Topic Resources
Diarrhea is a very common problem in children (see also Diarrhea
in adults). Diarrhea is frequent, loose, or watery bowel movements
(BMs) that differ from a child’s normal pattern. Sometimes diarrhea
contains blood or mucus. Identifying mild diarrhea may be difficult
because in healthy children, the number and consistency of BMs vary with
age and diet. For example, breastfed infants who are not yet receiving
solid food often have frequent, loose stools that are considered normal.
A sudden increase in number and looseness may indicate diarrhea in
these infants. However, having watery stools for more than 24 hours is
never normal.
Children with diarrhea may lose their appetite, vomit, lose weight, or have a fever. If diarrhea is severe or lasts a long time, dehydration
is likely. Infants and young children can become dehydrated more
quickly, sometimes in less than 1 day. Severe dehydration can cause
seizures, brain damage, and death.
Worldwide, diarrhea causes 1.5 million deaths a year mostly in
underdeveloped countries. In the United States, diarrhea accounts for
about 9% of hospitalizations for children under 5 years old.
Causes
Likely causes of diarrhea depend on whether it lasts less than 2
weeks (acute) or more than 2 weeks (chronic). Most cases of diarrhea are
acute.
Common causes
Acute diarrhea is usually caused by
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Infectious gastroenteritis
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Food poisoning
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Use of antibiotics
Gastroenteritis is usually caused by a virus, but it can be caused by bacteria or a parasite.
Food poisoning usually refers to diarrhea, vomiting, or both
caused by eating food contaminated by toxins produced by certain
bacteria, such as staphylococci or clostridia.
Certain antibiotics can alter the types and number of bacteria in
the intestine. As a result, diarrhea can occur. Sometimes using
antibiotics enables a particularly dangerous bacteria, Clostridium difficile, to multiply. Clostridium difficilereleases toxins that can cause inflammation of the lining of the large intestine (colitis—see Clostridium difficile -Induced Colitis).
Chronic diarrhea is usually caused by
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Dietary factors, such as lactose intolerance or overconsumption of certain foods
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Infections (particularly those caused by parasites)
Less common causes
Acute diarrhea can also result from more serious disorders such as appendicitis, intussusception, and hemolytic-uremic syndrome
(a complication of certain types of bacterial infection). These serious
disorders are usually associated with other worrisome symptoms besides
diarrhea, such as severe abdominal pain or swelling, bloody stools,
fever, and ill appearance.
Chronic diarrhea can also result from disorders that interfere with the absorption of food (malabsorption disorders), such as cystic fibrosis, and a weakened immune system (due to a disorder such as AIDS or use of certain drugs).
Diarrhea sometimes results from constipation. When hardened stool accumulates in the rectum, soft stool may leak around it and into the child's underwear.
Evaluation
Warning signs
Certain symptoms are cause for concern. They include
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Signs of dehydration, such as decreased urination, lethargy or listlessness, crying without tears, extreme thirst, and a dry mouth
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Ill appearance
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High fever
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Blood in stool
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Pain in the abdomen and, when touched, extreme tenderness
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Bleeding in the skin (seen as tiny reddish purple dots [petechiae] or splotches [purpura])
When to see a doctor
Children with any warning signs should be evaluated by a doctor
right away, as should those who have had more than 3 or 4 episodes of
diarrhea and are not drinking or are drinking very little.
If children have no warning signs and are drinking and urinating
normally, the doctor should be called if diarrhea lasts 2 days or more
or if there are more than 6 to 8 episodes of diarrhea a day. If diarrhea
is mild, a doctor’s visit is unnecessary. Children with diarrhea for 14
days or more should be seen by a doctor.
What the doctor does
Doctors first ask questions about symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see Table: Some Causes and Features of Diarrhea).
Doctors ask what the BMs look like, how frequent they are, how
long they last, and whether the child has other symptoms, such as fever,
vomiting, or abdominal pain.
Doctors also ask about potential causes, such as diet, use of
antibiotics, consumption of possibly contaminated food, recent contact
with animals, and recent travel.
A physical examination is done, looking for symptoms of
dehydration and disorders that can cause diarrhea. The abdomen is
checked for swelling and tenderness. Doctors also evaluate the child's growth.
Testing
If diarrhea lasts less than 2 weeks and warning signs are not
present, the cause is probably gastroenteritis due to a virus, and
testing is usually unnecessary. However, if doctors suspect another
cause, tests are done to check for it.
Tests are typically done when children have warning signs. If
they have signs of dehydration, blood tests are done to measure levels
of electrolytes (sodium, potassium, calcium, and other minerals
necessary to maintain the fluid balance in the body). If other warning
signs are present, tests may include a complete blood cell count, urine
tests, examination and analysis of stool, abdominal x-rays, or a
combination.
Treatment
Specific causes of diarrhea are treated. For example, if children
have celiac disease, gluten is removed from their diet. Antibiotics
that cause diarrhea are stopped if a doctor recommends it.
Gastroenteritis due to a virus usually disappears without treatment.
Drugs to stop diarrhea, such as loperamide, are not recommended for infants and young children.
Dehydration
Because the main concern in children is dehydration, treatment is focused on rehydrating by giving fluids and electrolytes (see Dehydration in Children).
Most children with diarrhea are successfully treated with fluids given
by mouth (orally). Fluids are given by vein (intravenously) only if
children are not drinking or are severely dehydrated. Oral rehydration
solutions that contain the right balance of carbohydrates and sodium are
used. In the United States, these solutions are widely available
without a prescription from pharmacies and most supermarkets. Sports drinks, sodas, juices, and similar drinks have too little sodium and too much carbohydrate and should not be used.
If children are also vomiting, small, frequent amounts of fluid
are given at first. Typically, 1 teaspoon (5 milliliters) is given every
5 minutes. If children keep this amount down, the amount is gradually
increased. If the child is not vomiting, the initial amount of fluid
does not need to be limited. With patience and encouragement, most
children can take enough fluid by mouth to avoid the need for
intravenous fluid. However, children with severe dehydration may need
intravenous fluids.
Diet
As soon as children have received sufficient fluids and are not
vomiting, they should be given an age-appropriate diet. Infants may
resume breast milk or formula.
In children with chronic diarrhea, the treatment depends on the
cause, but providing and maintaining adequate nutrition and monitoring
for possible vitamin or mineral deficiencies are most important.
Key Points
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Diarrhea is common among children.
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Gastroenteritis, usually due to a virus, is the most common cause.
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Children should be evaluated by a doctor if they have any warning sign (such as signs of dehydration, severe abdominal pain, fever, or blood or pus in stool).
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Testing is rarely necessary when diarrhea lasts less than 2 weeks.
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Dehydration is likely if diarrhea is severe or lasts a long time.
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Giving fluids by mouth effectively treats dehydration in most children.
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Drugs to stop diarrhea, such as loperamide, are not recommended for infants and young children.
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