Diarrhea: Breastfed Infants

What is diarrhea?

Diarrhea is the sudden increase in the frequency and looseness of stools. Mild diarrhea is the passage of a few loose or mushy stools. Severe diarrhea is the passage of many watery stools. Watery stools that occur every hour is definitely severe diarrhea. The best indicator of the severity of the diarrhea is its frequency or blood in the stools.

The main complication of diarrhea is dehydration from the loss of too much fluid from the body. Symptoms of dehydration are a dry mouth, the absence of tears, infrequent urination (for example, none in 8 hours), and a darker, concentrated urine. The main goal of diarrhea treatment is to prevent dehydration.

Is it diarrhea?

No matter how they look, the stools of a breastfed infant must be considered normal unless they contain mucus or blood or develop a bad odor. In fact, during the first months, breastfed babies normally pass very loose stools, some green stools, or even stools with a water ring.

The frequency of stools is also not much help in deciding whether your breastfed baby has diarrhea. Breastfed babies during the first 2 months pass from 4 stools per day to 1 after each feeding. The stools are normally liquid. However, if your baby's stools abruptly increase in number, your baby probably has diarrhea. Other clues are poor eating, acting sick, and a fever.

What is the cause?

Diarrhea is usually caused by a viral infection of the lining of the intestines (gastroenteritis). Sometimes it is caused by bacteria or parasites. Occasionally an infant has a food allergy or drinks too much fruit juice, which may cause diarrhea. If your child has just one or two loose stools, the cause is probably something unusual your child ate.

How long will it last?

Diarrhea caused by bacteria or a virus usually lasts several days to 2 weeks, regardless of the type of treatment. The main goal of treatment is to prevent dehydration. Your child needs to drink enough breast milk to replace the fluids lost in the diarrhea. Don't expect a quick return to solid stools.

What should I feed my child?

Increased fluids and dietary changes are the main treatment for diarrhea. One loose stool can mean nothing. Don't start dietary changes until your child has had several loose stools.

• Breastfeeding

  If your breastfed baby has diarrhea, treatment is straightforward. Continue breastfeeding but at more frequent intervals. Don't stop breastfeeding your baby because your baby has diarrhea. For severe (watery and frequent) diarrhea, offer Pedialyte or other electrolyte solutions between breastfeedings for 6 to 24 hours, but only if your baby is urinating less frequently than normal.

  You may have to stop breastfeeding temporarily if your baby is too exhausted to nurse and needs intravenous (IV) fluids for dehydration. Pump your breasts to maintain milk flow until you can breastfeed again (usually within 12 hours).

• Continuing solid foods

  Foods that contain a lot of starch are more easily digested than other foods during diarrhea. If your baby is over 6 months old, continue with solid foods. Good choices are: any cereal, strained bananas, mashed potatoes, and other high-fiber foods.

• Mother's diet

  Remember that something in the mother's diet may cause a breastfed baby to have more frequent or looser stools—for example, coffee, cola, or herbal teas. If you suspect this, take it out of your diet and see what happens.

How can I take care of my child?

• Prevention

  Diarrhea is very contagious. Always wash your hands after changing diapers or using the toilet. This is crucial for keeping everyone in the family from getting diarrhea.

• Diaper rash from diarrhea

  The skin near your baby's anus can become irritated by the diarrhea. Wash the area near the anus after each stool and then protect it with a thick layer of petroleum jelly or other ointment. This protection is especially needed during the night and during naps. Changing the diaper quickly after stools also helps. It may be necessary to get up once during the night to change the diaper.

• Overflow diarrhea

  For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery stools. Use diapers with snug leg bands or cover the diapers with a pair of plastic pants. Wash your child under running water in the bathtub.

• Vomiting with diarrhea
• If your baby vomits once, make no changes.
• If your baby vomits twice, continue breastfeeding but nurse on only one side for 5 minutes every 30 to 60 minutes. As soon as 4 hours have passed without vomiting, return to normal nursing on both sides.
• Pedialyte or other electrolyte solutions are rarely needed for breastfed babies. If vomiting continues, switch to Pedialyte for 4 hours. Spoon or syringe feed 1 to 2 teaspoons (5 to 10 ml) of Pedialyte every 5 minutes.

When should I call my child's healthcare provider?

Call IMMEDIATELY if:

• There are signs of dehydration (no urine in more than 8 hours, very dry mouth, no tears).
• Any blood appears in the diarrhea.
• The diarrhea is severe (more than 8 stools in the last 8 hours).
• The diarrhea is watery AND your child vomits repeatedly.
• Your child starts acting very sick.

Call during office hours if:

• Mucus or pus appears in the stools.
• A fever lasts more than 3 days.
• Mild diarrhea lasts more than 2 weeks.
• You have other concerns or questions.