Diarrhoea in children

What is diarrhoea?

Diarrhoea is a symptom where someone’s bowel movements are more frequent or looser and they pass 3 or more loose or liquid stools (poos) per day. If the stools are soft, formed and solid, then it is not diarrhoea.

Breastfed babies may pass soft, loose stools in a mustard yellow colour, but this is not diarrhoea either. See this article for what’s normal for baby poo.

Diarrhoea in children is often due to ‘gastro’ — viral gastroenteritis — which is infectious and easily spread from person to person.

What symptoms relate to diarrhoea in children?

Children with diarrhoea may also have other symptoms, including:

• abdominal pain (tummy pain)
• vomiting
• fever or high temperature
• loss of appetite
• dehydration

Signs of dehydration in babies, infants and children

Dehydration can be fatal, and babies and children are particularly vulnerable. It’s therefore important to recognise the signs of dehydration.

Babies and young children are much more likely than adults to become dehydrated when they have diarrhoea. They can become very sick very quickly and may need to go to hospital. Signs that a child is dehydrated include:

• dry mouth, tongue and lips
• sunken eyes
• being listless or irritable
• shedding fewer tears when crying

Severe dehydration is a medical emergency and can be fatal — get medical help for your child immediately.

Symptoms include:

• not drinking much or refusing drink
• feeling lethargic
• producing no urine or only a very reduced amount of urine
• very sunken eyes
• very sunken fontanelle in a baby
• cold, pale or blotchy skin
• fast breathing

When should my child see a doctor?

Got to a doctor or your local hospital emergency room straightaway if a child with diarrhoea:

• is younger than 6 months or weighs less than 8 kg
• was born preterm, or has ongoing health problems
• has blood or mucus in their stool (poo) — this suggests a bacterial infection
• has severe abdominal pain or constant tummy pain
• is a baby and is doing fewer than 4 wet nappies per day
• has green vomit
• keeps vomiting
• has a high fever
• shows signs of dehydration (see above)
• cannot take in enough fluids
• is tired or drowsy
• has other worrying symptoms, such as headache or pain when weeing
• is not getting any better

What causes diarrhoea in children?

There are many causes of diarrhoea in children — diarrhoea is a symptom, not a condition in itself. Conditions that can cause diarrohea in children include:

Viral gastroenteritis

Gastroenteritis is an infection of the bowel. Viruses are the most common cause of gastroenteritis in children. Rotavirus, norovirus, adenovirus and astrovirus can all cause viral gastroenteritis. The viruses are very infectious and are passed easily from person to person. Outbreaks happen more often in autumn and winter.

Viral gastroenteritis normally starts with vomiting, which can last 1 or 2 days. There may be low-grade fever. The diarrhoea, which is often watery, usually takes longer to clear up and may go on for up to a week to 10 days.

Bacterial gastroenteritis

Gastroenteritis can also be caused by bacteria, sometimes linked to food poisoning. Salmonella, E. coli, shigella and campylobacter are all bacteria that can cause gastroenteritis.

Bacterial gastroenteritis may cause blood or mucus in the stool and high fever. It comes on suddenly.

Parasites

Parasites may also cause gastroenteritis. The parasites that cause giardia and cryptosporidiosis are waterborne parasites and live in rivers, lagoons and streams throughout Australia. They may also infect swimming pools, water parks and tank water.

Giardia is common in Indigenous communities. It can cause ongoing or severe diarrhoea, stomach cramps, tiredness and weight loss. Symptoms of cryptosporidiosis include watery diarrhoea and stomach cramps, along with nausea, vomiting and loss of appetite.

Antibiotics

A course of antibiotics can sometimes wipe out ‘good’ bacteria as well as ‘bad’. This leaves an imbalance of bacteria in the bowel, which can cause diarrhoea, and is known as antibiotic-associated diarrhoea. See your doctor if you think antibiotics have caused your child’s diarrhoea.

Clostridium difficile

Clostridium difficile (also known as C. diff) is a bacterium that lives in the bowel of many children and some adults. If C. diff starts to overgrow after a course of antibiotics, it can cause serious gastrointestinal symptoms. These include watery diarrhoea, cramping abdominal pain and fever. The symptoms can be severe, including blood in the stool. You should take your child straight to the doctor or hospital emergency room if they have blood in their poo.

Long-term causes of diarrhoea

Several long-term (chronic) health conditions can cause diarrhoea in children including:

Chronic constipation

A hard stool can become impacted and stuck in the lower bowel due to constipation. This may lead to soft stools leaking around the partial blockage, sometimes with no warning, and soiling the underwear. These episodes of ‘diarrhoea’ are known as encopresis or faecal incontinence.

Lactose intolerance

Lactose intolerance, when the body can’t digest the lactose found in milk, is uncommon in babies and children. Lactose is the sugar found in the milk produced by all mammals, including humans. When lactose intolerance does occur, it causes diarrhoea and stomach pain.

