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Diarrhea is defined by pediatricians as frequent loose or watery stools. Most children at some point have loose stools, but if it is only once or twice a day it is probably safe to monitor for a few days to see if it resolves on its own. A child having more than 3 loose or watery stools a day should probably be evaluated by your pediatrician. Other reasons to contact your doctor immediately regarding diarrhea include:

Any signs of dehydration, including:

  • Lethargy or decrease in normal activity
  • Dark urine
  • Infrequent urination
  • Dry/sticky lips or mouth
  • Refusal to drink
  • Sunken eyes, no tears
  • Fever
  • Rash
  • Vomiting
  • Blood in stool

If none of the above are present, diarrhea often goes away on its own in a few days. Most diarrhea cases are caused by viral infections, which are generally harmless as long as the child does not become dehydrated. Other causes include food poisoning (usually associated with vomiting), bacterial infections (usually associated with fever, cramping and blood in the stool), or high sugar or water intake (drinking too much fruit juice, sweets). Lactose intolerance or food allergies are rare causes of diarrhea, often not considered unless the diarrhea has persisted for long periods of time or if it keeps coming back.

Treatment of diarrhea consists of avoiding dehydration by ensuring the child is getting enough to drink. Although milk may be avoided in the first day or so, getting back to a normal diet as soon as possible is more likely to help the diarrhea resolve sooner. Bland or BRAT diets are generally less helpful after the first 12-24 hours of illness. Fruit juices and other high-sugar drinks should be avoided. Electrolyte solutions (ie Pedialyte®) can be useful during the first 24 hours of illness and are a good substitute for a child who prefers juice to water or milk. The electrolyte solutions are especially helpful if a child is vomiting along with having diarrhea, and small amounts (ie one teaspoon) should be given every few minutes to help them stay down. Sports drinks (ie Gatorade®) often have too much sugar and should be avoided with vomiting or diarrhea in younger children.

Over the counter diarrhea medicines should not be used in children in general, as these medicines may hide signs of dehydration and prolong or worsen the illness. Any diarrhea that has lasted more than 7 days should be investigated by your doctor, even if the child is otherwise acting normally