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Offered by Richard W. Martin, M.D., Brighton Pediatrics

Diarrhea is defined as stools that are more frequent and looser in consistency than usual. The most common cause of sudden, new diarrhea is viral gastroenteritis, which often includes vomiting and low-grade fever. The diarrhea is usually watery and without visible blood. Vomiting, if present, usually stops within a day or two, but the diarrhea may last up to a week. Providing adequate liquids to avoid dehydration is the most important treatment. Start with clear liquids, such as Pedialyte or Gatorade, until the vomiting stops. You need to give enough liquids both to provide for a child’s usual fluid needs and to replace the fluid lost in the vomiting and diarrhea. Signs of dehydration include lethargy, sunken looking eyes, lack of tears with crying, dry mouth and unusually long periods of time without urinating.

Once the vomiting has stopped, resuming a balanced, nutritious diet will hasten intestinal healing and resolution of the diarrhea. You can gradually resume formula or milk when vomiting and nausea have resolved. Breastfeeding may be continued throughout the illness.

A child with bloody diarrhea is more likely to have a bacterial infection such as Salmonella or Shigella or E. coli O157:H7; parents should seek medical attention promptly. Bacterial infections are more likely to cause high fever and severe abdominal pain and less likely to cause vomiting or respiratory symptoms than viral gastroenteritis. Diarrhea from Shigella and Salmonella usually resolves spontaneously; antibiotics are needed only in special situations. E. coli O157:H7 may lead to a more serious illness called hemolytic uremic syndrome (HUS). Treatment with antibiotics is not recommended because they may increase the risk of HUS.

Other reasons to seek medical attention include signs of dehydration, a child who appears unusually sick in any way, or diarrhea that persists for longer than two weeks. Persistent diarrhea is more likely to have noninfectious causes. Celiac disease or inflammatory bowel disease, for example, are possibilities for a child who appears ill and is not growing well. Relatively harmless causes such as irritable bowel syndrome are more likely for a child who is generally acting well, eating well and growing normally.

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