What counts as diarrhea?
Most children have a couple of episodes of mild diarrhea a year. The stools can be more watery, more frequent, or both. Since most healthy young children have periods when they have 3-4 stools a day, we usually don't worry unless a child has more than 6 loose stools in a day: it's nearly impossible to have serious consequences like dehydration if the child is having 4-5 loose stools a day, but is otherwise well. In fact, there are some stages in your child's life when he or she should have this kind of stools. Young infants especially have variety in their stools, depending on whether they are breast or formula fed. But this is very normal.
What causes diarrhea?
Diarrhea in children is almost always caused by a viral illness (like the "stomach flu"). Viral diarrhea often goes hand-in-hand with vomiting and a few days of fever. This kind of diarrhea can last 3-10 days. Diarrhea can also be caused by diet. Any variation from a child's usual diet can cause loose stools. In young children, it often results from too much juice (more than 6 ounces a day), too much soda, or too much caffeine. "Diet diarrhea" usually comes and goes but can last weeks to months. If you are suspicious that your child's diet may be causing loose stools, keep a diet diary and bring it to the office for us to review together.
What can I do for my child's diarrhea?
Let 'em poop. First, remember that diarrhea is the body's natural way to get rid of germs in the intestine. Therefore, letting viral diarrhea run its course is a good plan. Even for many bacterial causes of diarrhea (such as salmonella and E. coli), the best course of action is to let it run its course. The stools may be profuse, even explosive, but they will get better with time.
Let 'em eat, if they want. Unless your child has an excess of sweets (including juice) in the diet, no special modification of his diet is necessary. Sometimes children have belly cramps with diarrhea, and so their appetites aren't great. That's okay -- they'll get their appetites back within a week or so. Many physicians used to advocate cutting out all dairy products and certain solid foods. New evidence suggests that this is not necessary: it doesn't make a difference in how fast the child gets better, and it makes the child hungry (and thus crabby.)
Lots of fluids. Encourage lots of fluids to help keep your child hydrated. Your child can have water, milk, weak juice, popsicles, weak Kool-Aid, lemonade, or whatever sounds good. Again, avoid very sweet drinks as they can make diarrhea worse. Also, avoid caffeinated drinks (tea, cola) as much as possible.
Don't use Imodium to stop stools in children under 12. With certain kinds of diarrhea, Imodium can rarely cause dangerous side effects.
Don't use Pepto-Bismol. Pepto-Bismol contains salicylates (similar to aspirin). Like other aspirin containing products, it should not be used in children unless directed by a doctor.
If your child is having vomiting as well as diarrhea, some diet modifications will help until the vomiting resolves. (See our information sheet on vomiting.)
When should I worry about diarrhea?
Most diarrhea can be treated at home. You should have your child checked out if any of the following occur:
There is blood or mucus in the stool.
Your child is having very severe abdominal pain.
The diarrhea lasts more than 10 days without improving at all.
Your child seems to be getting dehydrated. (See our information sheet on dehydration to see what to look for.)
Your child is less than 6 months old. (Small infants get dehydrated faster than older children.)
Your child looks very ill or lethargic.