Overview of Chronic Diarrhea in Infants and/or Young Children
Diarrhea is when you have loose, watery stools several times a day. This condition generally passes within a day or two without medical treatment. When it lasts longer than two days, it can lead to dehydration.
Diarrhea that continues for four weeks (even if it comes and goes) is considered to be chronic diarrhea.
Infants and young children are especially vulnerable to dehydration caused by diarrhea. During episodes of diarrhea, the body loses fluid and electrolytes it needs to function correctly. Electrolytes are minerals that affect the amount of water in your body, muscle function, and the acidity of your blood.
If your child has diarrhea lasting more than 24 hours, especially if accompanied by fever or unusual stools, consult your pediatrician. Chronic diarrhea can lead to organ damage, coma, or shock in infants and young children.
Diarrhea is a leading cause of malnutrition in children under the age of 5. Large numbers of these cases are due to contaminated water and food in developing countries, where a child under the age of 3 is likely to have three bouts of diarrhea a year. Continued episodes can cause malnutrition—and malnutrition can continue the cycle of diarrhea. Around the world, diarrhea is the second leading cause of death in children under age 5, taking the lives of 1.5 million children each year, according to the World Health Organization (WHO, 2009).
Causes of Diarrhea
The cause of diarrhea in children is not always found. Common causes are:
- too much fruit or fruit juice
- use of antibiotics or other medications (in baby or breastfeeding mother)
- allergies or sensitivities to particular foods
- changes in frequency of breastfeeding
- dietary changes (in baby or breastfeeding mother)
Severe diarrhea can be caused by:
- inflammatory bowel disease (IBD)
- bacterial infections due to contaminated water
- viral infections
- improper food preparation
- poor hygiene
Children visiting foreign countries (especially developing countries) are at risk of traveler’s diarrhea. This is usually due to contaminated water or food.
Symptoms of Diarrhea
Infants often produce loose stools, and this should not be immediate cause for concern. However, a sudden increase in watery stools, especially if accompanied by congestion or fever, may indicate diarrhea in infants and young children. Other symptoms include:
- abdominal pain or cramping
- urgency to use the bathroom, or loss of bowel control
- fever and chills
Symptoms of Dehydration
Dehydration is when the body no longer has enough fluids to function properly. In infants and young children, dehydration can progress rapidly, and can lead to more serious health complications if not treated quickly. Complications of dehydration include shock, organ damage, and coma.
Signs that your child is suffering from dehydration include:
- dry mouth
- dry/sunken eyes
- sunken cheeks
- no tears when crying
- dry skin
The following symptoms indicate severe dehydration:
- more than eight hours have passed without urination
- child is extremely listless
- the soft spot on top of your infant’s head (fontanelle) appears sunken
- pinched skin does not spring back
- high fever
If you believe your child is suffering from dehydration, seek immediate medical attention.
Caring for Your Child at Home
If your child has a mild case of diarrhea, home care is usually effective. It is important to note that over-the-counter medications used to treat diarrhea in adults should not be used for infants or children. Consult with your pediatrician before using over-the-counter diarrheal medicines.
Things you can do include:
- making sure your child drinks plenty of fluids—ask your pediatrician about which fluids contain electrolytes and are safe for infants and young children
- avoiding foods that appear to trigger diarrhea
- washing your hands often—especially after each diaper change—to avoid spreading bacteria in the home
If you are breast-feeding, continue nursing. Breast milk can help ease symptoms of diarrhea in infants and helps them recover more quickly (NLM, 2012).
Monitor your child carefully, looking for signs of dehydration. Call your doctor right away if you suspect your child is dehydrated.
To prevent diaper rash and irritation, change your child’s diaper immediately after a bowel movement. Use water instead of wipes, which can further irritate the skin. Over-the-counter creams such as Desitin and those with zinc oxide can also help soothe and protect skin.
When to Bring Your Child to the Doctor
Consult your pediatrician if your child has had diarrhea for more than two days, or if the child is a newborn. Seek immediate medical attention if any of the following signs are present:
- diarrhea is bloody or has mucus
- diarrhea is severe (more than eight stools in eight hours)
- diarrhea is accompanied by vomiting
- abdominal pain or cramping
- diarrhea goes away but keeps returning
- signs of dehydration
- recent travel to a foreign country
Diarrhea in infants and young children can quickly lead to dehydration, a dangerous condition. Do not hesitate to call a doctor.
Tests and Diagnosis: Determining the Cause
If your child’s diarrhea becomes chronic, your doctor will want to determine the cause. A complete medical history and physical examination will be required. Be prepared to provide information about your child’s diet, eating habits, and medications. Diagnostic procedures may include:
- blood tests (to check for disease)
- stool culture (to check for bacteria and parasites)
- allergy tests
Depending on the results of these tests, further testing, including imaging tests (X-rays) may be ordered.
Medical Treatment for Chronic Diarrhea
A treatment plan for your child will depend on the cause and the severity of his or her condition.
If your child is suffering from chronic diarrhea or dehydration, hospitalization may be necessary. To restore balance, fluids containing electrolytes will be given intravenously.
Follow your pediatrician’s advice carefully. Avoid giving your child foods or liquids that trigger diarrheal attacks. Stick to bland foods such as potatoes, toast, or bananas until the attack has subsided.
Diarrhea can’t always be prevented, but you can decrease your children’s risk by practicing good hygiene and following safe food preparation guidelines as recommended by the U.S. Centers for Disease Control and Prevention (CDC).
If you are planning to take your infant or child to a foreign country, check with your pediatrician first. He or she will be able to give you specific information on how to avoid traveler’s diarrhea. Some things to keep in mind when traveling:
- bottled water is recommended for drinking, making ice cubes, cooking, and brushing teeth
- avoid unpasteurized milk or milk products
- wash and peel raw fruits and vegetables
- avoid raw or undercooked meat, poultry, fish, and shellfish
- avoid food from street vendors
- pack some snacks from home for the children
- practice proper hygiene and wash your children’s hands often
- pack hand cleansers or wipes in case there are no hand-washing facilities. It is important to note that alcohol-based cleaners do not protect against all types of germs. Use soap and water whenever possible.
The U.S. Food and Drug Administration (FDA) has approved two oral vaccines that can help prevent rotavirus infections in children (RotaTeq and Rotarix). Both are given in multiple doses in the first months of life. Ask your pediatrician if these vaccines are recommended for your child.