- Diagnosis of Chronic Diarrhea in Children
- How do doctors find the cause of chronic diarrhea in children?
- What tests do doctors use to find the cause of chronic diarrhea in children?
- Back Pain
- What is back pain in children?
- What causes back pain in children?
- Diarrhea in Children: Common Causes and Treatments
- Diarrhea in Children
- What is diarrhea?
- What causes diarrhea?
- What are the symptoms of diarrhea?
- How is diarrhea diagnosed?
- How is diarrhea treated?
- What are the complications of diarrhea?
- What can I do to prevent diarrhea?
- When should I call my child’s healthcare provider?
- Key points about diarrhea
- Next steps
- When your child has diarrhea
- Is this your child’s symptom?
- When to Call for Diarrhea
- Seattle Children’s Urgent Care Locations
- Care Advice for Diarrhea
- The Meal Plan to Relieve Toddler Diarrhea
- Symptoms & Causes of Chronic Diarrhea in Children
- What are the symptoms of chronic diarrhea in children?
- What are the symptoms of malabsorption and dehydration in children?
- What causes chronic diarrhea in children?
- What Does Black Diarrhea Mean?
- Black, Tarry Stool
- Medications and Supplements
- Foods You Ate
- What To Do About Black Diarrhea?
- What are the symptoms of toddler’s diarrhoea?
- What is the cause of toddler’s diarrhoea?
- What is the treatment for toddler’s diarrhoea?
Diagnosis of Chronic Diarrhea in Children
How do doctors find the cause of chronic diarrhea in children?
To find the cause of a child’s chronic diarrhea, doctors may use information from the child’s medical and family history, a physical exam, or tests.
Medical and family history
Your child’s doctor will ask you for information about your child’s symptoms, such as
- how long your child has had diarrhea
- how much stool your child passes
- how often your child has diarrhea
- how your child’s stool looks, such as color and consistency
- whether your child has other symptoms along with diarrhea
The doctor will ask about the foods your child eats and beverages he or she drinks. The doctor may recommend keeping a diary of what your child eats and drinks and his or her bowel habits.
Your child’s doctor may also ask about family medical history. Some of the conditions that cause chronic diarrhea, such as Crohn’s disease and ulcerative colitis, run in families.
The doctor will ask about the foods your child eats and beverages he or she drinks.
During a physical exam, a doctor typically
- checks blood pressure and pulse
- checks for symptoms of dehydration and malabsorption
- listens to sounds in your child’s abdomen using a stethoscope
- taps on your child’s abdomen to check for pain or tenderness
What tests do doctors use to find the cause of chronic diarrhea in children?
Doctors may use the following tests to help find the cause of a child’s chronic diarrhea:
Stool tests can show the presence of blood and signs of infection, food allergies, and digestive tract problems, such as malabsorption of certain sugars, proteins, or nutrients. A health care professional will give you a container for catching and storing a sample of your child’s stool, along with instructions on where to send or take the sample for testing. A doctor may also do a digital rectal exam to check for blood in your child’s stool.
A health care professional may take a sample of your child’s blood to test for signs of certain diseases or disorders that can cause chronic diarrhea, such as infections or celiac disease.
Hydrogen breath tests
This test measures the amount of hydrogen in a child’s breath. Normally, little hydrogen is found in your child’s breath. However, bacteria break down sugars—such as lactose, fructose, and sucrose—that are not digested by the small intestine and produce high levels of hydrogen. By measuring the amount of hydrogen in your child’s breath, a doctor can diagnose
- lactose intolerance
- fructose intolerance
- sucrose intolerance
- small intestinal bacterial overgrowth (SIBO)
For a lactose intolerance test, your child will drink a beverage that contains a known amount of lactose. For a fructose intolerance test, your child will drink a beverage that contains a known amount of fructose For a sucrose intolerance test, your child will drink a beverage that contains a known amount of sucrose. For a SIBO test, your child will drink a beverage that contains a known amount of sugar. Your child will then breathe into a balloon-type container that measures hydrogen. If the hydrogen level is high, your doctor will diagnose one of these disorders.
To find out if a food allergy or intolerance is causing your child’s chronic diarrhea, the doctor may recommend that your child avoid foods with lactose, carbohydrates, wheat, or other ingredients to see if a change in diet reduces or stops the diarrhea.
Your doctor may use endoscopy to look inside your child’s body to help find the cause of his or her chronic diarrhea. Endoscopic procedures include
- flexible sigmoidoscopy
- upper gastrointestinal (GI) endoscopy
What is back pain in children?
Back pain is very common in children and adolescents and can be frustrating for kids and their families. Children and teens can experience back pain anywhere in their back, from their neck to their tailbone.
Where does back pain occur in kids?
Your child may experience back pain in one spot, or in many parts of their back. Children most commonly experience back pain in their lower back. It is also common for children with back pain to feel some associated “spread” or “tingling” in their back or buttocks.
