What Parents of Babies and Toddlers Should Know About Diarrhea

Diarrhea is a common but sometimes vexing problem in babies and toddlers. As a parent who wants to keep your child healthy and help him or her feel better, what do you need to know?

Edward Pickens, MD, medical director in general pediatrics and adolescent medicine at UNC Health, explains.

Diarrhea in Infants and Toddlers

Diarrhea is obvious in adults, but it may be hard to tell the difference between diarrhea and normal stool in babies.

“Some newborn babies have thicker stools, but others have loose, watery stools right from the very beginning, and that’s normal,” Dr. Pickens says.

In very young children, look for a change in the stool pattern to identify diarrhea. Babies can go from having fewer bowel movements a day to having a lot, or their stool is noticeably watery with a pungent smell.

Diarrhea is usually caused by a viral or bacterial infection, though it can be the result of a food sensitivity. It might be accompanied by vomiting (more forceful than spit-up), fever and irritability.

There is also a chronic condition called “toddler’s diarrhea,” common among children ages 1 to 5 years old. It’s defined by four or more watery, loose stools a day. It can be caused by excessive fluid intake, a high-fiber but low-fat diet, and trouble digesting sugars, even the fructose found naturally in fruits.

“Toddler’s diarrhea happens most often when children eat a lot of fruits, leading to very loose stools,” Dr. Pickens says. “The more sugars they consume, the more acidic the stool gets, which can cause scabs on their bottoms.”

Common Causes of Diarrhea in Children

Viruses: Viral gastroenteritis, often referred to as the “stomach flu,” is caused by an infection in the intestines. Typically, a child can experience watery diarrhea, cramps and a fever.

“Ninety percent of diarrhea is caused by viral infection,” Dr. Pickens says. If your child has been sickened by bacteria such as salmonella or E. coli, you will likely see additional symptoms.

“If a child or infant has either one of those infections, there may be other indicators, like a high fever or blood in the stool. Those types of infections cause diarrhea that can continue for several weeks,” Dr. Pickens says.

Viruses that cause diarrhea can get into children’s bodies in several ways. Most commonly, they are ingested when children get germs on their hands and stick them in their mouths. Eating or drinking contaminated food or water can also spread a virus that causes diarrhea.

Another potential cause of diarrhea in infants is rotavirus, which causes severe diarrhea along with vomiting, fever and abdominal pain.

Fortunately, there is now a vaccine for rotavirus, which babies typically receive at 2 months, 4 months and 6 months old.

“Since that vaccine came out, we’ve had a significant drop in the number of children who have needed to be hospitalized from dehydration due to diarrhea,” Dr. Pickens says.

Food allergies: Milk, soy, cereal grains, eggs and seafood are the most common food allergens that cause diarrhea in children. Other symptoms can include abdominal pain, vomiting, hives, itching and wheezing. In the most serious cases, food allergies can result in anaphylaxis, which causes swelling and difficulty breathing and is life-threatening.

Food intolerances: Some intolerances that can contribute to diarrhea include lactose (milk products), fructose (sugar found in fruits, fruit juices), and sucrose (foods and drinks containing sugar). Children might also experience cramps, bloating, headache and nausea.

Cystic fibrosis: Cystic fibrosis is a chronic, progressive disease that involves thick, sticky mucus that can damage many of the body’s organs. This mucus clogs the pancreas, which prevents digestive enzymes from getting to the intestines, impeding proper digestion. Symptoms may vary but include fatty, foul-smelling diarrhea, chronic cough, wheezing and poor growth.

Celiac disease: This autoimmune disease causes the intestines to become inflamed after consuming proteins found in wheat, rye and barley. Symptoms include bloating, constipation, gas and chronic diarrhea. This disease can cause additional effects for children, including poor growth, delayed puberty and weight loss.

Treatment and Prevention of Diarrhea in Children

Most of the time diarrhea will resolve on its own, but there are ways to encourage a faster recovery. Drinking plenty of liquids is the first step to preventing dehydration and feeling better.

Breastfed babies who have diarrhea should keep breastfeeding, which is “always the best thing for diarrhea,” Dr. Pickens says. Parents of formula-fed babies should add a liquid designed to replace water and salts lost during diarrhea, such as Pedialyte. Keep an eye on your baby’s diaper to make sure he or she is urinating at least every eight hours; if not, call the pediatrician right away.

For older children, ice chips, ice pops and Jell-O are also good sources of fluids. When children have recovered from diarrhea and are ready to eat regular foods, serve bland, easily digestible foods like bananas, crackers, chicken, pasta or rice cereal.

Proper hand hygiene is the best way to help prevent diarrhea, especially where there are multiple children in one setting, Dr. Pickens says.

“It is common to have infectious causes of diarrhea affect practically every infant or child in a day care setting. Hand-washing is the best way of preventing spread,” Dr. Pickens says.

Teaching children to wash their hands is a critical step in avoiding diarrhea. It’s important for children to wash their hands before meals and after using the bathroom to lower exposure to germs.

When to Seek Medical Attention or Visit the Emergency Department

Diarrhea can become dangerous if it leads to dehydration. Warning signs include dry mouth, decreased urine production, no tears when crying, and a child who feels weak or lacks energy. Parents or caregivers of a child showing those symptoms or a fever, bloody stools or pain in the abdomen should seek medical care right away. In some cases, hospitalization may be required for intravenous (IV) fluids.

Talk to your child’s doctor if you have concerns about your child having diarrhea. If you need a doctor, find one near you.