Diarrhea When a Minor Has a Major Mess
DIARRHEA When a Minor Has a Major Mess
An occasional ''accident'' on the way to the potty is one thing. But when your child has diarrhea, the accident looks more like an awful disaster. Frequent passage of unformed or watery stools is more than just messy--it's also potentially dangerous.
''Diarrhea depletes the body of fluid, and if that fluid is not replaced, the body will draw from its stores. When that happens, the child runs the risk of dehydration,'' says Shirley Menard, R.N., a certified pediatric nurse practitioner and assistant professor at the University of Texas Health Science Center at San Antonio School of Nursing.
Diarrhea can be the result of dietary factors, such as too much fruit juice or fiber. With babies, just the introduction of a new food may be enough to cause diarrhea. But it's often caused by viruses.
Whether or not it's caused by a virus, the diarrhea most parents see is usually the acute form. Although it doesn't last long, acute diarrhea is the most dangerous because it's often accompanied by fever, which increases the likelihood of dehydration. Some children, however, develop a mysterious bout of what is called chronic nonspecific diarrhea that has no known cause and is usually harmless. At the onset of any diarrhea, however, it really takes a doctor to tell the difference.
Diarrhea is one of those childhood ailments that usually responds well to care at home. But because it can have life-threatening side effects, or can be the symptom of a more serious illness, you'll want to give the doctor a call before trying any of these suggested remedies.
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| When to See the Doctor ''Parents should always call their child's doctor immediately at the first sign of diarrhea,'' says Marjorie Hogan, M.D., an instructor of pediatrics at the University of Minnesota and a pediatrician at the Hennepin County Medical Center in Minneapolis. She warns that diarrhea can be a symptom of many other ailments that can only be diagnosed by a doctor. With infants especially, there's a real danger of dehydration. According to Dr. Hogan, parents should be alert to these warning signs. * No urination (no wet diapers) for some time * Crying without tears * Loss of skin elasticity * Dry mouth * Sunken fontanelle (the soft spot at the top of an infant's head) * Lethargy or listlessness * Diarrhea accompanied by vomiting (which may increase the likelihood of dehydration) And you should get in touch with the doctor again if your child's diarrhea persists longer than three weeks, if stools contain blood or if there is severe abdominal pain or vomiting. Children who are between the ages of about six months and three years and have diarrhea are also at risk of developing a condition called intussusception. ''The bowel telescopes in on itself as a result of the violent force exerted by the bowel muscles,'' explains Shirley Menard, R.N., a certified pediatric nurse practitioner and assistant professor at the University of Texas Health Science Center at San Antonio School of Nursing. ''If your child suddenly has severe pain and dark stools, which look like currant jelly, it's a medical emergency,'' she says. Call your doctor or the emergency room at once. |
Drink, drink, drink. This is the most important piece of advice health professionals have to offer. For a child with diarrhea, drinking lots of liquids is the only thing that will prevent dehydration. Ice pops, crushed ice with or without flavoring or even a cold wet washcloth to suck on can be helpful.
Menard recommends, in addition, clear liquids such as Kool-Aid, tea, ginger ale and oral rehydration solutions (sold in drugstores). For older kids, Gatorade is also fine, according to Menard.
Babies up to 20 pounds who have diarrhea and are feverish or vomiting should be getting about 3 ounces of liquid per pound per day to avoid dehydration; children over 20 pounds should get 1 to 1½ ounces of fluid per pound daily.
When your child's hungry, resume feeding. Some experts still recommend the so-called BRAT diet once your child wants to eat again. BRAT stands for bananas, rice, applesauce and toast. ''Those are all foods that bind the bowels,'' says Loraine Stern, M.D., associate clinical professor of pediatrics at the University of California, Los Angeles, and author of When Do I Call the Doctor? But according to Dr. Stern, newer research suggests the BRAT diet may prolong the viral infection that causes the diarrhea.