How common is back pain?
Back pain is very common in kids and teenagers.
- Approximately 50% of kids and teenagers experience back pain at some point.
- Up to 10% of kids and teenagers who have back pain may have pain that is severe enough to keep them out of school or sports.
The good news is that almost all back pain in children and teenagers can be treated without medications or surgery.
What causes back pain in children?
There are many causes of back pain in children and teenagers, including:
- Muscle weakness and stiffness (the most common causes of back pain in growing children and adolescents)
- Tight hamstrings and weak core muscles
- Being overweight or obese
- Pain from overuse
- Pain from sports, dance or other activities
Diarrhea in Children: Common Causes and Treatments
Diarrhea is the body’s way of ridding itself of germs, and most episodes last a few days to a week. Diarrhea often occurs with fever, nausea, vomiting, cramps, and dehydration. Some of the most common reasons kids get diarrhea include:
- Infection from viruses like rotavirus, bacteria like salmonella and, rarely, parasites like giardia. Viruses are the most common cause of a child’s diarrhea. Along with loose or watery stools, symptoms of a viral gastroenteritis infection often include vomiting, stomachache, headache, and fever.
When treating viral gastroenteritis — which can last 5-14 days — it’s important to prevent fluid loss. Offer additional breast milk or an oral rehydration solution (ORS) to infants and young children. Water alone doesn’t have enough sodium, potassium, and other nutrients to safely rehydrate very young children. Be sure to talk to your doctor about the amount of fluids your child needs, how to make sure he or she gets them, when to give them, and how to watch for dehydration.
Older children with diarrhea can drink anything they like to stay hydrated, including ORS and brand-name products (their names usually end in “lyte”). Popsicles can also be a good way to get fluids into a child who’s been vomiting and needs to rehydrate slowly.
Be sure to consult with a doctor if you have travelled outside of the country recently; your child may need to have his or her stool tested.
Medications like laxatives or antibiotics can also lead to diarrhea in children as well as adults.
For mild diarrhea caused by medication, keep your child safely hydrated. If a course of antibiotics is causing your child’s diarrhea, be sure to continue the medication and call your doctor. Your doctor may recommend reducing the dose, changing your diet, adding a probiotic or switching to a different antibiotic.
Studies show that yogurt with live cultures or probiotics can help ease diarrhea caused by antibiotics. Cultures and probiotics help replenish healthy gut bacteria killed by antibiotics.
- Food poisoning can also cause diarrhea in kids. Symptoms usually come on quickly, may include vomiting, and tend to go away within 24 hours.
Treatment for food poisoning-related diarrhea is the same as for the diarrhea caused by infection: Keep your child hydrated and call your doctor with any questions.
- Other causes of diarrhea include irritable bowel disease, Crohn’s disease, food allergies, and celiac disease. If you’re not sure what’s causing your child’s diarrhea, give your doctor a call.
Diarrhea in Children
What is diarrhea?
Diarrhea is when stools (bowel movements) are loose and watery. Your child may also need to go to the bathroom more often.
Diarrhea is a common problem. It may last 1 or 2 days and go away on its own. If diarrhea lasts more than 2 days, your child may have a more serious problem.
Diarrhea may be either:
Short-term (acute). Diarrhea that lasts 1 or 2 days and goes away. This may be caused by food or water that was contaminated by bacteria (bacterial infection). Or it may happen if your child gets sick from a virus.
Long-term (chronic). Diarrhea that lasts for a few weeks. This may be caused by another health problem such as irritable bowel syndrome. It can also be caused by an intestinal disease. This includes ulcerative colitis, Crohn’s disease, or celiac disease. Giardia may also cause chronic diarrhea.
What causes diarrhea?
Diarrhea may be caused by many things, including:
Trouble digesting certain things (food intolerance)
An immune system response to certain foods (food allergy)
Parasites that enter the body through food or water
Reaction to medicines
An intestinal disease, such as inflammatory bowel disease
A problem with how the stomach and bowels work (functional bowel disorder), such as irritable bowel syndrome
Surgery on the stomach or gallbladder
Children who visit some foreign countries are at risk for traveler’s diarrhea. This is caused by having food or water that is not safe because of bacteria, viruses, or parasites.
Severe diarrhea may mean a child has a serious disease. Talk with your child’s healthcare provider if symptoms don’t go away. Also talk with the provider if symptoms stop your child from doing daily activities. It may be hard to find out what is causing your child’s diarrhea.
What are the symptoms of diarrhea?
Symptoms can occur a bit differently in each child. They can include:
Belly (abdominal) pain
Upset stomach (nausea)
Urgent need to use the bathroom
Loss of body fluids (dehydration)
The symptoms of diarrhea may look like other health problems. Severe diarrhea may be a sign of a serious disease. Make sure your child sees his or her healthcare provider for a diagnosis.
How is diarrhea diagnosed?
