Pediatrics - Diarrhea

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Introduction

Diarrhea is a very common condition for people of all ages.  A viral infection, such as the stomach flu, or a bacterial infection most frequently causes diarrhea.  Less commonly, diarrhea is associated with an underlying medical condition.

Symptoms include the passing of frequent stools that are loose, watery, and soft.  Diarrhea may also cause bloating, pain, cramps, and gas.  Most cases of diarrhea are treated at home and resolve in a few days.  Maintaining hydration is the goal of home care.  Severe diarrhea can be associated with serious medical complications and require hospitalization

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Anatomy

Whenever your child eats and drinks, food travels through your child’s digestive system for processing.  Your child’s body absorbs nutrients and removes waste products via his or her digestive system.  When your child eats, his or her tongue moves chewed food to the back of the throat.  When your child swallows, the food moves into the opening of the esophagus.  The esophagus is a tube that moves food from the throat to the stomach.

The stomach produces acids to break down food for digestion.  The stomach processes the food your child eats into a liquid form.  The processed liquid travels from the stomach to the small intestine.  The liquid solidifies as it moves through the large intestine, forming a stool.  The stool is eliminated from your child’s body when he or she has a bowel movement.

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Causes

Diarrhea is a very common condition for people of all ages.  Diarrhea is the passing of frequent stools that are loose, watery, and soft.  It may be associated with bloating, pain, cramps, and gas.
 
Diarrhea is most frequently caused by a viral infection, such as the stomach flu.  There are many viruses that cause the stomach flu.  Rotavirus and Norwalk virus are the most common ones.  The viruses are found in contaminated food or drinking water.  Poor hand washing frequently spreads the viruses.  The viruses can spread among groups of people, such as schools, employers, or families.  Symptoms typically appear within 4 to 48 hours after exposure to the virus.
 
Bacteria are another common cause of diarrhea and cause the most severe symptoms.  Bacterial causes include traveler’s diarrhea, food poisoning, handling undercooked meat or poultry, and handling reptiles with the bacteria.  Bacteria related conditions typically last from a few days to a week or more, depending on the cause, and can be associated with bloody bowel movements.
 
Parasites and chemical toxins can cause diarrhea.  Parasites are found in contaminated drinking water or swimming pools.  Chemical toxins are most frequently contained in seafood, certain medications, and metals including lead, mercury, and arsenic. 
 
Diarrhea is associated with certain medical conditions.  Malabsorption syndromes such as lactose intolerance, gluten malabsorption (celiac disease), and other food intolerances can cause diarrhea.  Diarrhea is symptom of inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis.  Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that causes alternating periods of diarrhea and constipation.  Immune deficiency, such as with HIV or AIDS infection, can also result in diarrhea.  Certain medications can cause diarrhea, especially some antibiotics.  Laxatives used to treat constipation can sometimes result in diarrhea.  Diarrhea is a common side effect of chemotherapy used to treat cancer. 
 
Less common causes of diarrhea include Zollinger-Ellison Syndrome, neuropathy, and carcinoid syndrome.  Diarrhea can be a symptom of colon cancer.  It may also occur after gastrectomy, the surgical removal of part or all of the stomach.  Further, diarrhea can be a side effect of high dose radiation therapy for cancer.
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Symptoms

Symptoms of diarrhea include loose watery soft or liquid stools.  Your child may go to the bathroom frequently.  Gas and abdominal bloating, cramps, or pain may precede the diarrhea.
 
Your child’s stools may be any color.  Passing blood or red stools can be a sign of a severe infection or another medical condition.  Black tarry stools may indicate bleeding in the stomach and may not be a sign of infection.  Diarrhea is usually not accompanied by a fever.  You should contact your doctor if your child experiences diarrhea with a fever, bloody stools, or black tarry stools.
 
