Diarrhea

Hilliard Pediatrics, Inc. - Dr. Tricia Lucin, MD

Introduction

Diarrhea means very loose, liquidy stool(s).  It can be almost any color from brown to green to yellow; can happen once or more than once; can be (but does not have to be) associated with cramping, nausea, or vomiting; can be extra stinky or not; and is generally unpleasant for kids and adults alike. Yuck.

Symptoms & Causes

Watery stools can be caused by many things - acute and chronic, infectious and not. Generally, it is the body's way of expelling something the gut doesn't want to be there. By far, the most common cause of diarrhea in children is infection. Typically viral (norovirus, rotavirus, etc.), gastrointestinal (GI) infections causing diarrhea are very contagious. That's why it wipes out (pun intended) whole families in one sweep. These viruses cause watery stools which are brown/yellow/green, but typically not bloody. You might also have vomiting, abdominal cramping (but not super severe pain), or fevers.

There are some bacteria which can cause diarrhea, often related to improper food preparation or recent antibiotic use. This can be very similar in symptoms to viral infections, and can be diagnosed by history and stool testing if needed. Some bacteria can cause bloody stools as well.

Many children also have bacteria after making poor food choices. Lots of sugar (candy, fruit, sugary beverages) can cause brief bouts of watery stools, as well as greasy foods, and very spicy foods. If a person has a food intolerance, they might also have diarrhea. A common offender is dairy (lactose-intolerance). Typically, if food choices are a problem, stools are watery, and happen shortly after the problem food, and then clear up fairly quickly.

Chronic diarrhea (lasting longer than a couple of weeks) also has many causes.

  • Irritable Bowel Syndrome (IBS) is a constellation of diarrhea and/or constipation with bloating and abdominal discomfort (not severe pain) that is not from a dangerous cause. It often worsens at times of stress, might show some relation to "trigger" foods, and does not cause weight loss or nighttime waking. Often this diarrhea is the "gotta go now!" type and abdominal discomfort improves after a bowel movement. Typically IBS does not cause a person to wake up overnight to run to the bathroom.
  • Celiac Disease is an allergy to gluten, which is found in wheat and some other grains. This causes diarrhea due to inflammation in the gut and thereby can also cause weight loss and even rashes. Often families can't pinpoint that symptoms are worse after wheat because Americans tend to eat a lot of grains. But if your child has long-term symptoms, we might do a blood test to determine if Celiac could be the cause.
  • Inflammatory Bowel Disease (IBD) includes both Chron's disease and Ulcerative Colitis. These are inflammatory conditions, such as the name implies, which causes changes to the intestines that cause diarrhea, bloody stools, weight loss, and chronic abdominal pain.

As many causes of diarrhea are infectious, good hand washing is paramount after bathroom use or diaper changes!

Testing

Testing to determine the cause of diarrhea is often not needed, as we can generally have a diagnosis based on history. However, if diarrhea is chronic, associated with weight loss, bloody stools, or other symptoms, testing might be warranted. Anyone with diarrhea lasting longer than 2 weeks, or significant enough to cause dehydration (read on) should be seen in the office.

Treatment

The main treatment of diarrhea is hydration. If your infant has diarrhea and you are breastfeeding, that is perfect to continue. Human milk is one of the easiest substances to digest. If your infant is formula feeding, that's great too! Keep feeding formula as you typically do. If you are having trouble with vomiting or need a little extra hydration, it is ok to add a little Pedialyte® if your baby is over 2 months old. Most formula-fed babies don't need to change their diet, but if your baby has had loose stools for more than a few days, you might need to change the formula to a soy or hypoallergenic version briefly (a few days to a week). This allows the parts of the gut that digest lactose (milk sugar) to settle back to normal.

For bigger kids, stick with clear fluids and slightly bland foods while tummies are upset. If diarrhea is brief (a day or two), you probably don't need to make any other big changes. We used to recommend BRAT (banana, rice, apples, toast) diets, but realistically just avoiding spicy/greasy/etc. foods is probably sufficient. Milk can be a little tricky for an upset stomach to digest as we already mentioned, so you might want to cut that out for a bit if watery stools are lasting longer than 48 hours. We often hear of kids who have watery stools, then eat a cheeseburger and end up with a bathroom explosion. Don't let this be you! A couple of days of dietary changes should work if diarrhea is long-lasting.

We recommend AGAINST use of over-the-counter diarrhea medications as they can cause significant side-effects. Picture this: your gut is trying to expel a yucky GI bug, but then a medication makes the movement slow down. Now the bug is trapped in the gut with nowhere to go and havoc to wreak! Rarely, this can even cause the intestines to allow the infection to spread to the bloodstream or stretch the gut so much that it becomes toxic. Unless directed by us or another physician, please don't use these medications.

Probiotics can be helpful with diarrhea, particularly if it is caused by antibiotics. Any over-the-counter brand containing Lactobacillus can be helpful.

Very rarely is diarrhea treated with antibiotics. Yes, some bacteria can cause watery stools, but some of these are made WORSE with treatment. Bummer!

What to Do When

  • My child has had a couple of watery stools, but is otherwise acting ok.
    • Don't panic. It is annoying but will likely pass. Work on fluids until feeling better.
  • My kid had green/smelly/frothy/otherwise weirdly colored diarrhea.
    • Again, probably don't panic. Infectious diarrhea is often all of these things. As long as it passes in a reasonable amount of time and no other worrisome symptoms (see below), we are probably good.
  • My child has a fever with diarrhea.
    • As long as they are not in awful pain, this is probably ok. You can treat the fever if it is making your little one feel bad (see fever protocol). Your child might also vomit. If he/she is still urinating at least 3-4 times per 24 hours, has perky moments of play, and no other worrisome signs (see below), this is ok.
  • My child has had diarrhea for longer than 10-14 days.
    • We need to see you during office hours to discuss.  Call the next business day and leave a message on the nurse line (option 1) to schedule an appointment.
  • My child looks dehydrated (not making good tears, not urinating at least every 6-8 hours, sticky-appearing tongue)
    • You need to be seen today/tonight, and probably in the emergency room to discuss IV fluids.
  • My child has bloody stools.
    • You need to call us so we can talk through next steps. If this happens after hours or over the weekend, call the on-call provider and leave a message in the urgent (2hr) mailbox, option 1.
  • Worrisome signs/we need to see your child soon if:
    • You are worried about dehydration (maybe ER)
    • Your child is having bloody stools (maybe ER)
    • Your child is having long-lasting diarrhea more than 2 weeks (call during office hours)
    • Your child is having intermittent, but frequent diarrhea over weeks and months (call during office hours)
    • If you have concerns!