The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may have lab tests to check blood and urine.
Other tests may include:
A stool culture to check for abnormal bacteria or parasites in your child’s digestive tract. A small stool sample is taken and sent to a lab.
A stool evaluation to check the stool for blood or fat
Blood tests to rule out certain diseases
Imaging tests to rule out structural problems
Tests to check for food intolerance or allergies
A sigmoidoscopy. This test lets the healthcare provider check the inside of part of your child’s large intestine. It helps to tell what is causing diarrhea, stomach pain, constipation, abnormal growths, and bleeding. It uses a short, flexible, lighted tube (sigmoidoscope). The tube is put into your child’s intestine through the rectum. This tube blows air into the intestine to make it swell. This makes it easier to see inside.
How is diarrhea treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Dehydration is the major concern with diarrhea. In most cases, treatment includes replacing lost fluids. Antibiotics may be prescribed when bacterial infections are the cause.
Children should drink lots of fluids. This helps replace the lost body fluids. If your child is dehydrated, be sure to:
Offer drinks called glucose-electrolyte solutions. These fluids have the right balance of water, sugar, and salts. Some are available as popsicles.
Avoid juice or soda. They may make diarrhea worse.
Not give plain water to your baby
Not give too much plain water to kids of any age. It can be dangerous.
Keep breastfeeding your baby. Breastfed babies often have less diarrhea.
Keep feeding your baby formula, if you were already doing so
What are the complications of diarrhea?
The greatest complication of diarrhea is dehydration. This is more likely with young children and those with a weakened immune system. Dehydration can be mild, moderate, or severe. Mild dehydration is the loss of fluid. Moderate or severe dehydration puts stress on the heart and lungs. In the worst cases it can lead to shock, which is life-threatening.
What can I do to prevent diarrhea?
Proper handwashing can reduce the spread of bacteria that may cause diarrhea.
A rotavirus vaccine can prevent diarrhea caused by rotaviruses. Ask your child’s healthcare provider which vaccines are right for your child.
When you travel, make sure anything your child eats and drinks is safe. This is even more important if you travel to developing countries.
Travel safety tips for drinking and eating include:
Not drinking tap water or using it to brush teeth
Not using ice made from tap water
Not drinking unpasteurized milk (milk that has not gone through a process to kill certain bacteria)
Not eating raw fruits and vegetables unless you wash and peel them yourself
Not eating raw or undercooked meat or fish
Not eating food from street vendors or food trucks
Talk with your child’s healthcare provider before traveling.
When should I call my child’s healthcare provider?
Call your child’s provider if your child is less than 6 months old or has any of the following symptoms:
Blood in the stool
Doesn’t want to drink liquids
Dry, sticky mouth
Urinates less frequently (wets fewer than 6 diapers per day)
No tears when crying
Sunken soft spot (fontanelle) on baby’s head
Key points about diarrhea
Diarrhea is loose, watery stool. Your child may also have to go to the bathroom more often.
It may be caused by many things, including bacterial infection or viral infection.
Dehydration is the major concern with diarrhea.
In most cases, treatment involves replacing lost fluids.
The rotavirus vaccine can prevent diarrhea caused by that virus.
Proper handwashing can help prevent diarrhea.
When you travel, make sure anything your child eats and drinks is safe.
Tips to help you get the most from a visit to your child’s health care provider:
Before your visit, write down questions you want answered.
At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
When your child has diarrhea
In many cases, you can continue feeding your child as usual. The diarrhea will normally go away in time, without any changes or treatment. But while children have diarrhea, they should:
- Eat small meals throughout the day instead of 3 big meals.
- Eat some salty foods, such as pretzels and soup.
When necessary, changes in the diet may help. No specific diet is recommended. But children often do better with bland foods. Give your child foods such as:
- Baked or broiled beef, pork, chicken, fish, or turkey
- Cooked eggs
- Bananas and other fresh fruits
- Bread products made from refined, white flour
- Pasta or white rice
- Cereals such as cream of wheat, farina, oatmeal, and cornflakes
- Pancakes and waffles made with white flour
- Cornbread, prepared or served with very little honey or syrup
- Cooked vegetables, such as carrots, green beans, mushrooms, beets, asparagus tips, acorn squash, and peeled zucchini
- Some desserts and snacks, such as Jell-O, popsicles, cakes, cookies, or sherbet
- Baked potatoes
In general, removing seeds and skins from these foods is best.
Use low-fat milk, cheese, or yogurt. If dairy products are making the diarrhea worse or causing gas and bloating, your child may need to stop eating or drinking dairy products for a few days.
Children should be allowed to take their time returning to their normal eating habits. For some children, a return to their regular diet can also bring a return of diarrhea. This is often due to mild problems the gut has while absorbing regular foods.
Is this your child’s symptom?
- Sudden increase in the number and looseness of stools
- Diarrhea means 2 or more watery or very loose stools. Reason: 1 loose stool can be normal with changes in diet.
