How do I suspect that my child
is having diarrhea?
A recent change in consistency of the stool is the most characteristic feature of diarrhea rather than frequency of stools
.When stool is unusually
loose or watery and if it occurs more than three times within a
24-hour time frame, we call it as diarrhea.
What do you mean by stool
consistency?
Consistency means degree
of firmness. A loose stool takes the shape of the container in which it is passed. Normal stool
consistency is soft, and it passes
easily. In diarrhoea stools contains more water than fecal matter content. Passage of more watery stools and less oral water intake can result in dehydration.
Can diarrhea be dangerous?
Dehydration is the most dreaded
complication of diarrhea.
Diarrhea can also result in
disturbances of electrolytes in the body, namely
sodium and potassium. Even a
single large stool in cholera may
result in severe dehydration.
Normal stool patterns:
In newborn babies:
Newborn baby normally passes meconium within 24-48 hours which is thick and sticky dark green to black in color.Stools becomes
loose or watery with a yellowish green or greenish brown color after 3–6 days. This is called transitional stool.
Transitional stools may be watery enough to resemble diarrhea, but if the baby has no other symptoms and is
feeding well, it should not be considered diarrhea. This watery consistency is a result of undigested sugar in
breast milk that acts as a laxative by acting as a osmotic agent. This type of stools indicate that mother is producing plenty of milk. Frequent passage of liquid stools also protects baby from having jaundice within first 1 to 2 weeks of age.
Breastfed babies:
Babies who have been fed only breast milk, no other liquid, not even water often pass frequent, liquid, or soft stool, usually many times in a day. The stools are usually yellowish, golden
brown or sometimes even greenish. Sometimes, the baby may pass a loose stool after every meal during the first
2–3 months of life. This happens because intestines of a small baby move very fast to digest frequent milk feeds.
When milk goes into the stomach, the colon ,a part of the intestine gets triggered due to gastro-colic reflex to empty itself for the next meal.
That is why babies have a bowel movement as soon as they feed, or even while feeding. However, but this is not
diarrhea. In some infants, this passage of stool may happen during the process of feeding itself. In another set of
babies, this may happen 0.5–1 hour after the feed. However, as the child grows older, this reflex diminishes.
Frequent passage of formed stools is not diarrhea:
Some children may normally pass stool
more frequently than others as a normal habit. The frequency of stool is mainly depends upon the type of food being consumed. Children who are breastfed, children who eat a lot of fruits, vegetables, and whole grain
products, or those who consume a lot of fat, sugar or caffeine may pass stool more frequently than children on a
low fibre diet.
However, if the passage of stools is accompanied with pain in abdomen or distention of abdomen, you should
consult your pediatrician to rule out irritability of the bowel or an infection or allergy.
Why does my child has diarrhoea?
Diarrhea can occur due to various reasons. The most common cause of diarrhea in children is a viral infection of the
intestine. Rotavirus is one such virus that causes diarrhea, especially in children younger than 2 years of age. Other
causes are bacterial or parasitic infections, reactions to medicines, allergy or intolerance to certain foods, and
disorders of intestines. Childrens get infected through feco-oral route by drinking impure water and due to poor sanitation and hygiene. Initiating semisolid foods or top milk before 6 months of age also increases the risk of diarrhea.
Excessive consumption of fruit juice and sugary or carbonated drinks can also cause diarrhea as lot of unabsorbed
sugar passes into the intestines and acting as osmotic agent.
We must follow all hygiene and sanitation processes to reduce the risk of diarrhea, but you must understand that
sometimes diarrhea may develop despite taking all hygiene precautions.
What fluid should I give to child when he/she is having diarrhoea?
If your child has diarrhea, she/he loses water and electrolytes in stools. This leads to dehydration, which can be
serious if not corrected promptly. In fact, dehydration is the reason to worry than the diarrhea itself.
