Normal bowel habits differ among children. Breast-fed infants normally have liquid bowel movements (stools) that are bright yellow in colour and contain bright yellow ‘curds.’ The frequency of bowel movements can be anywhere from five to six times a day to once a week. As long as the colour and texture remain unchanged, be reassured that things are normal.

Infants on formula or cow’s milk usually have stools that are pale yellow, with the texture of paste. Infants cannot absorb all of this type of milk, so there are leftover solids. Frequency should be once every one to three days. Older infants and children eating solid food will have bulkier stools that will be brown in colour and softly formed. Again, they should appear every one to three days.

What is diarrhea?

Diarrhea is any change in the bowel pattern that causes one or more of the following:

frequent bowel movements
soft or watery stools
blood, mucus, or undigested food or fat in the stools.

What causes diarrhea?

Finding the cause of an episode of diarrhea requires a bit of detective work. Clues are in the accompanying signs, and in the stool itself.

Infection is by far the most common cause, with viruses the major culprit. It is probably a virus if:

fever, nausea, muscle aching, vomiting and stomach cramps are present
it comes on fairly suddenly (over a few hours)
it follows an upper respiratory infection (cold)
the diarrhea is watery, explosive, frequent and green or brown.

It is often bacterial if:

fever, abdominal pain or cramps are present, but little nausea or vomiting
the diarrhea contains blood mixed with watery green or brown stool
it lasts several days with little change in symptoms.

Common bacteria include Salmonella, Shigella, Campylobacter, Yersinia or E. coli (hamburger disease). Infection usually comes from contaminated food or water. Parasites are another common cause of diarrhea. Parasites may be present if:

there is little or no fever
diarrhea is off and on over days or weeks
your child loses weight, but is not really sick
diarrhea is watery but usually brown
there is a history of travel or a change in water – especially untreated water.

Common parasites include Giardia (beaver fever) and Entameba.

Milk sugar (lactose) intolerance is now known to be a frequent cause of diarrhea. Often, there is little cramping and no fever, nausea or vomiting. The child is not sick and has no loss of appetite. Watery or very soft brownish stools, sometimes mixed with mucus, are often worse after large amounts of dairy products have been eaten. The problem settles when dairy products are withheld.

Other possible causes of diarrhea in children include:

celiac disease (gluten intolerance)
inflammatory bowel disease (Crohn’s or ulcerative colitis)
other food intolerances, (eggs and egg products are a common cause).

Any one of these requires medical attention.

How is diarrhea treated?
You can do several things to care for your child with the early stages of diarrhea.
If you are breastfeeding, do not stop. Your child may even want to nurse more frequently.
Give oral rehydration formulas (Pediatric Electrolyte™) early in the illness, and be generous with these solutions.
If diarrhea is mild or moderate, there is no need to avoid lactose (dairy products) in the diet.
Give acetaminophen (Tylenol™, Tempra™, Panadol™) for the fever and mild discomfort that often goes with diarrhea.

When reintroducing solids to a child who eats table food, try bananas, rice, applesauce, toast, cereal and potatoes. These are easily digested and do not irritate the bowel.

Frequent small meals will be handled better. Begin offering solids and dairy products after 24 to 48 hours to avoid ‘starvation diarrhea.’ If the diarrhea starts again, see your family doctor. Do not give medicines (such as Kaopectate™ or Imodium™) to stop diarrhea, unless your doctor tells you to do so.

When to seek medical help

Contact your doctor right away if your child seems dehydrated. This can happen with diarrhea from any cause, and means the body is lacking important fluids and electrolytes (body salt). Watch for:

drowsiness
little urination (fewer than six wet diapers a day in babies)
dry tongue, with saliva (rubbed between your fingers) that is ‘sticky’ rather than watery.
lack of tears
no interest in surroundings.

Seek medical help if your child seems well but diarrhea lasts longer than four days, blood is in the diarrhea or stools, or if there is persistent vomiting, high fever, or pain in the abdomen or rectum.

Diarrhea is the bowel’s way of ridding itself of irritations. It is common, usually short-lived, and not dangerous. Most cases can be dealt with at home and do not require medical care. However, ignoring danger signs can lead to serious illness and even death. If your child seems sick, follow the guidelines above and get help from your doctor.

Your Child's Diarrhea Dealing with a common problem

It is safe to say that at some stage in your young child’s life, you will find yourself faced with an episodea of diarrhea. Most cases last only a few days, clearing up without much effort from you or your doctor. However, you should know the signs that show your child needs medical care.

What is normal?

What is diarrhea?

What causes diarrhea?

When to seek medical help

Your Child's Diarrhea
Dealing with a common problem