Baby and Toddler Diarrhoea – Causes and Treatment

Diarrhoea, or “runny tummy”/”running stomach”, is frequent liquid stools or loose bowel movements which is one of the most common illnesses that affects all age groups. In most cases it resolves on its own without leading to any complications. However, in babies, toddlers and children, a parent has to be especially careful and guard against dehydration. This can rapidly set in with dangerous consequences and may even become life-threatening. In babies, sometimes the stool can be so liquid that it can be mistaken for urine.

Symptoms of Diarrhoea in Children

It can be difficult to diagnose diarrhoea in newborn babies since they may normally pass soft or loose stools, especially breastfed babies. However, an attentive mother can usually identify when the baby’s motions are more frequent or the consistency is more watery. In addition, if the number of bowel movements is more than one per feeding, it may be diarrhoea. Sometimes diarrhoea in babies or toddlers may be as a result of other conditions like teething, ear infections (otitis media), tonsillitis or sinusitis.

The most common symptoms of diarrhoea in children are :

• Loose frequent stools.
• Abdominal cramps or pain.
• Fever.
• Nausea and vomiting.
• Loss of appetite.
• Signs of dehydration.

Cow’s milk can sometimes cause green stools which may be harmless. Toddlers’ “pea and carrot” diarrhoea due to intestinal hurry usually resolves by 4 years.

Signs of Dehydration

• Dry, sunken eyes.
• Crying with no tears.
• Dry mouth.
• Dry skin with loss of turgor (tenting of the skin when pinched up).
• Irritability.
• Lethargic or drowsy.
• Reduced or no urination within an 8 hour period – less wet diapers.
• Sunken fontanelle (soft spot on the head) in infants.
• Sunken abdomen.
• Loss of consciousness.

Causes of Diarrhoea in Children

Diarrhoea Infections

Infections in children that results in diarrhoea are commonly spread through contaminated food and water, dirty hands, pets or direct contact with stool (from dirty diapers or toilet). An outbreak within a school or nursery is often viral in origin.

Viral infection

In most infants, diarrhoea is caused by rotavirus. Epidemics in schools are most frequently caused by norovirus. An adenovirus can cause diarrhoea in all age groups. Usually there is fever, chills, vomiting or abdominal pain accompanying the diarrhoea. It is often referred to as the tummy bug or gastric flu.

Bacterial infection

Severe diarrhoea, with blood in the stool, abdominal cramps and fever may be the features of a bacterial infection. It could be caused by bacteria such as Campylobacter, Salmonella, Shigella or E.coli. Food poisoning and cholera are two bacterial causes of diarrhoea, which may occur if contaminated food or water is consumed.

Parasitic infection

Parasites such as Giardia lamblia can cause giardiasis, which produces diarrhoea with greasy stools, gas and abdominal distention.

Other Causes of Diarrhoea in Children

• Diarrhoea could occur due to a change in the baby’s or mother’s diet (in breastfed babies).
• Use of antibiotics.
• Too much fruit juice.
• Baby formula – if not prepared properly.
• Food allergy – most frequently to milk protein.
• Food intolerance – usually lactose intolerance.
• Coeliac disease (sprue).
• Inflammatory bowel disease.
• Children often put things in their mouths or swallow carelessly kept medicines. These can cause vomiting, diarrhoea, breathing difficulty, convulsions or unconsciousness and may need immediate medical attention.

Treatment of Diarrhoea in Children

• Diarrhoea in babies and children needs quick attention to prevent dehydration. Fluids with electrolytes should be administered continuously. Plain water is not enough for rehydration. Paediatric oral rehydration solutions (ORS) may need to be given orally.
• Breastfeeding can be continued safely in most cases.
• A bland diet is necessary to gradually introduce solid foods to the child. Refer to the Diarrhoea Diet.
• Small babies will need frequent diaper changing and diaper creams to reduce the skin irritation caused by loose stools.
• If the child refuses to eat, it is generally not a cause for worry as long as  they are drinking fluids and there is no sign of dehydration.
• Antidiarrhoeal medicines are generally not given to children.
• Antibiotics are usually not necessary unless the diarrhoea is due to a bacterial infection and the condition is not improving.
• In severe cases, the child may need to be hospitalized and intravenous fluids given.