Diagnosing diarrhea is tricky, because every baby's normal stools vary in how watery they are, but we usually define diarrhea as a sudden onset of frequent bowel movements that are more watery than usual. The main concern with diarrhea in infants and toddlers is the risk of dehydration. Contact your doctor if you see any signs of diarrhea, especially if your baby is under 4 months old, or is showing signs of dehydration (dry mouth, crying without tears, or going eight hours without producing urine).
Common causes of diarrhea are changes in diet, use of antibiotics, and various stomach viruses. Your baby is most susceptible to stomach viruses that cause diarrhea if she has older siblings who may pass them on, or if she's in day care. Since viruses are transmitted from hand to mouth, the best prevention is frequent hand washing.
Birth to 4 months: Diarrhea is most dangerous for babies 4 months old and younger because they can lose a lot of fluid very quickly. If you're breastfeeding, continue to do so; it helps prevent the diarrhea from worsening and aids your baby's recovery. You may need to supplement breast milk with water or Pedialyte to keep your baby well hydrated.
If your baby is on cow's-milk-based formula, ask your doctor about switching to a soy-based formula, which can help slow diarrhea down. You only need to do this until the diarrhea goes away, usually within seven to 10 days. You can also supplement the formula with Pedialyte. But if your baby's diarrhea is not getting any better while she's on formula, your doctor may recommend giving her only clear liquids for at least six but not more than 24 hours before trying formula again -- this lets the bowels rest and facilitates healing. If after up to 24 hours of clear liquids the stools are still very watery, call your pediatrician.
5 months and up: If you have an older baby who takes solid foods, combat her diarrhea with clear liquids, bananas, rice cereal, applesauce, and toast, all of which slow down the stools. This combination of binding foods is known as the BRAT diet. Pedialyte, grape-flavored Kaoletrolyte, or frozen Pedia-Pops will help your baby stay hydrated. Avoid fruit juices, pears, peaches, plums, prunes, and apricots until the stools are back to normal.
Toddlers can sometimes resist eating and drinking when they're sick. They may be more willing to drink ginger ale or eat Jell-O or flavored Pedia-Pops, but you can also try crackers and the BRAT diet. Other helpful foods include chicken broth or soup and plain pasta. Avoid spicy, fatty, and citrus foods, and possibly dairy, until the diarrhea passes.
The most widespread and serious infectious cause of diarrhea is rotavirus. It's an extremely contagious virus and hits children younger than 2 the hardest. The rotavirus high season is December to April. Children attending day care or those with older siblings are at an increased risk.
What differentiates rotavirus from the run-of-the-mill stomach virus is that its onset is more dramatic. The infection starts with a fever, followed by vomiting and irritability. The vomiting goes away in one or two days, followed by watery diarrhea that lasts from three to nine days. The most important thing is to keep your baby hydrated; vomiting and diarrhea can put her at high risk for dehydration. To determine whether your baby has rotavirus, your doctor would have to perform a test on her stool. If it's positive, he'll advise you to be more aggressive about making sure your baby gets plenty of fluids.
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