Clinical Reference Systems: Pediatric Advisor 10.0
Diarrhea
Admission and Discharge Instructions
Description
Diarrhea is the sudden increase in the frequency and
looseness of bowel movements (BMs). Mild diarrhea is the
passage of a few loose or mushy BMs. Severe diarrhea is the
passage of many watery BMs. The best indicator of the
severity of the diarrhea is its frequency. Green bowel
movements are also a sign of severe diarrhea.
The main complication of diarrhea is dehydration from the
loss of too much body fluid. Symptoms of dehydration are a
dry mouth, the absence of tears, infrequent urination (for
example, none in 8 hours), and a darker, concentrated urine.
The main goal of diarrhea treatment is to prevent
dehydration.
Cause
Diarrhea is usually caused by a viral infection of the
lining of the intestines (gastroenteritis). Sometimes it is
caused by bacteria or parasites. Occasionally a food
allergy or drinking too much fruit juice may cause diarrhea.
If your child has just one or two loose bowel movements, the
cause is probably something unusual your child ate. A diet
of nothing but clear fluids for more than 2 days may cause
green, watery bowel movements (called "starvation stools").
Reasons for Admission to the Hospital
Your child's diagnosis: ________________________________________
Main complication: ___________________________________________
___ Needs IV fluids
___ Needs antibiotic or other medicine
___ Other reason: ____________________________________________
Expected Course
Diarrhea usually lasts several days to a week, regardless of
the type of treatment. The main goal of treatment is to
prevent dehydration. Your child needs to drink or receive
enough fluids to replace the fluids lost in the diarrhea.
Don't expect a quick return to solid bowel movements.
Requirements for Discharge
- _______________________________________________________
- _______________________________________________________
- _______________________________________________________
Discharge Instructions for Diet
Increased fluids and dietary changes are the main treatment
for diarrhea. Several diets are described below. The right
diet for your child depends on the severity of the diarrhea
and your child's age. Go directly to the section that
pertains to your child. (If you are breast-feeding your
child, please refer to the section for breast-fed babies.)
Note: One loose bowel movement can mean nothing. Don't
start dietary changes unless your child has had several loose
bowel movements.
BREAST-FED INFANTS
- Special considerations for breast-fed infants
No matter how they look, the bowel movements of a breast-
fed infant must be considered normal unless they contain
mucus or blood or develop a bad odor. In fact, breast-
fed babies may normally pass some green BMs or BMs with a
water ring.
The frequency of bowel movements is also not much help in
deciding whether your breast-fed baby has diarrhea.
During the first 2 or 3 months of life, the breast-fed
baby may normally have one BM after each feeding.
However, if your baby's BMs abruptly increase in number,
your baby probably has diarrhea. Other clues are poor
eating, acting sick, and a fever.
Remember that something in the mother's diet may cause a
breast-fed baby to have more frequent or looser bowel
movements (for example, coffee, cola, or herbal teas).
- Diet
Continue breast-feeding but at more frequent intervals.
Add solids as described below for formula-fed infants.
Don't stop breast-feeding your baby because your baby has
diarrhea. For severe (watery and frequent) diarrhea,
offer Kao Lectrolyte or Pedialyte between breast-feedings
for 6 to 24 hours only if your baby is urinating less
frequently than normal.
You may have to stop breast-feeding temporarily if your
baby is too exhausted to nurse and needs intravenous (IV)
fluids for severe diarrhea and dehydration. Pump your
breasts to maintain milk flow until you can breast-feed
again (usually within 12 hours).
FORMULA-FED INFANTS (less than 1 year old)
- Oral glucose-electrolyte solutions for 4 to 6 hours
If your child has severe diarrhea and also has dark urine
or not very much urine, buy Kao Lectrolyte or Pedialyte
at your pharmacy or supermarket. (These special
solutions are not needed for diarrhea that is not
severe.) If your child doesn't like the flavor, add a
bit of KOOL-Aid powder or 2 drops of Nutrasweet. Give as
much of the liquid as your baby wants. Give at least 10
ml for each pound your child weighs per hour. Diarrhea
makes children thirsty, and your job is to satisfy that
thirst and prevent dehydration. Never restrict fluids
when your child has diarrhea.
Until you get one of these special solutions, continue
giving your baby full-strength formula in unlimited
amounts. Avoid giving your baby Jell-O water mixtures or
sports drinks (they do not contain enough sodium). Fruit
juice will make the diarrhea worse.
If you aren't able to get an oral glucose-electrolyte
solution, ask your doctor about making a homemade
solution as follows: Mix 1/2 cup of dry infant rice
cereal with 2 cups (16 ounces) of water and 1/4 level
teaspoon of salt. Be careful not to add too much salt
(to avoid the risk of salt poisoning).