Therefore, the very first thing to do with the onset of diarrhea is to give your child plenty of fluids by oral route . This will provide water and electrolytes that are lost in stools. Oral rehydration salt (ORS) solution is one
such lifesaving fluid. ORS contains glucose and electrolytes in a specific ratio. It is given to replace the fluid that child
is losing because of vomiting and diarrhea. It is safe, simple to prepare and use, easily available in all government
hospitals; or can be purchased at most medical stores without a prescription.
How should I prepare ORS?
To be effective, the ORS should be prepared exactly as
indicated on the packet. One packet of ORS is usually
meant to make 1 L of solution, but sometimes smaller
packets to make 200 mL of solution are also available.
Remember that the entire packet has to be prepared
all in once. It should not be prepared partly,
like dissolving one spoon in one glass, as it will
change the concentration of the solution, and can
be harmful. Ready made liquid preparations of ORS
are best avoided as sometimes they may not have the
recommended composition of electrolytes and sugar.
How should I administer ORS to my
child with diarrhea?
Oral rehydration salt solution should be given slowly
with a spoon or in small sips. Giving it rapidly may lead to vomiting. If the
child vomits while drinking, wait for 10 minutes and
then give it more slowly at the rate of one teaspoon
every 1–2 minutes. Once prepared, the ORS can
be consumed up to 24 hours. Any remaining ORS
should be discarded and be freshly prepared for the
next use. Please note that ORS will not cure diarrhea, it will only ensure that child doesn't get dehydrated.
Can I also give fluids, other than ORS?
Breastfeeding needs
to be continued because it not only provides fluid and
energy but also provides factors that enhance immunity
of the child so that diarrhea gets better soon.
Apart from ORS and breastfeeding, other home
available fluids that can be given depending on
availability and preference of the child are:
Rice or pulses-based drink (rice water, dal water)
Vegetable soup
Yogurt drink with salt (salted Lassi)
Lemon drink (Shikanji with added salt and less sugar)
Coconut water
Plain water can be given in between.
Is there any medicine that I need to give, other
than ORS?
Other than ORS, the only recommended medicine
in diarrhea is zinc. Zinc should be taken after
prescription by a health worker. It is administered
20 mg/day for a total of 14 days to children between
6 months to 5 years of age. For children between
2-6 months of age, 10 mg/day for 14 days needs to be
given. It helps in reducing the duration and severity
of diarrhea. It is also helpful in preventing further
episodes of diarrhea for next 3 months.
What are the danger signs in diarrhoea?
Parents should immediately consult pediatrician if child is having reduced frequency or quantity
of urine, feeling very thirsty or restless, looking more ill, vomiting everything, blood in stool, inability to drink or
breastfeed, cold extremities, or change in responsiveness (drowsy or lethargy).
Does my child needs antibiotics for diarrhoea?
Antibiotic therapy is mostly not necessary to treat diarrhea in children as most diarrheal episodes are caused by
viruses, which do not get killed by antibiotics. Even in cases where bacteria (e.g., Escherichia coli) are the cause of
diarrhea, most episodes resolve without antibiotics. Most cases of diarrhea are self-limiting, regardless of causative
factor.
Inappropriate use of antibiotics neither reduces the severity of diarrhea nor shorten its duration. In fact, overuse
of antibiotics can cause side effects and may lead to prolongation of duration of diarrhea, and development of
antibiotic resistance.
When to give antibiotics?
In few cases where blood is present in the stool, or if the child is having some other concomitant infection (e.g.,
pneumonia, ear infection, and urine infection) or having any immunodeficiency or severe malnutrition, antibiotic
treatment may be required. Persistent fever, or other symptoms, such as cough or difficulty in breathing, ear pain
or pain during urination, may indicate presence of some other infection, which sometimes may need antibiotics
or any other medicine. However, only a doctor/healthcare personnel can evaluate the need, type, and duration of
antibiotics in such cases. You must visit your pediatrician, if there is any such concern.
How to keep child healthy and active during diarrhoea?
