What causes diarrhea?

Diarrhea is the passage of watery stools. Most diarrhea in children is caused by one of several diarrhea-causing viruses and gets better by itself within a week. Although there can be many causes of diarrhea, the treatment suggested here is appropriate for acute illness (sudden onset, short lasting), which occurs most commonly.

A child with viral diarrhea often has a fever and may start 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. You should 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
• urinates less frequently (wets fewer than 4 diapers per day)
• no tears when crying
• loss of appetite for liquids
• high fever
• frequent diarrhea
• dry, sticky mouth
• weight loss
• extreme thirst

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

What do we do about fevers?

FEVER IN CHILDREN

This is often a frightening, and sometimes dangerous symptom in children. Due to the possible danger of serious illness, THIS WEB SITE INFORMATION CANNOT REPLACE THE OPINION OF YOUR PEDIATRICIAN. However, some general truths are important to understand.

WHY DO CHILDREN GET FEVER?

A rise in body temperature is a common occurence when our bodies are fighting infections. Some research says that our immune system gets stronger at a higher temperature. Other causes occur rarely, such as medicine effects and over heating, but infections are the most common cause of fever.

IS A FEVER HARMFUL?

Fever is a symptom of a disease...it is not the disease itself. Therefore fever can do very little to hurt you. Temperatures over 102 degrees usually do make children 'grumpy' or irritable. Hallucinations sometimes occur at high temperatures. Actual damage to your body from high temperatures does not generally occur until your temperature goes over 107 degrees.

WHEN IS FEVER A DANGEROUS SIGN?

You cannot tell what infection a child has by the fever. Therefore, any fever might indicate a dangerous infection. Here are some helpful guidelines:

1. Any infant less than 8 weeks old with a temperature over 100 degrees is at risk for dangerous newborn infections and should be seen immediately.

2. Any child, no matter how high a fever, that has significant pain or is acting unusually (e.g. too sleepy, too lethargic, disoriented) should be evaluated. Your child's behavior tells you more about their illness than does their temperature. A parent that can tell his/her child is just 'not right,' is usually RIGHT!

3. It is NEVER wrong to call your pediatrician and discuss your child's fever or illness with them. No website can be as good as person-to-person communication.

HOW DO WE CONTROL FEVER?

The most common fever control medicine is acetominophen. This should be given every 4 hours. Consult your physician or the manufacturers label for proper dosing amount.

Ibuprofen is also helpful to control fever. Many pediatricians prefer to use this only after 6 months of age. Ibuprofen can be given every 6 hours. Consult you pediatrician or the manufacturer label for dosing amounts.

How long should 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 I do about diarrhea?

MILD ILLNESS AND DIET

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 cow1s milk or formula, call your pediatrician to discuss a temporary change in diet.

Special fluids are not usually necessary for children with mild illness.

MODERATE ILLNESS

Children with moderate diarrhea can be cared for easily at home with close supervision, special fluids, and your pediatrician1s advice. Your pediatrician will recommend the amount and length of time that special fluids should be used. Later, a normal diet can be resumed. Some children are not able to tolerate cow1s milk when they have diarrhea and it may be temporarily removed from the diet by your pediatrician. Breastfeeding should continue.

Special fluids for moderate illness

Special fluids have been designed to replace water and salts lost during diarrhea. These are extremely helpful or the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. It is too easy to get confused by some of these complex recipes. You could accidentally make a bad fluid for your baby. Use a fluid that is made by one of the reputable manufacturers. The two most widely available products that you will find in nearly every pharmacy are:

• Pedialyte Ross Laboratories
• Infalyte Mead Johnson Nutritionals
• Many drug stores have their own generic brands of special fluids. Ask the pharmacist for assistance.

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.

SEVERE ILLNESS

If your child develops the warning signs of illness listed on the first page, he or she may require IV fluids in the emergency department for several hours to correct dehydration. Usually hospitalization is not necessary. Immediately seek your pediatrician1s advice for the appropriate care if symptoms of severe illness occur.

Other common questions and answers:

Q. Should a child with diarrhea be fasted?

A. Absolutely not! 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.

Q. What about soft drinks, juices, or boiled skim milk?

A. 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 (see Special fluids for moderate illness). Soft drinks, soda pop, soups, juices, sports drinks, and boiled skim milk have the wrong amounts of sugar and salt and may make your child sicker.

Q. What about anti-diarrhea medicines?

A. These medicines are not useful in most cases of diarrhea and can sometimes be harmful. Never use them unless they are recommended by your pediatrician.

Q. Which therapy is best?

A. Because diarrhea is so common, there are many different home remedies that have been tried through the years. Some of these old ideas may not be effective and some may actually make things worse. The recom-mendations in this brochure are based on the best information available at this time. If you have any questions about them, please check with your pediatrician.

Diarrhea DO's and DON'TS:

DO

• 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 102°F or 39°C).
• 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.

DON'T

• Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.
• Prevent the child from eating if she is hungry.
• Use boiled milk or other salty broths and soups.
• Use 3anti-diarrhea2 medicines unless prescribed by your pediatrician.

Symptoms and Sickness Guide

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