Dr. Greene, my baby has been having 4 runny poops each day for the last 5 days (she normally goes once a day). Is this diarrhea? How do you tell diarrhea in a baby? If it is, what should I do?
Bob - Walnut Creek, California
Normal baby stool can look a lot like an adult’s diarrheal stool. Healthy baby poop is often soft and runny, and (especially in the first month) quite frequent. One 2-week-old with 10 runny stools a day may be perfectly healthy, while another 4-month-old with 3 stools a day, all firmer than the other baby’s, may have diarrhea. So how can a parent tell if their child’s stool is normal or considered diarrhea?
Look for a sudden increase in the frequency of the stools. Each baby has her own stool frequency pattern that changes slowly over time. If it changes noticeably within only a few days, she may have diarrhea. Any baby who has more than one stool per feeding should also be suspected of having diarrhea, even if this isn’t a sudden change. Also look for a sudden increase in the water content of the stool. Other signs of illness in your baby, such as poor feeding, a newly congested nose, or a fever, make the diagnosis of diarrhea more likely.
Diarrhea in babies can be caused by a change in diet (including, sometimes, a change in mother’s diet if the baby is breast-fed), infection, antibiotic use, or a number of rare diseases. In resource-rich countries, the most common causes of infant diarrhea are mild allergies and viral infections. In developing countries, unsafe water and inadequate sanitation contribute to the vast majority of diarrheal illnesses in children.
Worldwide, there are about one billion cases of diarrhea in children each year. Fortunately, in most cases (more than 990 million of them), will resolve by itself within a week or so. Still, the Centers for Disease Control and Prevention (CDC) reports that 1 in 9 childhood deaths around the world are due to diarrhea. The vast majority of this diarrhea is caused by unsafe water and inadequate sanitation, and hygiene practices. In the US between 250-350 childhood deaths each year are associated with diarrhea.
The central concern with diarrhea is the possibility of dehydration from loss of body fluids. Treatment is aimed at preventing dehydration, the real culprit. Most children with diarrhea can be treated safely at home.
If your baby is breast-fed, don’t stop. Breastfeeding helps prevent diarrhea (making diarrhea only half as likely); it also speeds recovery and helps prevent hospitalizations. If your baby still seems thirsty after or between nursing sessions, you can supplement with an oral rehydration solution (Pedialyte is the most well-known, but other brands are also effective. Children in my practice seem to prefer the taste of grape-flavored KaoLectrolyte — chilled). Do not try to make your own electrolyte solution at home, as the commercially available solutions are specially formulated to meet your baby’s electrolyte needs.
Anti-diarrheal medications are not recommended for infants or children. Some studies suggest that the addition of probiotics may decrease the length of diarrhea by about 24 hours, but this is still an area of study and not yet universally adopted by pediatricians.
If your baby is formula-fed, you might want to switch to a soy-based formula while the diarrhea lasts. A soy formula containing fiber, such as Isomil DF, can be tried if your baby is at least 6 months old and may potentially be more effective at slowing down the stools (. Do not dilute the formula. As with breast-fed babies, supplementation with an oral rehydration solution can help replenish the fluids and electrolytes that have been lost in the diarrheal stools.
If your baby is already big enough to be taking solid foods, then carrots, rice cereal, bananas, potatoes, and applesauce can help slow down the stools. Avoid fruit juices, peas, pears, peaches, plums, prunes, and apricots until the stools are back to normal, which should be within a week or so.
Sometimes infants may develop diarrhea with the introduction of formula. If this continues more than a few days it is important to consider an intolerance to one of the proteins or perhaps, rarely, to the lactose. (Breast milk contains lactose so babies are very rarely lactose intolerant. That tends to develop after age 2.)
In general, soy formula results in firmer stools, and most kids who don’t tolerate cow’s milk will tolerate soy, though there are some–perhaps 20 percent–who overlap and will keep the loose stools on soy. Most of those kids do well on a hydrolysate formula, such as Nutramigen. Thankfully, most of these intolerances or allergies will get better with age. Kids who can’t take cow’s milk as an infant will usually be able to as they get older. Lactose intolerance is an exception to this–once it sets in, it often continues.
If diarrhea lasts longer than a week or is accompanied by fever, get in touch with your pediatrician. Contact your pediatrician right away, however, if your baby won’t drink or appears to be getting dehydrated (dry mouth, crying without tears, sunken soft spot, lethargic, or going 8 hours without producing urine) or if your baby is under 3 months and has diarrhea with a fever. Vomiting for 24 hours, 8 stools in 8 hours, or the presence of blood, mucus, or pus in the stool should also prompt a call to your pediatrician.
So far we’ve been talking about poop. One final thought —
Don’t forget your baby’s bottom. Stool normally contains some of the enzymes that help us digest our food. When stool travels through the intestines more quickly, not only is there more poop, but the poop contains more of these enzymes, which can then start to “digest” the soft skin of your baby’s bottom. Frequent diaper changes, rinsing the bottom with water, air drying, and protective ointments and creams, such as Desitin, can be a real help. Cut down on baby wipes during diarrhea. When wiping, remember to pat rather than wipe the irritated area.
During diarrhea, most parents are focused on the frequent, runny poops. Most doctors are focused on the possibility of dehydration. From your baby’s point of view, however, the burning irritation of the diaper rash may be the most pressing issue.
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