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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.
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.
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.
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 or intussusception.
- 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.
Check your child's symptoms to decide if and when your child should see a doctor.
Normal stool during infancy may be runny or pasty, especially if the baby is breastfed. 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.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
What you are looking for is a change in your child's usual bowel habits.
- Diarrhea means that the child is having more stools and looser ones than usual.
- Constipation means that the child is having fewer stools than usual.
Every baby and child has different bowel habits. What is "normal" for one child may not be normal for another. In general:
- Many newborns have at least 1 or 2 bowel movements a day. By the end of their first week, they may have as many as 5 to 10 bowel movements a day. They may pass a stool after each feeding.
- By 6 weeks of age, your baby may not have a bowel movement every day. This usually isn't a problem as long as the baby seems comfortable and is growing as expected, and as long as the stools aren't hard.
- By about 4 years of age, it's normal for a child to have as many as 3 bowel movements a day or as few as 3 a week.
Anywhere in these ranges can be considered normal if the habit is normal or usual for your child.
Babies can quickly get dehydrated when they lose fluids because of problems like vomiting or fever.
Symptoms of dehydration can range from mild to severe. For example:
- The baby may be fussy or cranky (mild dehydration), or the baby may be very sleepy and hard to wake up (severe dehydration).
- The baby may have a little less urine than usual (mild dehydration), or the baby may not be urinating at all (severe dehydration).
You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.
Symptoms of dehydration can range from mild to severe. For example:
- You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
- You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).
Severe dehydration means:
- The baby may be very sleepy and hard to wake up.
- The baby may have a very dry mouth and very dry eyes (no tears).
- The baby may have no wet diapers in 12 or more hours.
Moderate dehydration means:
- The baby may have no wet diapers in 6 hours.
- The baby may have a dry mouth and dry eyes (fewer tears than usual).
Mild dehydration means:
- The baby may pass a little less urine than usual.
Severe dehydration means:
- The child's mouth and eyes may be extremely dry.
- The child may pass little or no urine for 12 or more hours.
- The child may not seem alert or able to think clearly.
- The child may be too weak or dizzy to stand.
- The child may pass out.
Moderate dehydration means:
- The child may be a lot more thirsty than usual.
- The child's mouth and eyes may be drier than usual.
- The child may pass little or no urine for 8 or more hours.
- The child may feel dizzy when he or she stands or sits up.
Mild dehydration means:
- The child may be more thirsty than usual.
- The child may pass less urine than usual.
Symptoms of serious illness in a baby may include the following:
- The baby is limp and floppy like a rag doll.
- The baby doesn't respond at all to being held, touched, or talked to.
- The baby is hard to wake up.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
If you're not sure if a child's fever is high, moderate, or mild, think about these issues:
With a high fever:
- The child feels very hot.
- It is likely one of the highest fevers the child has ever had.
With a moderate fever:
- The child feels warm or hot.
- You are sure the child has a fever.
With a mild fever:
- The child may feel a little warm.
- You think the child might have a fever, but you're not sure.
A baby that is extremely sick:
- May be limp and floppy like a rag doll.
- May not respond at all to being held, touched, or talked to.
- May be hard to wake up.
A baby that is sick (but not extremely sick):
- May be sleepier than usual.
- May not eat or drink as much as usual.
Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.
Oral (by mouth), ear, or rectal temperature
- High: 104° F (40° C) and higher
- Moderate: 100.4° F (38° C) to 103.9° F (39.9° C)
- Mild: 100.3° F (37.9° C) and lower
A forehead (temporal) scanner is usually 0.5° F (0.3° C) to 1° F (0.6° C) lower than an oral temperature.
Armpit (axillary) temperature
- High: 103° F (39.5° C) and higher
- Moderate: 99.4° F (37.4° C) to 102.9° F (39.4° C)
- Mild: 99.3° F (37.3° C) and lower
Note: For children under 5 years old, rectal temperatures are the most accurate.
An illness plan for people with diabetes usually covers things like:
- How often to test blood sugar and what the target range is.
- Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
- What to do if you have trouble keeping food or fluids down.
- When to call your doctor.
The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.
It is easy for your diabetes to become out of control when you are sick. Because of an illness:
- Your blood sugar may be too high or too low.
- You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
- You may not know how to adjust the timing or dose of your diabetes medicine.
- You may not be eating enough or drinking enough fluids.
Blood in the stool can come from anywhere in the digestive tract, such as the stomach or intestines. Depending on where the blood is coming from and how fast it is moving, it may be bright red, reddish brown, or black like tar.
A little bit of bright red blood on the stool or on the toilet paper is often caused by mild irritation of the rectum. For example, this can happen if you have to strain hard to pass a stool or if you have a hemorrhoid.
Certain medicines and foods can affect the color of stool. Diarrhea medicines (such as Pepto-Bismol) and iron tablets can make the stool black. Eating lots of beets may turn the stool red. Eating foods with black or dark blue food coloring can turn the stool black.
If you take aspirin or some other medicine (called a blood thinner) that prevents blood clots, it can cause some blood in your stools. If you take a blood thinner and have ongoing blood in your stools, call your doctor to discuss your symptoms.
Many prescription and nonprescription medicines can cause diarrhea. A few examples are:
- Proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid).
- Medicines used to treat cancer (chemotherapy).
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
It's important to take action to prevent dehydration.
Newborns and babies younger than 1 year of age
Don't wait until you see signs of dehydration in your baby. These signs include your baby being thirstier than usual and having less urine than usual.
- If you breastfeed your baby, nurse him or her more often. Offer each breast to your baby for 1 to 2 minutes every 10 minutes.
- If you use a bottle to feed your baby, increase the number of feedings to make up for lost fluids. The amount of extra fluid your baby needs depends on your baby's age and size. 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 (90 mL) at each extra feeding.
- Ask your doctor if you need to use an oral rehydration solution (ORS) if your baby still isn't getting enough fluids from formula or the breast. The amount of ORS your baby needs depends on your baby's age and size. You can give the ORS in a dropper, spoon, or bottle.
- If your baby has started eating cereal, you may replace lost fluids with cereal. You also may feed your baby strained bananas and mashed potatoes if your child has had these foods before.
Children ages 1 through 11
- Make sure your child is drinking often. Frequent, small amounts work best.
- Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles. Note: Do not give your child fruit juice or soda pop. Fruit juice and soda pop contain too much sugar and not enough of the essential minerals (electrolytes) that are being lost. Diet soda pop lacks calories that your child needs.
- Cereal mixed with milk or water may also be used to replace lost fluids.
- If your child still is not getting enough fluids, you can try an oral rehydration solution (ORS).
- 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.
- 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.
- 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.
- Learn how to clean up diarrhea safely. Protect your hands with gloves while cleaning up. Wash your hands after you are done cleaning up.
If your child is also vomiting, learn about home treatment for vomiting.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Blood in diarrhea develops.
- Signs of dehydration develop. These include your child being thirstier than usual and having less urine than usual.
- Your child has diarrhea and a fever.
- Symptoms become more severe or frequent.
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 at home until your doctor has determined that his or her diarrhea can't 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 following steps are recommended 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 questions 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 traveler's diarrhea from food or water because the methods of food preparation are different.
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 medicines?
- 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?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine