites like giardia. Viruses are the most common cause of a child's diarrhea. Along with loose or watery stools, symptoms of a viral infection often include vomiting, stomachache, headache, and fever.
Medications like laxatives or antibiotics can also lead to diarrhea in children as well as adults.
Food poisoning can also cause diarrhea in kids. Symptoms usually come on quickly, may include vomiting, and tend to go away within 24 hours.

What are the symptoms of viral diarrhea?
A child with viral diarrhea has a fever and often starts the illness with some vomiting. Shortly after these symptoms appear, the child develops diarrhea. Often children with viral diarrhea “feel bad,” but do not act ill.

What are the warning signs of severe illness in a child with diarrhea?
Dehydration (Fluid loss from the body) is one of the most worrisome complications of diarrhea in children. Mild diarrhea usually doesn't cause significant fluid loss, but moderate or severe diarrhea can.
Severe dehydration is dangerous; it can cause seizures, brain damage, even death. Know the signs of dehydration. Call your doctor if your child has:
• Dizziness and light-headedness
• Dry, sticky mouth
• Dark yellow urine, or very little or no urine(gaps of more than 6 hours)
• Few or no tears when crying
• Cool, dry skin
• Lack of energy
• Loss of appetite for liquids
• Frequent diarrhea
• Weight loss
• Extreme thirst

You should also call your pediatrician if your child is less than 6 months of age or has any of the following:
• blood in stool
• frequent vomiting
• abdominal pain
• Can't hold down fluids or has vomited more than two times
• Has a fever over 105° F or is under age 6 months with a fever over 100.4° F (determined by a rectal thermometer)

It is not necessary to call your pediatrician if your child continues to look well even though there may be:
• frequent or large stools
• lots of intestinal gas
• green or yellow stools

How long will the diarrhea last?
Most of the time mild diarrhea lasts from 3 to 6 days. Occasionally a child will have loose stools for several days longer. As long as the child acts well and is taking adequate fluids and food, loose stools are not a great concern.
What should be the diet in diarrhea?
Most children should continue to eat a normal diet including formula or milk while they have mild diarrhea. Breastfeeding should continue. If your baby seems bloated or gassy after drinking cow’s milk or formula, call your pediatrician to discuss a temporary change in diet.
A child with diarrhea should never be fasted. Once she is rehydrated, let the child eat as much or as little of the usual diet as she wants. If she is vomiting, offer small amounts of liquids frequently. A child with mild diarrhea can have regular fluids. But, if there is enough diarrhea to make your child thirsty, he must have special fluids (ORS). Soft drinks, soda, soups, fruit juices, sports drinks, and boiled skim milk have the wrong amounts of sugar and salt and may make your child sicker.

How should special fluids (ORS) be used in diarrhea?
Special fluids like ORS have been designed to replace water and salts lost during diarrhea. These are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. You could accidentally make a bad fluid for your baby. Use a fluid that is made by one of the reputable manufacturers according to WHO guidelines. Usually, one large pack is to be dissolved in 1 liter of boiled, cooled water and should be used within 24 hours. If a child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again. However, if your child develops the warning signs of dehydration, he or she may require hospital care and IV fluids. Immediately seek your pediatrician’s advice for the appropriate care if symptoms of severe illness occur.

Q. What about medicines in diarrhea?
Anti-diarrheal medicines are not useful in most cases of diarrhea and can sometimes be harmful. Never use them unless they are recommended by your pediatrician.
Oral zinc formulations and probiotics ( beneficial bacteria) are helpful and can be taken after prescription from your doctor.
Reminder–do’s and don’ts
• Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.
• Keep your pediatrician informed if there is any significant change in how your child is behaving.
• Report if your child has blood in his stool.
• Report if your child develops a high fever (more than 102ºF or 39ºC). • Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give your child foods that do not further upset his or her stomach.
• Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty.
• Try to make special salt and fluid combinations at home.
• Prevent the child from eating if she is hungry.
• Use boiled milk or other salty broth and soups.
• Use “anti-diarrhea” medicines unless prescribed by your pediatrician. circumstances.

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