My child has had diarrhea for two days. I’m worried about dehydration. 
How should I treat this?

Diarrhea is a common manifestation in many illnesses. There is no recommended treatment for most diarrheal illnesses (outside of hydration) in infants or children. Adult diarrhea medications can, in fact, be harmful to infants and children. A good option for hydration is Pedialyte®, because it contains some sugar and salts which are essential to getting fluids absorbed into the body.

The World Health Organization (WHO) has a recipe for a homemade oral rehydration solution, as follows; 1 quart water, 1 teaspoon baking powder, 1 cup orange juice, and 3/4 teaspoon table salt. Plain water will not do the trick as well. Juices alone are OK, however be weary of very sugary or syrupy juices, which can actually make diarrhea worse. If your child refuses the ideal liquids, give him/her anything age appropriate, as any fluid is better than none. Studies have shown that most children can be rehydrated very well with oral fluids, in fact with better outcomes than IV fluids. Only in rare cases are IV fluids needed, like a child who cannot tolerate fluids despite anti-vomiting medications, a child who is severely dehydrated, or a child who needs surgery. We often do prescribe anti-vomiting medications to help with oral rehydration.

Generally an infant or child having only 3-4 loose to watery stools per day is unlikely to become dangerously dehydrated if not vomiting. Each stool might have 2-3 oz of fluid loss, so that child might lose 6 to 12 oz of fluid from his diarrhea. Try to get your child to drink 2-3 oz of fluid for each watery stool in addition to what he would normally drink in a day. Some children with severe diarrhea for several days may benefit from a zinc supplement (zinc can be lost in the stool causing zinc deficiency, which in turn can make the diarrhea worse). Probiotics may also be beneficial as well. As for foods, you should encourage your child to eat the usual nutritious foods. I have, unfortunately, seen children come to the ER literally starving after 3 or 4 days of nothing but Pedialyte. Some of you may have heard of the BRAT diet (bananas, rice, applesauce, and toast). I prefer to think of it as BRAT therapy, because it should be a stool bulking supplement to other healthy foods rather than a complete diarrhea diet.
 
In the following two circumstances you should contact your child’s medical provider immediately: 

  • no urine output for 8 hours or more, very dry mouth, dough like skin, dry eyes when crying, sunken-in soft spot on an infants scalp, or listlessness.
  • Bloody diarrhea

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