Diarrhea

Myth #1: Diarrhea should be treated with antibiotics.

This is false. Actually, most infectious causes of diarrhea are caused by viruses which are unaffected by antibiotics. Most bacterial causes of diarrhea also do not require antibiotic treatment. In fact, certain types of bacterial infectious diarrhea are made worse by antibiotics. This is yet another great example of how interfering with normal bodily functions can do more harm than good.

Myth #2: My child needs a medication to stop the diarrhea.

False. Again, this would prevent the body from doing its job. If you give your child an anti-diarrheal medication you will probably increase the overall time it takes them to get better. Worse, some types of diarrhea are made worse by taking these medications. Never give them to your child.

Myth #3: My child needs IV Fluids.

False again. Most children who have diarrhea will be able to drink fluids. So long as your child is able to drink some fluids, like Pedialyte, they will not get dehydrated. Rarely do kids have both vomiting and diarrhea for a sufficient time to cause serious dehydration.

Myth #4: My child needs a stool test.

False. Most stool tests are negative and show only normal flora in the stool. Unless your child has prolonged diarrhea (more than a week) or has blood in their stool there is no reason to test the stool.

Fact #1: Blood in the stool requires evaluation.

You need to see your doctor if you notice blood in your child's stool. This is one of the indications for a stool test. Blood in the stool may indicate a more severe type of infection and may require monitoring or treatment. While this should prompt a call to your doctor it is generally not an emergency unless associated with severe pain, and thus should NOT prompt a visit to the ER in the middle of the night.

Fact #2: Diarrhea may cause dehydration.

Diarrhea causes loss of body fluid. If your child is also having repeated episodes of vomiting in the setting of watery and profuse diarrhea, they may be at risk for dehydration. That said, it still takes time to get dehydrated, and a trial of home rehydration therapy is indicated before calling your doctor or rushing off to the ER.

Fact #3: Diarrhea is contagious.

This is mostly true. Many cases of diarrhea are infectious and very contagious. The best way to prevent spread of the diarrhea is to wash your hands well and often.

Fact #4: Diarrhea is GOOD.

This of course should be self-evident. It is a rare child who needs anything other than time when they have diarrhea. Avoid the temptation to try and DO something and just let the body get on with ridding itself of whatever caused the diarrhea in the first place. Make sure to give plenty of fluids to replace those fluids that are lost.

There is little controversy on this topic. It is a rare child who needs antibiotics for diarrhea. There is also little controversy over the need to test the stool. I have included some classic references.

If you decide that you need to take your child to the ER to be evaluated for dehydration, I suggest you exhaust all attempts at oral rehydration before you put your child through the process of getting an IV and IV fluids. It is also a rare child who needs IV fluids.

References:

New England Journal of Medicine: 2000

This classic article in the NEJM demonstrated that you can make things worse by using antibiotics in some cases.

Pediatrics: 1997

This article in Pediatrics showed that Oral Rehydration Therapy (ORT) is underused in the U.S. and could prevent as many as 100,000 needless trips to the ER or hospital.

MMWR: 2003

Check out this comprehensive guide published by the CDC.

1. Do not panic. Diarrhea is generally a self-limited illness and will resolve on its own.

2. NEVER give anti-diarrheal medicine.

3. Start oral rehydration. If your child is also vomiting refer to my guidelines for vomiting. If your child is not vomiting, then try to replace what comes out with Pedialyte. In most children this will be about 4-8 ounces of Pedialyte for every stool.

4. If your child has blood in the stool notify your doctor, although there is little reason to rush off the the ER unless there is a large amount of blood.

5. Monitor your child for dehydration such as no urine for more than 12 hours, rapid breathing, or lethargy. If you feel like your child is getting dehydrated you should call your doctor, although there is again little reason to rush off to the ER in the middle of the night.

6. Follow the BRAT(Banana, Rice, Applesuace, and Toast) diet until the diarrhea is mostly resolved.

7. Diarrhea that has not improved after 3-4 days should prompt a call to your physician.

It is important for everyone to understand that the purpose of this website is educational - to provide information. It is not a replacement for your doctor and I am not entering into a doctor-patient relationship with any of the readers of these pages or their children. It is my goal that by providing you with easy to understand information based on the latest research you will be empowered to work with your doctor to raise...healthy kids!