For severe dehydration, hospitalization is sometimes necessary so that your child can be rehydrated intravenously. In milder cases, all that may be necessary is to give your child an electrolyte replacement solution according to your pediatrician’s directions. The table below indicates the approximate amount of this solution to be used.
*Note: This is the smallest amount of fluid that a normal child requires. Most children drink more than this.
Exclusively breastfed babies are less likely to develop severe diarrhea. If a breastfed infant does develop diarrhea, generally you can continue breastfeeding, giving additional electrolyte solution only if your doctor feels this is necessary. Many breastfed babies can continue to stay hydrated with frequent breastfeeding alone.
Once your child has been on an electrolyte solution for twelve to twenty-four hours and the diarrhea is decreasing, you gradually may expand the diet to include foods such as applesauce, pears, bananas, and flavored gelatin, with a goal of returning to his usual diet over the next few days as he tolerates. In children over age one, milk can be withheld for one to two days until the diarrhea begins improving. In infants on formula, you can mix the formula with twice as much water as usual to make half-strength formula for a few feeds until the diarrhea seems to be improving and then you can mix it as usual. (Add an equal volume of water to your child’s usual full-strength formula.) As the vomiting and diarrhea improve, an older child may be able to eat small quantities of bland foods such as rice, toast, potatoes, and cereal, and should be moved to an age-appropriate diet as soon as possible. You can continue to give the electrolyte replacement solution if your child likes it or they are not taking usual amounts of their regular fluids.
It is usually unnecessary to withhold food for longer than twenty-four hours, as your child will need some normal nutrition to start to regain lost strength. After you have started giving him food again, his stools may remain loose, but that does not necessarily mean that things are not going well. Look for increased activity, better appetite, more frequent urination, and the disappearance of any of the signs of dehydration. When you see these, you will know your child is getting better.
Diarrhea that lasts longer than two weeks (chronic diarrhea) may signify a more serious type of intestinal problem. When diarrhea persists this long, your pediatrician will want to do further tests to determine the cause and to make sure your child is not becoming malnourished. If malnutrition is becoming a problem, the pediatrician may recommend a special diet or special type of formula.
If your child drinks too much fluid, especially too much juice or sweetened beverages as mentioned earlier, a condition commonly referred to as toddler’s diarrhea could develop. This causes ongoing loose stools but shouldn’t affect appetite or growth or cause dehydration. Although toddler’s diarrhea is not a dangerous condition, the pediatrician may suggest that you limit the amounts of juice and sweetened fluids your child drinks (limiting fruit juice is always a good idea). You can give plain water to children whose thirst does not seem to be satisfied by their normal dietary and milk intake.
When diarrhea occurs in combination with other symptoms, it could mean that there is a more serious medical problem. Notify your pediatrician immediately if the diarrhea is accompanied by any of the following:
- Fever that lasts longer than twenty-four to forty-eight hours
- Bloody stools
- Vomiting that lasts more than twelve to twenty-four hours
- Vomited material that is green-colored, blood-tinged, or like coffee grounds in appearance
- A distended (swollen-appearing) abdomen
- Refusal to eat or drink
- Severe abdominal pain
- Rash or jaundice (yellow color of skin and eyes)
If your child has another medical condition or is taking medication routinely, it is best to tell your pediatrician about any diarrheal illness that lasts more than twenty-four hours without improvement, or anything else that really worries you.