- Returning to formula
After being given clear fluids for 4 to 6 hours, your
baby will be hungry, so begin giving her full-strength
formula. Offer it more frequently then you normally do.
If the diarrhea continues to be severe, begin with a soy
formula. If you give cow's milk formula and the diarrhea
doesn't improve after 3 days, change to a lactose-free
formula (a soy formula or milk-based Lactofree). If you
start giving soy formula, plan to keep your baby on the
soy formula until the diarrhea is gone for 3 days.
- Adding solids
Foods that contain a lot of starch are more easily
digested than other foods during diarrhea. If your baby
is over 4 months old and has had diarrhea for over
24 hours, give her the following starchy foods until the
diarrhea is gone: any cereal, applesauce, strained
bananas, strained carrots, mashed potatoes, and other
high-fiber foods.
OLDER CHILDREN (over 1 year old)
- Fluids
Give your child only water to drink for the first
24 hours of watery diarrhea. (Most toddlers don't need
oral glucose-electrolyte solutions such as Pedialyte
unless they are dehydrated). On day 2, offer some
milk as well as water. Avoid fruit juices because they
usually make the diarrhea worse. If your child refuses
solids, give your child milk or formula rather than
water.
- Table foods
Keep giving your child table foods while he has diarrhea.
The choice of food is important. Starchy foods are
digested best. Examples of such foods are cereal
(especially rice cereal), grains, bread, crackers, rice,
noodles, mashed potatoes, carrots, applesauce, and
bananas. Pretzels or salty crackers can help meet your
child's need for sodium. On the second day of the
diarrhea, if your child wants some protein, soft-boiled
eggs are usually easily digested.
Discharge Instructions for Home Care
- Common mistakes
Using boiled skim milk or any concentrated solution can
cause serious complications for babies with diarrhea
because it contains too much salt. KOOL-Aid, soda pop,
or water should not be used as the only food because they
contain little or no salt. Use only the fluids suggested
here.
Clear fluids alone should be used for only 4 to 6 hours
because the body needs more calories than clear fluids
can provide. Likewise, a diluted formula is not needed
because regular formula contains enough water.
The most dangerous myth is that the intestine should be
"put to rest." Restricting fluids can cause dehydration.
There is no effective, safe drug for diarrhea. Extra
fluids and diet therapy work best.
- Prevention
Diarrhea is very contagious. Always wash your hands
after changing diapers or using the toilet. This is
crucial for keeping everyone in the family from getting
diarrhea.
- Diaper rash from diarrhea
The skin near your baby's anus can become irritated by
the diarrhea. Wash the area near the anus after each
bowel movement and then protect it with a thick layer of
petroleum jelly or other ointment. This protection is
especially needed during the night and during naps.
Changing the diaper quickly after bowel movements also
helps.
- Overflow diarrhea in a child not toilet-trained
For children in diapers, diarrhea can be a mess. Place a
cotton washcloth inside the diaper to trap some of the
more watery BM. Use disposable superabsorbent diapers to
cut down on cleanup time. Use the diapers with snug leg
bands or cover the diapers with a pair of plastic pants.
Wash your child under running water in the bathtub.
- Vomiting with diarrhea
If your child has vomited more than twice, follow the
recommended treatment for vomiting instead of this
treatment for diarrhea until your child has gone 8 hours
without vomiting.
Medicines
- For pain or fever over 102ƒF (39ƒC) give
_____________________________
- ____________________________________________________________
- ____________________________________________________________
Additional Instructions
________________________________________________________________
________________________________________________________________
________________________________________________________________
Follow-up Appointment after Discharge
___ Your child needs to be rechecked and has an appointment
on _____________ at _______ with
_________________________.
___ Your child needs to be rechecked in ________ days. Call
your child's doctor to make an appointment.
___ A follow-up appointment is not necessary. Call the
doctor if you have any concerns.
Call your physician immediately if:
- There are signs of dehydration (no urine in more than
8 hours, very dry mouth, no tears).
- Any blood appears in the diarrhea.
- The diarrhea is severe (more than 8 BMs in the last
8 hours).
- The diarrhea is watery AND your child also vomits the
clear fluids three or more times.
- Your child starts acting very sick.
Call your physician during office hours if:
- Mucus or pus appears in the BMs.
- A fever (over 100 degrees F, or 37.8 degrees C) lasts
more than 3 days.
- Mild diarrhea lasts more than 2 weeks.
- You have other concerns or questions.
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