Causes of Acute Diarrhea
- Virus (such as Rotavirus). An infection of the intestines from a virus is the most common cause.
- Bacteria (such as Salmonella). Less common cause. Diarrhea often contains streaks of blood.
- Food Poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. It is caused by toxins from germs growing in foods left out too long. Most often, symptoms go away in less than 24 hours. It often can be treated at home without the need for medical care.
- Giardia (a parasite). More likely in child care center outbreaks.
- Traveler’s Diarrhea. Caused by germs in food or drink. Suspect this if it follows recent foreign travel.
- Serious Causes. Most bacterial diarrhea goes away on its own. A few can cause a severe large bowel infection (such as Shigella colitis). C. difficile is a serious cause that can occur after being on strong antibiotics.
- Serious Complication: Dehydration. This is the health problem where the body has lost too much fluid. (See below for more on this).
Causes of Recurrent Diarrhea
- Cow’s Milk Allergy. Can cause loose, slimy stools in babies. Can be blood-streaked. Starts within the first 2 months of life. Need to avoid cow’s milk formulas.
- Toddler’s Diarrhea. Toddlers who pass 3 to 6 sloppy stools per day. Stools may run out of the diaper. Symptoms begin at age 1. Symptoms resolve at age 3 or 4, after toilet trained. Harmless and no impact on growth. Fruit juice makes it worse. The cause is rapid transit time from stomach to anus. May develop irritable bowel syndrome (IBS) in adult years.
- Lactose Intolerance. Lactose is the sugar in milk. Many people cannot absorb lactose. The gut bacteria convert the lactose to gas. The main symptoms are a lot of gas, loose stools and stomach bloating. Onset usually at age 4 or 5. This most often runs in the family (genetic).
- Mild: 2-5 watery stools per day
- Moderate: 6-9 watery stools per day
- Severe: 10 or more watery stools per day
- The main risk of diarrhea is dehydration.
- Loose or runny stools do not cause dehydration.
- Frequent, watery stools can cause dehydration.
Dehydration: How to Know
- Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. A weight loss of more than 3% is needed. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.
- Dehydration is the most important problem caused by diarrhea. Dehydration is a reason to see your doctor right away.
- These are signs of dehydration:
- Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.
- Dry tongue and inside of the mouth. Dry lips are not helpful.
- Dry eyes with decreased or absent tears
- In babies, a depressed or sunken soft spot
- Slow blood refill test: longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
- Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
- A child with severe dehydration becomes too weak to stand. They can also be very dizzy when trying to stand.
Diarrhea in Breastfed Babies: How to Tell
- Diarrhea in a breastfed baby is sometimes hard to tell.
- Normal breastfed stools are loose (often runny and seedy). Stools are yellow, but sometimes can be green. The green color is from bile. Runny stools can even be bordered by a water ring. These are all normal stools.
- Breastfed babies often pass more than 6 stools per day. Until 2 months of age, they may pass a stool after each feeding. But, if stools suddenly increase in number and looseness, suspect diarrhea. If it lasts for 3 or more stools, the baby has diarrhea.
- If the stools contain mucus, blood or smell bad, this points to diarrhea.
- Other clues to diarrhea are poor eating, acting sick, or a fever.
Diarrhea in Formula-Fed Infants: How to Tell
- Formula-fed babies pass 1 to 8 stools per day during the first week. Then it starts to slow down to 1 to 4 per day. This lasts until 2 months of age.
- The stools are yellow in color and thick like peanut butter.
- Suspect diarrhea if the stools suddenly increase in number or looseness. If it lasts for 3 or more stools, the baby has diarrhea.
- If the stools contain mucus, blood, or smells bad, this points to diarrhea.
- Other clues to diarrhea are poor eating, acting sick or a fever.
- After 2 months of age, most babies pass 1 or 2 stools per day. They can also pass 1 every other day. They no longer appear to have mild diarrhea.
When to Call for Diarrhea
Call 911 Now
- Not moving
- Too weak or dizzy to stand
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
- Blood in the stool
- Constant stomach pain lasts more than 2 hours
- Vomits clear liquids 3 or more times
- Age less than 1 month with 3 or more diarrhea stools in past 24 hours
- Severe diarrhea. 10 or more watery stools in the last 24 hours.
- Fever over 104° F (40° C)
- Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
- Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Call Doctor Within 24 Hours
- Moderate diarrhea. 6 or more watery stools in the last 24 hours.
- Stomach pain that do not go away after each diarrhea stool
- Loss of bowel control in a toilet trained child occurs 3 or more times
- Fever lasts more than 3 days
- Close contact with person or animal who has bacterial diarrhea
- Contact with reptile (snake, lizard, turtle) in past 14 days
- Travel to country at risk for diarrhea within past month
- You think your child needs to be seen, but the problem is not urgent
Call Doctor During Office Hours
- Diarrhea lasts more than 2 weeks
- Loose stools are a frequent problem
- You have other questions or concerns
Self Care at Home
- Mild diarrhea (probably caused by a virus)
- Diarrhea disease: how to prevent
Seattle Children’s Urgent Care Locations
If your child’s illness or injury is life-threatening, call 911.
