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C difficile in Children: What Parents Need to Know

By: Robert W. Frenck Jr., MD, FAAP

Clostridioides difficile—sometimes called C difficile or "C diff" for short—is a type of bacteria that up to 5% of people have in their digestive system. About half of healthy babies under age 1 year have C diff in their stool without any symptoms. However, sometimes C diff bacteria produce a toxin (poison) that causes diarrhea, stomach cramps and colitis (gut inflammation).

It is not clear why so many children have the bacteria but do not become sick. However, it may be related to the balance of other bacteria living in the gut.

Read on to learn how the bacteria spreads, symptoms of and risk factors for C diff infection and how it may be treated.

How do children get C difficile?

The bacteria spread through the poop of an infected person. This can happen when a child touches an object or surface with the bacteria on it and then puts their fingers into their mouth, for example.

C difficile was called Clostridium difficile when it was discovered in 1935. Researchers are still learning more about C difficile in infants and young children.

We do know that C diff is associated with recent antibiotic use. When antibiotics kill "bad" bacteria, they also kill "good" bacteria. Some of the healthy bacteria that get killed are those that help keep C diff bacteria from causing an infection.

Because of this risk, children should only take antibiotics when needed to get rid of a bacterial infection. It's estimated that at least half of all antibiotics prescribed for children at medical and dental visits are not necessary.

What are symptoms of C difficile?

A child with mild C. diff illness may have diarrhea, a mild stomachache and low fever. More severe symptoms include a high fever, stomach cramps, bloating and sometimes blood in the stool or bloody diarrhea.

Just finding C diff in the stool is not enough to say that the bacteria are the cause of a child's diarrhea. When diarrhea does not go away, your child's stool can be tested for toxins produced by C difficile.

A child with C difficile should be taken off their antibiotic. In mild cases, children often get better once they stop taking the antibiotics. If your child does not get better, they may need to be given a different antibiotic than the one that caused the infection, such as metronidazole or vancomycin.

Despite antibiotic treatment for C diff, about 2 to 3 out of 10 people continue to have symptoms. They may need two or more courses of antibiotics.

If a child has a stubborn infection that keeps coming back, a treatment called fecal microbiota transplantation, or FMT, may be recommended. For FMT, a product that is prepared from stool from a healthy donor is given to the person to help replace "good" bacteria in their gut.

How long should my child stay home from child care or school if they have C diff?

People can carryC diff in their body or on their skin and spread it to others. Keep your child out of child care until their symptoms get better. Children with C difficile diarrhea may return to child care when:

  • Stools can be contained in the diaper well, or potty-trained children do not have toileting accidents.

  • The stool frequency is no more than 2 stools above that child's normal frequency.

  • Children do not need another stool test to see if the infection is gone. C diff can remain in the stool for weeks after symptoms have resolved.

How to prevent C diff infection

To avoid spreading germs to others, handle dirty diapers and other waste matter with care. Always wash your hands with soap and water to remove C diff bacteria. Hand sanitizer does not get rid of the germs.

Recent antibiotic use may raise your child's risk of C difficile infection. If your child has an ear infection, for example, your pediatrician may take a wait-and-see approach and only prescribe antibiotics when absolutely necessary. Talk with your pediatrician if you have questions about keeping your child healthy.

More information

About Dr. Frenck

Robert W. Frenck Jr, MD, FAAP, is board-certified in general pediatrics and pediatric infectious diseases. He practices at Cincinnati Children's Hospital Medical Center and is a Professor in the Department of Pediatrics at the University of Cincinnati School of Medicine in Cincinnati, Ohio. Within the American Academy of Pediatrics, Dr. Frenck is a member of both the Section on Uniformed Services (SOUS) and the Section on Infectious Diseases (SOID).

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American Academy of Pediatrics (Copyright @ 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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