One of the main consequences of diarrhea is malnutrition. This could be caused by a decrease in appetite, recurrent
vomiting, reduced absorption of food in the intestine, or the body’s need for extra food because of the infection. But
it could also be the result of the common yet very harmful practice of withholding or diluting food or restricting the
child to a liquid diet.
What diet should I give to my child with diarrhea?
Unnecessary curtailing a child’s diet results in an inadequate intake of nutrients that could hamper the growth and
makes the child weak. Therefore, milk or food intake should not be restricted during or after diarrhea. Children
suffering from diarrhea who continue feeding tend to recover more quickly and regain weight better when they
recover than children whose diet is restricted.
To help the child digest food more easily, meals should be given more frequently and in small amounts. This will
also reduce the risk of vomiting.
Breastfeeding must be continued in children who were receiving it before.
Food such as gruel from rice, pulses, or other cereals which are readily available and can be easily prepared at
home are the best option besides breastfeeding.
After each episode of diarrhea, the child’s food intake should be increased from its usual intake for at least a
week or two, after the diarrhea stops or until the child is back on its original weight.
Also, it is important that the child continues to consume enough of its regular liquids (including breastfeeding),
in addition to the ORS.
My child developes diarrhoea repeatedly, what should I do?
Frequent episodes of loose motion will require certain
preventive measures. Following steps will be useful:
1. Care of nutrition:
Taking care of the child’s nutrition
is important, because good nutrition is one of the
crucial factors for preventing any recurrent infection.
To make sure that a child gets proper nutrition,
it is important that up to the age of 6 months
only breastfeeding should be given because it is
safe, clean, and have nutrients as per the needs of
the baby. Breastfeeding also protects the child from
infection. At 6 months of age, breastfeeding needs to
be complemented with age-appropriate nutritious
food. Consumption of sugary drinks should be
avoided (especially marketed fruit juices).
2.Completing the course of zinc:
Child should complete
the 14-day course of zinc prescribed by doctor for
his/her episode of diarrhea, even if the diarrhea
stops earlier than that. Zinc helps in averting another
episode of diarrhea in the next 3 months.
3.Care of personal and food hygiene:
Most frequent
cause of diarrhea occurring repeatedly is lack of
personal or food hygiene, and thus it is vital to take care
of this aspect to prevent diarrheal episodes.
Wash your hands with soap and clean running
water after changing diapers, disposing child’s
feces, using toilet, and prior to preparing the food
or feeding the child can alone bring down the
possibility of diarrhea substantially
Use safe drinking water.
Prepare, store, and serve of food in hygienic way that
include using clean utensils, keeping the cooked
food covered, and consuming freshly prepared food.
Do not allow your child to swim at unclean pools.
Use toilets and avoid open defecation.
4. Vaccination:
Up-to-date immunization, especially for
rotavirus and measles, helps in preventing diarrhea.
5.Medicines:
Avoid self-medication, especially antibiotics.
These should always be used only in consultation of
your doctor.
6. Diseases:
Certain diseases such as dietary allergies and
inflammatory bowel diseases can lead to recurrent
diarrhea and need evaluation by a doctor.
My child's diarrhoea is not resolving for long time?Is it persistent diarrhoea?
What is persistent diarrhea?
The usual duration of diarrhea is 5–7 days, and
in most children, it stops within this period.
In children <2 years of age, especially in those who
have malnutrition, it may sometime persist beyond
2 weeks, and then it is called persistent diarrhea.
When a child develops persistent diarrhea, which is
observed in upto 10% cases, it can lead to significant
nutritional problems.
What are the causes of persistent diarrhea?
Persistent diarrhea could be because of an unusual
infection that does not go away on its own, or it
could be because of damage to gut lining because
of an acute episode of diarrhea. Too much juice
or carbohydrate sweetened liquid consumption,
medication, and altered immune function are some
uncommon causes of persistent diarrhea.
Can allergies cause prolonged diarrhea?