Care Advice for Diarrhea
Treatment for Mild Diarrhea
- What You Should Know About Diarrhea:
- Most diarrhea is caused by a virus.
- Bacterial infections as a cause of diarrhea are not common.
- Diarrhea is the body’s way of getting rid of the germs.
- The main risk of diarrhea is dehydration. Dehydration means the body has lost too much fluid.
- Most children with diarrhea don’t need to see their doctor.
- Here are some tips on how to keep ahead of the fluid losses.
- Mild Diarrhea:
- Most kids with diarrhea can eat a normal diet.
- Drink more fluids to prevent dehydration. Formula, breastmilk and/or regular milk are good choices for diarrhea.
- Do not use fruit juices or full-strength sports drinks. Reason: they can make diarrhea worse.
- Solid foods: eat more starchy foods (such as cereal, crackers, rice, pasta). Reason: they are easy to digest.
- Formula-Fed Babies with Frequent, Watery Diarrhea:
- Keep giving formula but feed more often. Offer as much formula as your child will take.
- Mix formula the normal way. Reason: The formula contains plenty of water and doesn’t need more.
- Solid foods: If on baby foods, continue them. Cereals are best.
- Breastfed Babies with Frequent, Watery Diarrhea:
- Give your baby breastmilk more often.
- Also, give extra fluid if breast milk isn’t keeping up with the fluid losses. You can use formula or ORS (Pedialyte).
- Solid foods: If on baby foods, continue them. Cereals are best.
- Older Children (age more than 1 year old) with Frequent, Watery Diarrhea:
- Offer as much fluid as your child will drink. If also eating solid foods, water is fine. So is half-strength Gatorade or half-strength apple juice.
- If won’t eat solid foods, give milk or formula as the fluid.
- Caution: do not use most fruit juices, full-strength sports drinks or soft drinks. Reason: they can make diarrhea worse.
- Solid foods: Starchy foods are easy to digest and best. Offer cereals, bread, crackers, rice, pasta or mashed potatoes. Pretzels or salty crackers will help add some salt to meals. Some salt is good.
- Oral Rehydration Solutions (ORS), such as Pedialyte:
- ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand. It can be bought in food stores or drug stores.
- When to use: Start ORS for frequent, watery diarrhea if you think your child is getting dehydrated. That means passing less urine than normal. Increase fluids using ORS. Continue giving breastmilk, formula or regular milk.
- Amount: For babies, give 2-4 ounces (60-120 mL) of ORS after every large watery stool.
- For children over 1 year old, give 4-8 ounces (120-240 mL) of ORS after every large watery stool. Children rarely need ORS after age 3.
- Caution: Do not give ORS as the only fluid for more than 6 hours. Reason: Your child will need calories and cry in hunger.
- Probiotics are healthy bacteria (such as Lactobacilli). They can replace harmful bacteria in the gut (stomach).
- Age over 12 months old: Yogurt is the easiest source of probiotics. Give 2 to 6 ounces (60 to 180 mL) of yogurt. Do this twice daily. (Note: Today, almost all yogurts are “active culture”.)
- Probiotic supplements can also be bought in health food stores.
- Fever Medicine:
- For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Note: Fevers less than 102° F (39° C) are important for fighting infections.
- For all fevers: Keep your child well hydrated. Give lots of cold fluids.
- Diaper Rash – Prevention:
- Wash buttocks after each stool to prevent a bad diaper rash.
- To protect the skin, use an ointment (such as Vaseline or Desitin). Put it on the skin around the anus.
- Return to School:
- Your child can go back to school after the stools are formed.
- The fever should also be gone.
- The older child can go back if the diarrhea is mild.
- The toilet trained child also needs to have good control over loose stools.
- What to Expect:
- Viral diarrhea lasts 5-14 days.
- Severe diarrhea only occurs on the first 1 or 2 days. But, loose stools can last for 1 to 2 weeks.
- Call Your Doctor If:
- Blood in the diarrhea
- Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
- Diarrhea lasts over 2 weeks
- You think your child needs to be seen
- Your child becomes worse
Preventing Diarrhea Disease
- Safety Tips in All Countries:
- Hand washing is the key to preventing the spread of infections.
- Always wash the hands before eating, feeding or handling young children or cooking.
- Always wash the hands after any contact with vomit or stools.
- Wash the hands after using the toilet or changing diapers. Help young children wash their hands after using the toilet.
- Cook all poultry fully. Never serve chicken that is still pink inside. Reason: Undercooked poultry is a common cause of diarrhea in developed countries.
