Diarrhoea can be acute (sudden onset and lasts less than two weeks) or chronic (persistent). This leaflet deals with acute diarrhoea, which is common in children. In most cases, diarrhoea eases and goes within several days, but sometimes takes longer. The main risk is dehydration. The main treatment is to give your child lots to drink; this may be by giving special rehydration drinks. Also, once any dehydration is treated with drinks, encourage your child to eat as normally as possible. See a doctor if you suspect that your child is dehydrating, or if they have any worrying symptoms such as those which are listed below.
The rest of this leaflet deals only with infectious causes of acute diarrhoea. Click the links to the various other leaflets that give more details about some of the different microbes that cause infectious diarrhoea.
Symptoms can range from a mild stomach upset for a day or two with slight diarrhoea, to severe watery diarrhoea for several days or longer. Diarrhoea means loose or watery stools (faeces), usually at least three times in 24 hours. Blood or mucus can appear in the stools with some infections.
Crampy pains in the abdomen (tummy) are common. Pains may ease each time some diarrhoea is passed. Vomiting, high temperature (fever), aching limbs and headache may also develop.
Diarrhoea often lasts for 3-5 days, sometimes longer. It often continues for a few days after any vomiting stops. Slightly loose stools (loose faeces) may persist for a week or so further before a normal pattern returns. Sometimes the symptoms last longer.
Diarrhoea and vomiting may cause dehydration (a lack of fluid in the body). Seek medical advice quickly if you suspect that your child is becoming dehydrated. Mild dehydration is common and is usually easily and quickly reversed by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to function normally.
Dehydration in children with acute diarrhoea is more likely to occur in:
For most children, diarrhoea will usually be quite mild and will get better within a few days without any treatment other than drinking plenty of fluids. You will often not need to take your child to see a doctor or seek medical advice.
However, in some circumstances, you may need to seek medical advice for your child (see below). If this is the case, the doctor may ask you questions about recent travel abroad, if your child has been in contact with someone with similar symptoms, or if they have recently taken antibiotics, or been admitted to hospital. This is to look for a possible cause of their diarrhoea. They will usually examine your child for signs of dehydration. They may check their temperature and heart rate. They may also examine your child's abdomen to look for any tenderness.
Tests are not usually needed. However, in certain cases, the doctor may ask you to collect a stool sample from your child - for example, if your child is particularly unwell, has bloody stools, is admitted to hospital, if food poisoning is suspected, if your child has recently travelled abroad, or their symptoms are not getting better. The stool sample can then be examined in the laboratory to look for the cause of the infection.
As mentioned already, most children with diarrhoea have mild symptoms which get better in a few days. The important thing is to ensure that they have plenty to drink. In many cases, you do not need to seek medical advice. However, you should seek medical advice in the following situations (or if there are any other symptoms that you are concerned about):
Diarrhoea often settles within a few days or so as a child's immune system is usually able to clear the infection. Children can usually be treated at home. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop.
You should encourage your child to take plenty of fluids. The aim is to prevent dehydration (low body fluid). The fluid lost in their vomit and/or diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks, as these can make diarrhoea worse.
Babies under six months old are at increased risk of dehydration. You should seek medical advice if they develop acute diarrhoea. Breast-feeds or bottle-feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.
Rehydration drinks may be advised by a doctor for children at increased risk of dehydration (see above for who this may be). They are made from sachets available from pharmacies and on prescription. You should be given instructions about how much to give. Rehydration drinks provide a perfect balance of water, salts, and sugar. The small amount of sugar and salt helps the water to be absorbed better from the gut into the body. Do not use home-made salt/sugar drinks as the quantity of salt and sugar has to be exact.
If your child vomits, wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.
Note: if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice urgently.
If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. Your doctor or nurse will advise about how to make up the drinks and about how much to give. The amount can depend on the age and the weight of your child. If you are breast-feeding, you should continue with this during this time. Otherwise, don't give your child any other drinks unless the doctor or nurse has said that this is OK. It is important that your child is rehydrated before they have any solid food.
Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a nasogastric tube. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with intravenous fluids (fluids given directly into a vein).
Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not starve a child with diarrhoea. This used to be advised but is now known to be wrong. So:
Medicines are not normally given to stop diarrhoea to children under 12 years old. They sound attractive remedies, but are unsafe to give to children, due to possible serious complications. However, you can give paracetamol or ibuprofen to ease a high temperature or headache. There is also a medicine which can be given to reduce the amount of fluid that is secreted into the gut. This will make the stool more solid. It is used along with rehydration medicines. It can be used in babies and children from 3 months of age.
If symptoms are severe, or persist for several days or more, a doctor may ask for a sample of the diarrhoea. This is sent to the laboratory to look for infecting germs (bacteria, parasites, etc). Sometimes an antibiotic or other treatments are needed, depending on the cause of the infection.
Complications from infective diarrhoea in children are uncommon in the UK. They are more likely in very young children. They are also more likely if your child has a chronic (ongoing) disease such as diabetes, or if their immune system is weakened in some way. For example, if they are taking long-term steroid medication or they are having chemotherapy treatment for cancer. Possible complications include the following:
Diarrhoeal infections can very easily be passed on from person to person. Therefore, you and your child need to take measures to try to reduce this chance.
If your baby has diarrhoea, be especially careful to wash your hands after changing nappies and before preparing, serving, or eating food. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry your hands properly after washing. For older children, whilst they have diarrhoea, the following are recommended:
The advice given in the previous section is mainly aimed at preventing the spread of infection to other people. But, even when we are not in contact with someone with infectious diarrhoea, proper storage, preparation and cooking of food, and good hygiene help to prevent us catching an infection. In particular, always wash your hands, and teach children to wash theirs:
The simple measure of washing hands regularly and properly is known to make a big difference to the chance of developing gut infections and diarrhoea.
You should also take extra measures when in countries of poor sanitation. For example, avoid water and other drinks that may not be safe, and avoid food washed in unsafe water.
Breast-feeding is also protective. Breast-fed babies are much less likely to develop infectious diarrhoea compared to bottle-fed babies.
As mentioned earlier, rotavirus is the most common cause of infective diarrhoea in children. There is an effective vaccine against rotavirus. In the UK it has now been decided to routinely vaccinate babies against rotavirus. From September 2013 babies will receive drops (by mouth) to prevent rotavirus, along with their other routine vaccinations. These drops will be given at 2 and 3 months old.