Instead of the restricted BRAT diet, most experts recommend offering the child with diarrhea a choice of all foods--except for milk--and allowing him to eat whatever appeals to him. child with diarrhea a choice of all foods--except for milk--and allowing him to eat whatever appeals to him.
| Don't Be Alarmed by the Color ''Stools come in all sorts of cockamamy colors,'' says Loraine Stern, M.D., associate clinical professor of pediatrics at the University of California, Los Angeles, and author of When Do I Call the Doctor? A child's oddly colored bowel movement can be frightening to a parent, but usually there's a perfectly logical explanation and no cause for alarm. Red stools, for example, can result from something as minor as a tiny burst blood vessel caused by straining or as ridiculous as too much Kool-Aid. ''Sometimes laxatives can give stools a reddish color. So can beets and food dyes in cereal,'' says Dr. Stern. Licorice, iron medication, spinach and Pepto-Bismol can make stools look black, says Dr. Stern. Sandy, gritty stools can be caused by pears. And even bananas can cause unusual looking stools. But Dr. Stern also warns that red stools--or stools with flecks of red--can signify internal bleeding, which is quite serious. So if there's no ready explanation for the color, call the doctor. |
But don't offer milk or milk products. ''A lot of children have trouble digesting milk when they're sick,'' says Marjorie Hogan, M.D., an instructor of pediatrics at the University of Minnesota and a pediatrician at the Hennepin County Medical Center in Minneapolis. ''That's because illness frequently causes superficial damage to the intestines that disrupts normal production of lactase, the enzyme that helps digest the lactose in milk.''
If your baby is on a cow's milk formula, switch over to a soy or hypo-allergenic formula that doesn't contain lactose. You can find these nonmilk formulas in most pharmacies. If your baby is breastfeeding, though, you need to continue breastfeeding ''as much as you can'' to keep up his strength, says Dr. Stern.
Read baby formula labels carefully. If you've been mixing baby formulas incorrectly, you may have inadvertently caused your baby's diarrhea, says Dr. Hogan. Review the labels and make sure your measurements are exact.
Cut back on fruit juice. In babies, especially, too much fruit juice can cause diarrhea or make it worse. Some experts recommend serving only two or three small portions a day, says William B. Ruderman, M.D., Chairman of the Department of Gastroenterology at the Cleveland ClinicFlorida in Fort Lauderdale. For children under one, the serving sizes should be no larger than one-third cup of vitamin C--rich juice ( like orange juice). If your baby wants more, dilute it with water.
Cut back on fruit, too. Children under one who have diarrhea problems should eat no more than ¼ to 1/3 cup of soft fruit at each serving--and no more than three servings a day, says Dr. Ruderman. Be alert, too, for fruit that's in prepared or packaged food--such as figs in Fig Newtons.
Fatten up the diet. There is some evidence that a low-fat diet can promote a certain kind of chronic diarrhea in children, explains Dr. Ruderman. Experts suggest adding margarine to vegetables, and serving fish, poultry and meats that have moderate amounts of fat. In addition, children under the age of two should normally drink whole, rather than low-fat, milk.
Avoid artificial sweeteners. Foods that contain artificial sweeteners such as sorbitol and saccharin may promote diarrhea, according to Dr. Ruderman. Read labels, and avoid food products with these additives whenever possible.
Watch those bottoms. A child with diarrhea may suffer from a painful irritation of the anus. That's because the enzymes that help us digest food are also present in stool, and those enzymes irritate the anal area, says Dr. Stern. '' When you have diarrhea, stools go through very quickly and frequently these enzymes also start to 'digest' the skin.''
If irritation develops, wash the child's bottom with running water and some soap to get the enzymes off. ''Don't just use wipes,'' says Dr. Stern. ''Rinse their bottoms well and dry them off well, too.''
Don't use drugstore remedies . . . unless you call the doctor. Over-the-counter anti-diarrhea products are available for children, but that doesn't mean they're recommended by physicians. In fact, not all pediatricians and family physicians are in agreement over whether they should be used at all. ''My feeling is they should be used only for a day, if there are no other complications,'' says Dr. Stern. ''They just slow the diarrhea down a little bit so the child is more comfortable, but they don't cure anything.'' Before you use any anti-diarrhea medication, Dr. Stern recommends that you consult with your pediatrician.