- Extra Safety Tips in Developing Countries:
- Drink bottled water or boiled water. Avoid tap water, ice cubes and flavored ices.
- Eat foods that have been fully cooked and that are still hot.
- Dry foods such as bread are usually safe.
- Avoid salads and raw vegetables. Avoid fruits that cannot be peeled. Bananas, oranges and apples are safe. Wash your hands before peeling fruit.
- Avoid all undercooked meat and fish.
- Avoid buying foods and drinks from street vendors. Reason: This is a common cause of traveler’s diarrhea.
- Formula for babies: Breastfeed if possible. If not, use premixed formula. If you prepare your own, mix the formula with bottled or boiled water.
- Feeding babies: Wash bottles, nipples, spoons and dishes with soap and water. Then sterilize them in boiling water for 5 minutes if possible.
- Brush your teeth with bottled or boiled water.
- Call Your Doctor If:
- You have other questions or concerns
And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 02/01/2020
Last Revised: 03/14/2019
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
The Meal Plan to Relieve Toddler Diarrhea
Because the child with toddler diarrhea is, by definition, healthy and thriving, most experts recommend no pharmaceutical treatment at all.
That’s why there is no “cure” for toddler diarrhea, as it’s not really a disease. But there are some things you can do to make it better.
Keep a food diary and relate it to the amount, frequency, and timing of diarrhea. This may help your child’s doctor eliminate any other causes of diarrhea that are more concerning, like food intolerances or allergies.
Check for Bloody Stool
Ensure that there is no blood in the stool. This seems obvious for children still in diapers, but make sure to check the stool of those who are potty-trained, as they may not mention this to you. If you do find blood in the stool, see your child’s doctor right away.
Sometimes blood in the stool can be microscopic, so your child’s pediatrician may ask for a stool sample to test for blood if there is any concern.
In addition, talk to your doctor if your child has diarrhea along with weight loss or poor weight gain, vomiting, fever, abdominal pain, or stools that are greasy or oily.
Skip the Fruit Juices
Limit juice and other liquids with fructose and sorbitol, such as sports drinks and soda. Keep the total amount of juice, if any, to less than 8 ounces a day.
Up the Fiber Intake
More fiber may actually help firm up the stools. Choose whole-grain cereals and breads, beans, and fresh fruits and vegetables. And adding a little more fat to the diet may also help.
This might be surprising, as so much attention is paid to limiting fat intake. But if your toddler is not overweight and gets a good amount of exercise, as most do, then a little extra fat should be fine. Be sure to check with your doctor if this is appropriate for your child. If you do add fat, make it healthy fat like dairy, avocado, olive oil, or eggs.
Probiotics are available over the counter. Probiotics are live bacteria and yeasts that are beneficial to your body. These will most likely not harm the child, and may help. However, there are no studies that demonstrate these are effective.
Symptoms & Causes of Chronic Diarrhea in Children
What are the symptoms of chronic diarrhea in children?
The main symptom of chronic diarrhea in children is passing loose, watery stools three or more times a day for at least 4 weeks.
Depending on the cause, children with chronic diarrhea may also have one or more of the following symptoms:
- bloody stools
- loss of control of bowel movements
- nausea or vomiting
- pain or cramping in the abdomen
Chronic diarrhea may cause malabsorption and may lead to dehydration.
Chronic diarrhea may cause malabsorption and may lead to dehydration.
What are the symptoms of malabsorption and dehydration in children?
Symptoms of malabsorption may include
- changes in appetite
- loose, greasy, foul-smelling bowel movements
- weight loss or poor weight gain
Symptoms of dehydration may include
- urinating less than usual, or no wet diapers for 3 hours or more
- lack of energy
- dry mouth
- no tears when crying
- decreased skin turgor, meaning that when your child’s skin is pinched and released, the skin does not flatten back to normal right away
- sunken eyes, cheeks, or soft spot in the skull
What causes chronic diarrhea in children?
Common diseases and disorders that cause chronic diarrhea in children include
- infections of the digestive tract
- celiac disease
- functional gastrointestinal (GI) disorders
- food allergies and intolerances
- inflammatory bowel disease
- small intestinal bacterial overgrowth
Infections of the digestive tract
Infections from harmful viruses, bacteria, or parasites sometimes lead to chronic diarrhea. Children may become infected through contaminated water, beverages, or food; or through person-to-person contact. After an infection, some children have problems digesting carbohydrates such as lactose or proteins in foods such as milk, milk products, or soy. These problems can cause prolonged diarrhea—often for up to 6 weeks—after an infection. Also, some bacterial and parasitic infections that cause diarrhea do not go away quickly without treatment.
Read more about infections that cause diarrhea, such as foodborne illnesses and viral gastroenteritis.
Celiac disease is a digestive disorder that damages the small intestine. The disease is triggered by eating foods containing gluten. Gluten is a protein found naturally in wheat, barley, and rye. Gluten is common in foods such as bread, pasta, cookies, and cakes. Celiac disease can cause chronic diarrhea in children of any age.
