Few things are more frustrating to deal with than diarrhea in a toddler. I’ve yet to find a brand of diapers that truly holds in a watery stool without it leaking down my child’s legs and back. Besides that, the associated diaper rash that accompanies prolonged diarrhea can be very painful and frustrating to treat.

So what do you do when your child gets diarrhea. When is it serious enough to call a doctor? How can you make it go away more quickly?

First, it’s helpful to group toddler diarrhea into two categories: infectious (i.e. diarrhea that’s caused by a bacteria or a virus) and non-infectious. In this article, we will look at infectious diarrhea. Our next article will cover non-infectious diarrhea.

Infectious diarrhea can be caused by viruses, bacteria, and parasites. We will detail each of these types below:

Viral Diarrhea

Viruses are the most common cause of infectious diarrhea and, unfortunately for us, there are hundreds of viral strains. Viral diarrhea (also called viral enteritis) is usually preceded by vomiting and abdominal pain. Fever may or may not be associated with it. The diarrhea is self-limited and will go away on it’s own over 5-10 days. It’s very contagious and will quickly spread among household contacts.

I’ll never forget the Thanksgiving holiday my mother came down with viral vomiting and diarrhea. Her symptoms started on Monday; by mid-week she’d spread it to my grandparents, my father, and my two siblings. Because I was the last to get it I thought I’d manage to avoid it. Unfortunately I woke up Thanksgiving morning with ominous pain in my belly…by dinner, I was miserable and spent the day fasting instead of feasting.

Bacterial Diarrhea

This type of diarrhea is often spread via food that has been contaminated with animal or human feces. It can be spread person to person if strict hand hygiene is not practiced. Please—wash your hands. The diarrhea can be both watery and bloody. Bacterial diarrhea often lasts a bit longer than viral diarrhea but still usually goes away on its own. Antibiotics are rarely recommended and can actually make the diarrhea worse. While there can be serious side effects from the bacteria (such as kidney failure with E. coli 0157) they are usually very rare.

Parasitic Diarrhea

Drinking parasite-contaminated water or eating parasite-contaminated food is the most common cause of parasitic diarrhea. However, it can also be spread from person to person such as Giardia in a daycare setting. Diarrhea caused by a parasite is often NOT self-limited (it won’t go away by itself) and requires medical intervention to eradicate the resident parasites and restore normal bowel function.

Warning Signs

No matter what the cause of diarrhea, you should know when to seek medical attention for your child. Here are several warning signs you should look for:

1. The child is unable to take oral liquid. Pedialyte is the best over the counter solution to give anyone with diarrhea. It has electrolytes in a form that are easily absorbed to replace the electrolytes lost due to illness. If the child is unable to keep down oral solution and is still having diarrhea, the child should be evaluated as he/she may rapidly develop dehydration.

2. If you child has less than 1 wet diaper/time urinating in 6 hours they are likely dehydrated. When you start to see a drop off in the urine, increase the oral fluids. If the child cannot tolerate the increased oral rehydration or is still not having wet diapers/urinating they must be evaluated immediately.

3. If your child’s eyes appear sunken in, their fontanelle (the soft spot on an infant’s skull) is sunken, or hands or feet are cold the child should be evaluated immediately.

4. If your child is acting more tired (lying down on the floor, refusing to get up and play) or is less responsive you should take them to be evaluated immediately.

5. If the diarrhea persists greater than 7 days or worsens you should take your child to be evaluated.

Managing Diarrhea

If your child is remaining hydrated, is acting normally, and doesn’t appear sick you can manage his/her diarrhea at home. Follow these tips:

  • Give a regular diet as long as the child can tolerate it. Physicians used to advocate a BRAT diet (bananas, rice, apples, toast) but studies have shown following this diet can actually delay recovery because that food doesn’t have all the nutrients the gut needs to re-grow.
  • Avoid juices and other sugary foods as sugar can actually make the diarrhea worse.
  • Make sure your child gets plenty of water alternated with an electrolyte containing solution such as pedialyte. Some children don’t like plain pedialyte but will go for the flavored variety. You can even make pedialyte popsicles your child can suck on.
  • Wash your hands, wash your hands, and wash them again! Hand washing is the NUMBER 1 way to avoid transmitting a diarrheal illness to other people.

Infectious diarrhea is no fun but thankfully, in the majority of cases, will go away on it’s own without long-term consequences.

To learn about noninfectious diarrhea continue to The Scoop on Poop Part 3. To learn more about constipation, another common childhood problem, see The Scoop on Poop Part 1.


About the Author

Rachel Nelson MD

graduated from Loma Linda University and completed a pediatric residency at UC Davis. She has a passion for helping children reach their full potential. She is married to a colorectal surgeon and together they have two children: Amy and Michael. Dr. Nelson enjoys playing outside with her kids, gardening, and music.

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