Diarrhea in Children

Acute diarrhea is usually caused by

Gastroenteritis is usually caused by a virus, but it can be caused by bacteria or a parasite.

Food poisoning usually refers to diarrhea, vomiting, or both caused by eating food contaminated by toxins produced by certain bacteria, such as staphylococci Staphylococcal Food Poisoning Staphylococcal food poisoning results from eating food contaminated with toxins produced by certain types of staphylococci, resulting in diarrhea and vomiting. This disorder can be caused by... read more or clostridia Clostridium perfringens Food Poisoning Clostridium perfringens food poisoning results from eating food contaminated by the bacterium Clostridium perfringens. Once in the small intestine, the bacterium releases a toxin... read more .

Certain antibiotics can alter the types and number of bacteria in the intestine. As a result, diarrhea can occur. Sometimes using antibiotics enables a particularly dangerous bacteria, Clostridioides difficile (formerly Clostridium difficile), to multiply. Clostridioides difficile releases toxins that can cause inflammation of the lining of the large intestine (colitis— see Clostridioides (formerly Clostridium) difficile-Induced Colitis Clostridioides (formerly Clostridium) difficile-Induced Colitis Clostridioides difficile (C. difficile)–induced colitis is an inflammation of the large intestine (colon) that results in diarrhea. The inflammation is caused by toxin produced... read more ).

Chronic diarrhea is usually caused by

Acute diarrhea can also result from more serious disorders such as appendicitis Appendicitis Appendicitis is inflammation and infection of the appendix. Often a blockage inside the appendix causes the appendix to become inflamed and infected. Abdominal pain, nausea, and fever are common... read more , intussusception Intussusception Intussusception is a disorder in which one segment of the intestine slides into another, much like the parts of a telescope. The affected segments block the bowel and block blood flow. The cause... read more , and hemolytic-uremic syndrome Hemolytic-Uremic Syndrome (HUS) Hemolytic-uremic syndrome (HUS) is a serious disorder that usually occurs in children and involves the formation of small blood clots throughout the body that block the flow of blood to vital... read more (a complication of certain types of bacterial infection). These serious disorders are usually associated with other worrisome symptoms besides diarrhea, such as severe abdominal pain or swelling, bloody stools, fever, and ill appearance.

Chronic diarrhea can also result from disorders that interfere with the absorption of food ( malabsorption disorders Overview of Malabsorption Malabsorption syndrome refers to a number of disorders in which nutrients from food are not absorbed properly in the small intestine. Certain disorders, infections, and surgical procedures can... read more ), such as cystic fibrosis Cystic Fibrosis (CF) Cystic fibrosis is a hereditary disease that causes certain glands to produce abnormally thick secretions, resulting in tissue and organ damage, especially in the lungs and the digestive tract... read more , and a weakened immune system (due to a disorder such as AIDS Human Immunodeficiency Virus (HIV) Infection in Children Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and causes acquired immunodeficiency syndrome (AIDS). Human immunodeficiency... read more or use of certain drugs).

Diarrhea sometimes results from constipation Constipation in Children Constipation refers to delay or difficulty in passing stool for a period of at least 1 month in infants and toddlers and a period of 2 months in older children (see also Constipation in adults)... read more . When hardened stool accumulates in the rectum, soft stool may leak around it and into the child's underwear.

Certain symptoms are cause for concern. They include

Children with any warning signs should be evaluated by a doctor right away, as should those who have had more than 3 or 4 episodes of diarrhea and are not drinking or are drinking very little.

If children have no warning signs and are drinking and urinating normally, the doctor should be called if diarrhea lasts 2 days or more or if there are more than 6 to 8 episodes of diarrhea a day. If diarrhea is mild, a doctor’s visit is unnecessary. Children with diarrhea for 14 days or more should be seen by a doctor.

Doctors first ask questions about symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done ( see Table: Some Causes and Features of Diarrhea Some Causes and Features of Diarrhea ).

Doctors ask what the BMs look like, how frequent they are, how long they last, and whether the child has other symptoms, such as fever, vomiting, or abdominal pain.

Doctors also ask about potential causes, such as diet, use of antibiotics, consumption of possibly contaminated food, recent contact with animals, and recent travel.

A physical examination is done, looking for symptoms of dehydration and disorders that can cause diarrhea. The abdomen is checked for swelling and tenderness. Doctors also evaluate the child's growth Physical Growth of Infants and Children Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more .

If diarrhea lasts less than 2 weeks and warning signs are not present, the cause is probably gastroenteritis due to a virus, and testing is usually unnecessary. However, if doctors suspect another cause, tests are done to check for it.

Tests are typically done when children have warning signs. If they have signs of dehydration, blood tests are done to measure levels of electrolytes (sodium, potassium, calcium, and other minerals necessary to maintain the fluid balance in the body). If other warning signs are present, tests may include a complete blood cell count, urine tests, examination and analysis of stool, abdominal x-rays, or a combination.

Because the main concern in children is dehydration, treatment is focused on rehydrating by giving fluids and electrolytes ( see Dehydration in Children Dehydration in Children Dehydration is loss of water from the body, usually caused by vomiting and/or diarrhea. Dehydration occurs when there is significant loss of body water and, to varying amounts, electrolytes... read more ). Most children with diarrhea are successfully treated with fluids given by mouth (orally). Fluids are given by vein (intravenously) only if children are not drinking or are severely dehydrated. Oral rehydration solutions that contain the right balance of carbohydrates and sodium are used. In the United States, these solutions are widely available without a prescription from pharmacies and most supermarkets. Sports drinks, sodas, juices, and similar drinks have too little sodium and too much carbohydrate and should not be used.

If children are also vomiting, small, frequent amounts of fluid are given at first. Typically, 1 teaspoon (5 milliliters) is given every 5 minutes. If children keep this amount down, the amount is gradually increased. If the child is not vomiting, the initial amount of fluid does not need to be limited. With patience and encouragement, most children can take enough fluid by mouth to avoid the need for intravenous fluid. However, children with severe dehydration may need intravenous fluids.

As soon as children have received sufficient fluids and are not vomiting, they should be given an age-appropriate diet. Infants may resume breast milk or formula.

In children with chronic diarrhea, the treatment depends on the cause, but providing and maintaining adequate nutrition and monitoring for possible vitamin or mineral deficiencies are most important.