Diarrhea: Toddler (age 1 to 3 years)

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. The best indicator of the severity of the diarrhea is its frequency.

The main complication of diarrhea is dehydration from the loss of too much body fluid. Symptoms of dehydration are a dry mouth, the absence of tears, infrequent urination (for example, none in 12 hours), and a darker, concentrated urine. The main goal of diarrhea treatment is to prevent dehydration.

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 a food allergy or drinking too much fruit juice may cause diarrhea. If your child has just one or two loose stools, the cause is probably something unusual your child ate. A diet of nothing but clear fluids (such as Pedialyte) for more than 2 days may cause green, watery stools (called "starvation stools").

How long will it last?

Diarrhea from a viral infection 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 fluids 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.

Note: One loose stool can mean nothing. Don't start dietary changes until your child has had several loose stools.

Frequent, watery diarrhea

• Fluids

  Encourage your child to drink lots of fluids to prevent dehydration. Milk and water are both fine. However, if your child refuses solids, give your child just milk, rather than water.

  Most toddlers don't need oral glucose-electrolyte solutions such as Pedialyte unless the child is dehydrated. Avoid fruit juices, because they all make diarrhea worse.

• Table foods

  Keep giving your child table foods while he has diarrhea. The choice of food is important. Starchy foods are digested best. Examples of such foods are dried cereals, grains, bread, crackers, rice, pasta, and mashed potatoes. Pretzels or saltine crackers can help meet your child's need for sodium. Soft-boiled eggs and yogurt are easily digested and provide some protein.

Mild diarrhea (loose stools)

Follow a regular diet with a few simple changes:

• Eat more foods containing starch. Starchy foods are easily digested during diarrhea. Examples are cereal, breads, crackers, rice, mashed potatoes, and pasta.
• Drink extra water. Avoid all fruit juices and carbonated drinks.
• Milk and milk products are fine.
• Avoid beans or any other foods that cause loose stools.
• Add a probiotic to the diet. Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy bacteria in the GI tract. Yogurt is the easiest source of probiotics. If your child is over 12 months old, give 2 to 6 ounces (60 to 180 ml) of yogurt twice daily.

How can I take care of my child?

There is no effective, safe drug for diarrhea. Extra fluids and diet therapy work best.

• Probiotics

  Probiotics contain healthy bacteria (lactobacilli) that can replace unhealthy bacteria in the GI tract.

  Yogurt is the easiest source of probiotics. Give your child 2 to 6 ounces (60 to 180 ml) of yogurt twice daily. Today almost all yogurts are “active culture”, which means that they contain live and active bacteria.

  Probiotic supplements in liquid, granules, tablets, or capsules are also available in health food stores. These can be more helpful than yogurt.

• Common mistakes

  Kool-Aid and soda pop, should be avoided because they contain no salt and too much sugar. Use only the fluids suggested above.

  Fruit juices (especially apple and grape) should be avoided because they are too concentrated and make the diarrhea worse.

  Clear fluids alone should be used for only 4 to 6 hours because the body needs more calories than clear fluids can provide. Milk is a good well balanced fluid for diarrhea.

  The most dangerous myth is that the intestine should be "put to rest." Restricting fluids can cause dehydration.

• Prevention

  Diarrhea can be 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 child'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.

• Overflow diarrhea in a child not toilet-trained

  For children in diapers, diarrhea can be a mess. Place a cotton washcloth inside the diaper to trap some of the more watery stool. 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 child has vomited more than twice, follow your doctor's recommended treatment for vomiting instead of this treatment for diarrhea until your child has gone 8 hours without vomiting.

When should I call my child's healthcare provider?

Call IMMEDIATELY if:

• There are signs of dehydration (no urine in more than 12 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 also 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.