Functional GI disorders
In functional GI disorders, symptoms are caused by changes in how the digestive tract works. Children with a functional GI disorder have frequent symptoms, yet the digestive tract does not become damaged. Functional GI disorders are not diseases; they are groups of symptoms that occur together.
Two functional GI disorders that cause chronic diarrhea in children are toddler’s diarrhea and irritable bowel syndrome (IBS).
Toddler’s diarrhea—also called functional diarrhea, or chronic nonspecific diarrhea of childhood—is a common cause of chronic diarrhea in toddlers (ages 1 to 3), and preschool-age children (ages 3 to 5). Children with toddler’s diarrhea pass four or more watery or loose stools a day and do not have any other symptoms. They typically are growing well, gaining weight, and are healthy.
Toddler’s diarrhea develops between the ages of 6 months and 3 years, and it usually goes away on its own by the time children begin grade school. Researchers think that drinking too many sugar-sweetened beverages, especially those high in high-fructose corn syrup and sorbitol, may cause toddler’s diarrhea.
The most common symptoms of IBS are abdominal pain, discomfort, or cramping; along with diarrhea, constipation, or both. The pain or discomfort of IBS typically gets better with the passage of stool or gas. IBS does not cause symptoms such as weight loss, vomiting, or blood in the stool.
IBS is a common cause of chronic diarrhea in grade school-age children and adolescents. Doctors rarely diagnose IBS in younger children because younger children are not able to report symptoms of IBS such as abdominal pain or discomfort.
Food allergies and intolerances
Food allergies, lactose intolerance, fructose intolerance, and sucrose intolerance are common causes of chronic diarrhea.
Milk, milk products, and soy allergies are the most common food allergies that affect the digestive tract in children. Food allergies usually appear in the first year of life. Many children outgrow allergies to milk, milk-products, and soy by age 3. Allergies to other foods such as cereal grains, eggs, and seafood may also affect the digestive tract in children.
Lactose intolerance is a common condition that may cause diarrhea after eating foods or drinking beverages that contain milk or milk products. Low levels of lactase—the enzyme that helps digest lactose—or lactase deficiency, and malabsorption of lactose cause lactose intolerance.
The most common type of lactase deficiency in children develops over time, beginning after about age 2, when a child’s body begins to produce less lactase. Children who have lactase deficiency may not experience symptoms of lactose intolerance until they become older teenagers or adults.
Infants—newborns to age 1—rarely have lactose intolerance at birth. However, premature infants may experience lactose intolerance for a short time after birth. People sometimes mistake milk allergy, which can cause diarrhea in infants, for lactose intolerance.
Fructose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain fructose, a sugar found in fruits, fruit juices, and honey. Fructose is added to many foods and soft drinks as a sweetener called high-fructose corn syrup. Fructose malabsorption causes fructose intolerance. The amount of fructose that a child’s body can absorb varies. A child’s ability to absorb fructose increases with age. Some children may be able to tolerate more fructose as they get older.
Sucrose intolerance is a condition that may cause diarrhea after eating foods or drinking beverages that contain sucrose, also known as table sugar or white sugar. Sucrose malabsorption causes sucrose intolerance. Children who are sucrose intolerant lack the enzyme that helps digest sucrose. Most children with sucrose intolerance are better able to tolerate sucrose as they get older.
Inflammatory bowel disease (IBD)
The two main types of IBD are Crohn’s disease and ulcerative colitis. These disorders can affect children at any age. However, they commonly begin in the grade school years or in adolescence.
Small intestinal bacterial overgrowth (SIBO)
SIBO is an increase in the number of bacteria or a change in the type of bacteria in your small intestine. SIBO is often related to diseases that damage the digestive system such as Crohn’s disease.
What Does Black Diarrhea Mean?
While many cases of diarrhea will resolve themselves within a few days, black diarrhea (and stool in any form) can be a sign of a larger medical issue. Often, it signifies blood in the digestive tract or a reaction to a food, medication or supplement.
In this article, we’ll look at what black diarrhea means, and what you can do about it.
Black, Tarry Stool
It’s important to consider the color and consistency of your stool. Black diarrhea that has a somewhat tarry consistency should be taken seriously. While this stool type can be caused by certain foods (like black licorice), it can also be a symptom of bleeding in the gastrointestinal tract.
Black, tarry diarrhea is often caused by bleeding in the esophagus, stomach or small intestine. Another common cause for black, tarry stool could be a bleeding ulcer in the stomach, or inflammation of your stomach lining (AKA, gastritis).
If your toddler has black diarrhea (check out this tool to find out what the color of your toddler’s stool means), it is likely from an ulcer, so check in with their pediatrician.