Allergies and intolerances to certain food may cause prolonged diarrhea that may persist over many weeks to
months and causes problems with the absorption of nutrients from the gut, known as malabsorption. If children do
not absorb enough nutrients from the food, they may become malnourished. To treat these allergies and intolerance,
we sometimes need to remove the food that triggers the problem from the child’s diet.
For example, people who have a condition called celiac disease cannot tolerate gluten, a protein found in wheat.
After proper diagnosis of this condition, a gluten-free diet in these children will improve the symptoms tremendously.
Another example is lactose intolerance, in which milk or milk products trigger digestive symptoms. People with
lactose intolerance do not have enough enzymes to breakdown lactose, which is a type of sugar present in milk or
milk products.
The other food allergies are those to cow milk, soy products, eggs, and seafood. A healthcare provider should be
consulted for dietary advice to allay the symptoms.
The treatment of these prolonged episodes of diarrhea lies between taking care of a possible infection and review
of nutritional changes required.
Children with persistent diarrhea may also have deficiency of vitamin A, zinc, and other nutrients, which will
need an assessment. Parents must follow the advice of a pediatrician for the best management of persistent diarrhea.
What foods are to be avoided during episodes of diarrhoea?
1.You should avoid giving drinks with lots
of added sugar such as carbonated drinks,
fruit drinks, fruit juices, and plain glucose
solutions during an episode of diarrhea.
High sugar and sorbitol present in
these drinks might make diarrhea
worse because of the osmotic effect.
These drinks may even increase
electrolyte imbalance in the body
because they do not contain the correct
sodium and glucose ratio required.
2.Avoid giving caffeinated
drinks like tea, coffee,
or carbonated drinks,
during diarrhea.
Caffeine stimulates
gut and has laxative
property and can also
induce diuresis leading
to exacerbation of
dehydration.
3.Avoid giving
street foods
as poor
hygiene can
further lead
to infection
and parasitic
infestations
compounding
the diarrhea.
4.Similarly, processed
foods should be
avoided, because
of excess salt
in these foods
that can disturb
the electrolyte
equilibrium further
and can make the
dehydration worse.
Should I stop giving milk or change milk if my child has diarrhoea?
One of the most critical nutritional consequence of
diarrhea in children is malnutrition. Thus, continuation
of feeding is very crucial to provide essential nutrients
during diarrheal episode and prevent malnutrition.Breastfeeding helps
to provide important nutrients and fluids to the baby
and should never be discontinued when the child is
having diarrhea.
As per the observations, compared to milk-free
diet, children tend to recover better with milk-fed diet,
without any increase in duration of diarrhea or relapse.
Routinely, stopping the milk and changing the
preparation are therefore not necessary. Breastfeeding
must be continued, and if the baby is >6 month old
and is on predominant milk diet, mixing it with cereals
helps in improving energy density and absorption of
nutrients.
However, in cases of persistent diarrhea (persist
for >14 days), a few dietary modifications, including
reducing the quantity of milk in the diet, may be needed
but these should be done only in consultation with your
pediatrician.
What to do in diarrhoea?
Start giving ORS and plenty of suitable home available fluids at the earliest, to
prevent dehydration.
Continue breastfeeding and usual diet of the child during diarrhea.
Ensure proper sanitation and hygiene, especially handwashing, for the child and
caregiver.
Complete full 14-day course of zinc tablet/syrup as prescribed by your doctor.
Consult your pediatrician promptly if there is blood in stools, or if the child appears
unwell or dehydrated.
Things to be avoided in diarrhoea?
Do not starve the child. Offer him/her small, frequent home-cooked hygienic food.
Do not give antibiotics or any other drug on your own. Except ORS, any other
medicine needs to be prescribed by healthcare provider, if required.
Do not use sugar/glucose solutions, fruit juices or carbonated drinks for rehydration.
Do not stop breastfeeding or milk routinely during diarrhea.
Do not delay consulting a pediatrician if child does not improve on his/her own or if
child appears dehydrated or unwell.
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