Returning to Formula
See More Appropriate Topic (instead of this one):
- 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
- 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.
Formula-Fed Infants WITH frequent, watery diarrhea: Start Oral Rehydration Solutions (ORS)
When to Call for Diarrhea
Call 911 Now (your child may need an ambulance) If
- Not moving or too weak to stand
Call Us Now (night or day) If
- Your child looks or acts very sick
- Signs of dehydration (e.g., no urine over 8 hours, no tears with crying and very dry mouth)
- Blood in the stool
- Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc)
- Abdominal pain present over 2 hours
- Vomiting clear liquids 3 or more times
- Age under 1 month with 3 or more diarrhea stools (mucus, bad odor, increased looseness)
- Passed more than 8 diarrhea stools in the last 8 hours
- Severe diarrhea while taking a medicine that could cause diarrhea (e.g., antibiotics)
- Fever over 104° F (40° C) and not improved 2 hours after fever medicine
- Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
- You think your child needs to be seen urgently
Call Us Within 24 Hours (between 9 am and 4 pm) If
- You think your child needs to be seen, but not urgently
- Pus in the stool present for over 2 days
- Loss of bowel control in a toilet trained child occurs 3 or more times
- Fever present for more than 3 days
- Close contact with person or animal who has bacterial diarrhea
- Contact with reptile (snake, lizard, turtle) in previous 14 days
- Travel to country at risk for bacterial diarrhea within past month
Call Us During Weekday Office Hours If
- You have other questions or concerns
- Diarrhea persists over 2 weeks
- Loose stools are a chronic problem
Parent Care at Home If
- Mild diarrhea (probably viral gastroenteritis) and you don't think your child needs to be seen
HOME CARE ADVICE FOR DIARRHEAReassurance:
- 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.
- 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).
- 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.
- 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 mls) of ORS after every large watery stool.
Breastfed Infants WITH frequent, watery diarrhea:
- Infants over 4 months old: Continue solids (e.g., rice cereal, strained bananas, mashed potatoes, etc).
Older Children (over 1 year old) WITH frequent, watery diarrhea:
- Continue breastfeeding at more frequent intervals. Continue solids as for formula-fed.
- Offer 2-4 ounces (60-120 mls) ORS (e.g., Pedialyte) after every large watery stool (especially if urine is dark) in addition to breastfeedings.
- 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 (120-240ml) 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.
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.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.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. Call Your Doctor If:
- 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.
- Signs of dehydration occur
- Diarrhea persists over 2 weeks
- Your child becomes worse
First Aid - Shock
And remember, contact your doctor if your child develops any of the "Call Us" symptoms.
Author and Senior Reviewer: Barton D. Schmitt, M.D.