Diarrhea can cause dehydration from loss of fluids.  Dehydration can be severe and life threatening.  It is especially concerning for infants, children, and older adults.  Dehydration can cause sleepiness, thirst, and dry mouth.  Infants and children may appear to have sunken eyes.  An infant’s fontanels, the “soft spots” on the head, may also appear sunken.  They may refuse to eat or drink.  Older adults with dehydration may experience behavior changes and confusion.  Their skin may appear to be loose.  Consult your doctor if you or your loved one experiences signs of dehydration.
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Diagnosis

Most cases of diarrhea can be treated at home.  Contact your doctor if your child becomes dehydrated.  In cases of severe dehydration, you should take your child to the emergency room of a hospital.  You should consult your doctor if your child is unable to tolerate food or drink, has a high fever, or experiences abdominal pain.  Contact your doctor if your child has black stools, bloody stools, or pus with stools.  You should call your doctor if your child’s diarrhea does not improve after a few days or if it becomes worse.
 
Your doctor will review your child’s medical history and conduct a physical examination to determine the cause of the diarrhea in order to provide appropriate treatment.  You should tell your doctor about your child’s symptoms, risk factors, travel history, and if your child has been around people with similar symptoms.  Your doctor will ask you questions about your child’s lifestyle, diet, bowel movement patterns, and stools to help make a diagnosis.  Your doctor may order stool tests, blood tests, and urine tests.
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Treatment

Treatment depends on the cause and severity of your child’s diarrhea.  Most cases of diarrhea caused by bacteria or viruses can be treated at home.  Your child should drink plenty of fluids to avoid dehydration.  Your child should avoid drinks that contain caffeine and milk.  Milk may make diarrhea worse.  Your doctor may recommend hydration drinks for your infant or child.  People with severe dehydration may need fluid replacement via an IV line and hospitalization. 
 
Your child should avoid eating greasy foods, fatty foods, and alcohol.  Bananas, rice, applesauce and toast are helpful foods to eat.  If your child feels too sick to eat, he or she may try sucking on ice chips until food is tolerated.
 
Your doctor may prescribe antibiotics to treat some types of bacterial infections.  However, antibiotics do not work on viruses.  Stomach viruses usually go away on their own in a few days.  Generally, anti-diarrhea medications should not be given for the stomach flu as they only prolong the infection.
 
Your child should not take over-the-counter diarrhea medications unless your doctor instructs you to.  Treatments vary for diarrhea caused by other medical conditions.  Lifestyle and dietary changes may help some conditions.  Ask your doctor for suggestions specific to your child’s condition.
 
If your child has a serious medical condition including HIV, AIDS, diabetes, heart disease, kidney disease, or liver disease, contact your doctor as soon as your diarrhea starts.  Your child may need prompt treatment.  Your child may be at risk for developing complications from diarrhea.
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Prevention

The stomach flu can be prevented with good hand washing.  Hands should be washed thoroughly after going to the bathroom and before handling food.  Your child should avoid contaminated food or water.  Enzyme supplements are available to help digest foods with lactose.  Additionally, there are many lactose-free products and some gluten-free products available on the market. 
 
If you travel to underdeveloped countries, drink only bottled water and do not use ice.  Ice made with contaminated water can contain bacteria.  Eat only well-cooked foods including meats, vegetables, and shellfish.  Do not consume dairy products.  Do not eat fruit that does not have a peel.
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Am I at Risk

Is My Child at Risk?

Infants, children, the elderly, and people with suppressed immune systems have the highest risk for getting diarrhea caused by viruses and bacteria.  The risk is increased if your child travels or lives in areas with poor sanitation.  Your child is at risk if he or she eats or drinks contaminated food or water.

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Complications

Severe symptoms can lead to severe dehydration and death.  You should consult your doctor if your infant or child has prolonged or severe diarrhea.  Call your doctor if your child’s diarrhea lasts longer than a few days.  You should call your doctor if your child experiences symptoms including faintness, dizziness, dry mouth, and blood or pus in his or her stools.  More serious symptoms include a swollen or painful abdomen; fever higher than 101°, vomiting that lasts for more than 48 hours, and dehydration.  Extreme thirst, dry mouth, little urine production, and a lack of tears are signs of dehydration.  The eyes of children and infants may appear sunken.  An infant’s fontanels, the “soft spots” on the head, may also appear sunken.  You should take your child to a hospital emergency room if your child is sleepy or unaware of his or her surroundings.
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Advancements

In 2006 a vaccine was approved to prevent the rotavirus in infants.  Vaccines are available for Salmonella typhi, Vibrio cholerae, and rotavirus.  Doctors administer the vaccines selectively, based on your foreign travel plans and medical history. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.