Temporary lactose intolerance sometimes occurs after gastroenteritis. If you think your baby or child is lactose intolerant, see your doctor. Don’t try and modify their diet yourself.

Inflammatory bowel disease (IBD)

Crohn’s disease and ulcerative colitis are 2 conditions collectively known as inflammatory bowel disease. The symptoms, including diarrhoea, can flare up and then die down (remit). A child with IBD may lose weight for no obvious reason.

Coeliac disease

Coeliac disease is an autoimmune condition where someone is abnormally sensitive to the dietary protein gluten. It can cause diarrhoea, bloating, abdominal pain, and weight loss or slow growth in children.

Malabsorption

Malabsorption syndrome refers to several disorders that affect someone’s ability to absorb nutrients from their food. A child with malabsorption may have ongoing diarrhoea and difficulty gaining weight.

If your child has diarrhoea and needs to see a doctor for any reason, they will check whether the child is dehydrated. The doctor will also ask you if they have recently been on antibiotics or had contact with anyone who had similar symptoms. Doctors don’t usually do tests if they suspect there is a short-term infectious cause of the diarrhoea, so you may never know for certain what the cause was.

How is diarrhoea in babies and children treated?

The treatment of diarrhoea in babies and children will depend on the underlying cause.

Antibiotic-associated diarrhoea: The doctor may advise you to stop or change the antibiotic.

Coeliac disease or lactose intolerance: These conditions can be treated with dietary adjustments.

Constipation: If ongoing constipation is causing faecal incontinence in your child, this will need to be managed by a doctor or a paediatrician.

Cryptosporidiosis: There is usually no specific treatment for this condition and it generally clears up by itself.

Dehydration: Your child may need to go to hospital for rehydration via a nasogastric tube, which goes down their nose into their stomach, or intravenously via a drip.

Gastroenteritis: Treatment will focus on keeping your child hydrated and replacing any lost minerals and salts. You can do this with an oral rehydration solution, which you can buy from the pharmacy. Gastroenteritis will usually clear up without specific treatment.

Giardia: This can be treated with specific antibiotics.

Inflammatory bowel disease (IBD): Your child will need to see a specialist and will need medicines and specialised formula.

Malabsorption: Treatment will depend on the underlying cause and may involve replacing missing nutrients.

Anti-diarrhoeal medicines are not suitable for use in children.

How should I care for a child with diarrhoea at home?

Most cases of diarrhoea in children are due to viral gastroenteritis, and can be treated with home care, as long as the child does not have dehydration.

If you are caring for a child at home because they have diarrhoea due to gastroenteritis:

• Take them to a doctor immediately if they also have any signs or symptoms in the list above — these may indicate something serious.
• Babies under 6 months of age should always be taken to the doctor.
• Breastfed babies older than 6 months should continue to be breastfed but the should be fed more often. If they vomit, offer them a drink after each time. You can also offer them oral rehydration solution or water for the first 12 hours.
• Bottlefed babies should have their formula replaced with oral rehydration solution or water for the first 12 hours, then they can have normal formula in small amounts, more often than normal feeding. If they vomit, they should be offered a drink after every time.
• Oral rehydration solutions are strongly recommended for infants and toddlers with diarrhoea and any child with frequent diarrhoea or vomiting.
• Give older children small amounts of fluids to drink often — say every 15 minutes. Oral rehydration solutions are best, but if they won’t drink those, very diluted cordial (one part cordial to 20 parts of water) or diluted soft drink or juice (one part juice to one part water) may be used with caution. Do not use diet or low-kilojoule versions.
• Alternatively, oral rehydration solution can be chilled or made into ice blocks for a child to suck.
• Don’t give your child undiluted drinks that are high in sugar, such as sports drinks, lemonade or cordial — they can make diarrhoea or dehydration worse.
• Children with gastroenteritis may refuse solid food, but it’s good for them to return to their normal diet as soon as possible so long as they are not dehydrated or vomiting.
• Do not give children anti-diarrhoeal medicines or anti-vomiting medicines (anti-emetics) unless your doctor advises since they may be harmful.
• Make sure your baby or child rests.
• Don’t send them to nursery, daycare or school until they have not had a loose bowel motion for 24 hours.

What complications can occur in children with diarrhoea?

• Dehydration is the most serious complication of diarrhoea in young children and babies.
• Temporary lactose intolerance can result from an episode of gastroenteritis, but normally this goes away after a couple of weeks.

Can you prevent diarrhoea in children?

Gastroenteritis is the most common cause of diarrhoea in children. It is highly infectious and easily spread between people, especially between children.

You can help minimise the spread of gastroenteritis by:

• washing your hands regularly, especially after nappy changes and before feeding
• washing your hands before food preparation and after going to the toilet
• wearing gloves when cleaning up diarrhoea or vomit and sealing it in a plastic bag before putting in the bin
• following good food safety practices
• keeping your child away from nursery, day care or school until they have not had a loose bowel motion for 24 hours
• getting babies vaccinated against rotavirus