Medications and Supplements
Certain medications can cause black diarrhea or stools, such as bismuth-based medicines like Pepto Bismol. Believe it or not, iron supplements could also be to blame, along with iron-containing multivitamins. If you are on a medication or supplement that you worry could be causing black diarrhea, it’s best to check in with your doctor to rule out bleeding in the gastrointestinal tract.
Foods You Ate
Something you ate, like black licorice, dark chocolate, blueberries, beets, or tomatoes can also cause black diarrhea (although the last two are more likely to produce a dark red color).
What To Do About Black Diarrhea?
It is important to call your doctor at the first sign of black diarrhea (unless you’re certain a food is the cause). In both kids and adults, a doctor will test to see if there is blood present in the stool, and this will help them narrow down what might be causing the black diarrhea. If your black diarrhea has red streaks or is accompanied by a fever, nausea, or cramping or pain, it’s especially important to seek medical attention right away.
What are the symptoms of toddler’s diarrhoea?
Toddler’s diarrhoea is also known as chronic nonspecific diarrhoea. Affected children develop three or more watery loose stools (bowel motions) per day. Sometimes it can be 10 or more. The stools are often more smelly and pale than usual. You can often see bits of vegetable food in the stools (such as bits of carrot, sweetcorn, etc). These have come from a recent meal. Mild tummy (abdominal) pain sometimes occurs but is unusual. Some affected children develop constipation which alternates with diarrhoea.
A child with just toddler’s diarrhoea is otherwise well, grows normally, plays normally and is usually not bothered about the diarrhoea. An examination by a doctor doesn’t reveal anything abnormal. No further tests are usually needed if the child is otherwise well. Symptoms usually go, with or without treatment, by the age of 5-6 years.
See the separate leaflet called Acute Diarrhoea in Children for more information about other causes of childhood diarrhoea.
What is the cause of toddler’s diarrhoea?
The cause is not clear. The small bowel (small intestine) digests and absorbs food into the body and works normally in affected children. The large bowel (colon) normally absorbs any excess water and forms stools.
It is thought that the balance of fluid, fibre, undigested sugars and other undigested foods that reach the colon may be upset in affected children. This can increase the amount of fluid (water) that is kept in the colon rather than being absorbed into the body. In young children, even a slight increase in fluid left in the colon can cause stools to become more frequent and runny than normal. As the child grows, the colon becomes more efficient and the condition goes.
Toddler’s diarrhoea is not due to poor absorption (malabsorption) of food or to a serious bowel problem. It is also not due to an intolerance of a type of food.
What is the treatment for toddler’s diarrhoea?
Often, no treatment is needed, particularly if symptoms are mild. The child is usually not concerned. Reassurance that it will ease in time may be all that is required. However, in many cases the diarrhoea will go, or become less severe, if the child changes certain eating and drinking habits. Many toddlers develop eating and drinking habits that are not ideal and these may contribute to causing the diarrhoea. One or more of the following may be relevant. They are the ‘4 Fs’: fat, fluid, fruit juices and fibre.
Toddler’s diarrhoea is more common in children who eat a low-fat diet. Although a low-fat diet is good for adults to help prevent heart disease, it is not good for young children. The diet of preschool children should have about 35-40% fat. In general, this means drinking whole milk rather than semi-skimmed or skimmed and to include foods such as yoghurts, milk puddings, cheeses and dairy products.
Fluid and fruit juice
Do not give children too much fruit juice or squash. Some children only drink fruit juice to quench their thirst. It is best to give water to children for most drinks and keep fruit juice as a treat. However, some children have become used to squash or juice on a regular basis and may become upset if they are suddenly denied their usual drink. In this case, if you do give your child squash or juice, make sure that it is very well diluted. And then, aim to increase the dilution gradually over time.
Too much juice or squash is not good for the following reasons:
- Fruit juices contain various sugars (carbohydrates). Some types of sugar are not digested or absorbed and so get to the large bowel (colon). Here they may act to keep water in the bowel and cause watery stools. Clear apple juice seems to be the worst, as it contains a lot of certain sugars. Cloudy juices that contain some fibre are not as bad.
- The sugar in juice and squash contains a lot of calories. This can reduce the appetite for normal meals. Therefore, the child tends to eat less fat and fibre at normal mealtimes. Some children seem to obtain most of their daily calories from juice and don’t eat very much solid food.
Changing the fibre content of the diet may be helpful, as very low- or high-fibre intakes may make symptoms worse in some children. Fibre (roughage) is the part of plant food that is not digested. It stays in the gut and is passed in the stools (faeces). Fibre is present in many foods, in particular in fruit, wholemeal bread and vegetables. Fibre has an action a bit like blotting paper and absorbs water in the bowel. So, if your child has a low-fibre diet, it may help to increase the fibre in the diet to normal levels. This is simply achieved by eating a healthy balanced diet that includes some fruit and vegetables. However, a high-fibre diet may make things worse, as too much fibre can cause loose stools.