Diarrhea has long been a threat to young children, especially in developing countries where access to clean drinking water is lacking and malnutrition runs rampant. According to UNICEF, however, the number of deaths from diarrhea have dropped by over 60% in the last couple decades. Nevertheless, diarrhea continues to be a relatively common problem in children under the age of five even in the United States. If left untreated, severe diarrhea can lead to dehydration and a number of other complications.

How Is Diarrhea Defined?

Diarrhea is a common gastrointestinal condition that is most concerning in kids but also affects older children and adults. Diarrhea is most commonly defined as having three or more loose or watery bowel movements in the course of a day, though the frequency can vary from person to person. In addition to watery stools, people suffering from diarrhea may also experience other symptoms like abdominal pain, cramping, bloating, or nausea. For most kids, diarrhea is a temporary issue that resolves on its own, but it can also lead to other problems:

  • Dehydration: One of the biggest risks of diarrhea is the excessive fluid loss that occurs during the passage of loose stools. Dehydration is particularly dangerous in infants, young children, older adults, and anyone with a weakened immune system. Signs of severe dehydration include excessive thirst, dry mouth, decreased urine output, dark-colored urine, fatigue, dizziness, and confusion.
  • Electrolyte imbalance: Along with dehydration, diarrhea can also disrupt the balance of electrolytes (such as sodium, potassium, and chloride) in the body, leading to an electrolyte imbalance. Electrolytes are essential for various bodily functions, including nerve function, muscle contraction, and fluid homeostasis, and an imbalance can cause muscle weakness, irregular heartbeats, seizures, and other complications.
  • Malnutrition: Severe or chronic diarrhea can also impair the absorption of nutrients from food in the intestines. This can in turn lead to malnutrition, which causes deficiencies of essential vitamins, minerals, and macronutrients. Malnutrition is a potentially life-threatening condition in children that can also stunt growth or cause weight loss.

In pediatric cases, it can sometimes be difficult to determine if the child has diarrhea; this is particularly true for infants that are breastfeeding. It is considered normal for breast milk to result in 6 or more relatively loose stools in a day, but a rapid increase in the number and looseness can indicate diarrhea. Additional signs that an infant has diarrhea include bloody stools, the presence of mucus in stool, or high fever.

What Causes Diarrhea in Children?

As with adults, there are a wide variety of factors that can directly lead to or contribute to the development of diarrhea in children. Most of these factors can affect either adults or children, but some are either unique to children or affect children in a way that makes it more dangerous. Below are some common causes of diarrhea in children:

  • Infections: Viral infections, bacterial infections, and parasitic infections are the most common causes of diarrhea. When such pathogens infect the digestive tract, they trigger an immune response and changes to the balance of fluids in the intestines that increase bowel motility. Rotavirus and norovirus are common viral culprits, while bacteria such as Escherichia coli (E. coli) and Salmonella, as well as parasites like Giardia and Cryptosporidium, can also lead to diarrhea.
  • Food poisoning: While an infection can come from many sources, food poisoning refers to the toxins released by foodborne pathogens. In food poisoning, it is possible to develop an infection, but it can also cause only temporary diarrhea until the body rids itself of the pathogens.
  • Food intolerance: Food intolerance (or food allergies) essentially means having an adverse reaction to certain foods or food components. One common example is lactose intolerance, which results from a deficiency in lactase, the enzyme that breaks down lactose. Another example is celiac disease, an autoimmune disease that involves having allergic reactions to gluten.
  • Diet: Even apart from foodborne illness, there are certain foods and drinks that are known to be more irritating to the digestive tract, especially in children. Examples include excessive consumption of sugary or fatty foods, artificial sweeteners (such as sorbitol), spicy foods, or dairy products (in children with lactose intolerance).
  • Medication: Some medications can disrupt the balance of bacteria in the gut microbiome in a way that can cause gastrointestinal symptoms like diarrhea, constipation, or stomach pain. Antibiotics are probably most associated with this effect, but some laxatives or magnesium-containing antacids can also cause diarrhea.
  • Gastrointestinal conditions: There are also a number of digestive diseases and disorders that typically include diarrhea as a symptom. Examples include gastroenteritis, inflammatory bowel disease (principally ulcerative colitis and Crohn’s disease), and irritable bowel syndrome.

    Diarrhea Treatment and Prevention

    For both children and adults, treatment is dependent on the cause and any underlying medical conditions. Mild diarrhea usually goes away on its own, but more persistent forms may require intervention from a healthcare provider. These are the main methods for treating diarrhea in children.

      • Fluid replacement: For children with persistent diarrhea, the biggest risk is becoming dehydrated. Because of this, fluid replacement is the first step in treatment. This involves getting the child to drink fluids like water, diluted fruit juice, or sports drinks. In more severe cases, oral rehydration solutions like Pedialyte can help hydrate and resolve an electrolyte imbalance.
      • Diet change: In addition to making sure the child doesn’t consume any foods they have an allergy to, avoid spicy, fatty, or dairy-rich foods that may exacerbate diarrhea or irritate the digestive tract. Foods with probiotics may also help.
      • Medication: Over-the-counter anti-diarrheal medications such as loperamide (Imodium) may be used in older children under the guidance of a healthcare provider. However, these medications are not recommended for infants and young children without medical supervision.

      Even though there are numerous treatments for diarrhea, many parents would ideally like to prevent it in the first place. One of the easiest ways to greatly reduce the chances of a foodborne illness is to encourage regular hand washing with soap and water, especially before eating, after using the toilet, and after playing outdoors. Another way to help is through vaccinations; a rotavirus vaccination, for instance, can head off a pathogen before it can develop into an infection. Also, it’s overall important to practice safe food preparation and storage practices so that bacteria and other pathogens can’t grow.

      About Cary Gastro

      Diarrhea is one of the most common gastrointestinal problems, and it will likely happen to everyone at some point. In children, though, it can become a potentially life-threatening problem if left untreated. Understanding the causes and treatment may allow you to more quickly head off a future bout with diarrhea. At Cary Gastro, our passionate team is dedicated to outstanding digestive health care, from providing recommendations and treatment tips, to evaluation during in-office visits, to procedures, including colonoscopies.