Diarrhea in Children – By Dr. Medhat Abu Shaaban Pediatrician in Dubai
Diarrhea is one of the most common childhood illnesses, affecting children of all ages and causing significant concern for parents. While most cases of diarrhea in children are mild and resolve on their own, understanding the condition—its causes, symptoms, treatment, and warning signs—empowers parents to provide appropriate care and know when to seek medical attention. At myPediaClinic in Dubai, Dr. Medhat Abu Shaaban provides expert pediatric care for children with gastrointestinal issues, including diarrhea. This comprehensive guide covers everything parents need to know about managing diarrhea in children, from identifying the cause to preventing dehydration and knowing when professional medical care is needed.
Understanding Diarrhea in Children
Before diving into treatment and prevention, it is essential to understand what diarrhea is, what causes it, and how it differs from normal bowel patterns in children.
What Is Diarrhea?
Diarrhea is defined as an increase in the frequency and decrease in the consistency of bowel movements. While normal stool frequency varies widely among children—from several times a day to once every few days—diarrhea typically involves three or more loose or watery stools in a 24-hour period. The stools may be larger in volume than normal and may contain mucus or undigested food particles.
It is important to note that normal stool consistency varies by age. Breastfed infants often have soft, seedy, yellow stools multiple times per day—this is normal, not diarrhea. Formula-fed infants typically have firmer, darker stools less frequently. As children grow and eat solid foods, stools become more formed and follow more regular patterns.
True diarrhea represents a change from the child’s normal pattern, with stools becoming more frequent, looser, or more watery than usual.
Types of Diarrhea
Diarrhea can be classified in several ways:
By Duration: Acute diarrhea lasts less than two weeks and is usually caused by infections. Most cases of childhood diarrhea fall into this category. Persistent diarrhea lasts between two and four weeks. Chronic diarrhea lasts more than four weeks and may indicate an underlying condition requiring investigation.
By Cause: Infectious diarrhea is caused by viruses, bacteria, or parasites. Non-infectious diarrhea may result from food intolerances, medications, or underlying medical conditions.
By Characteristics: Watery diarrhea involves frequent, liquid stools. Bloody diarrhea (dysentery) contains blood or mucus and often indicates bacterial infection. Fatty diarrhea (steatorrhea) involves greasy, foul-smelling stools that may float, indicating fat malabsorption.
Common Causes of Diarrhea in Children
Understanding the potential causes of diarrhea helps guide appropriate management:
Viral Infections: Viruses are the most common cause of acute diarrhea in children. Rotavirus was historically the leading cause but has decreased significantly since the introduction of the rotavirus vaccine. Norovirus is now the most common cause of gastroenteritis in children, highly contagious and often causing outbreaks in schools and childcare centers. Adenovirus, astrovirus, and other enteric viruses also commonly cause diarrheal illness.
Bacterial Infections: While less common than viral infections, bacterial causes can lead to more severe illness. Salmonella can be contracted from contaminated food, especially poultry and eggs. Campylobacter is often associated with undercooked poultry. E. coli, while some strains are harmless, others cause significant illness. Shigella spreads easily in childcare settings and causes dysentery.
Parasitic Infections: Giardia is a common parasitic cause, particularly in travelers and in areas with contaminated water. Cryptosporidium is another waterborne parasite that can cause prolonged diarrhea.
Food-Related Causes: Food poisoning occurs from toxins produced by bacteria in contaminated food. Food intolerances such as lactose intolerance cause diarrhea when specific foods are consumed. Excessive juice or sugar intake can cause osmotic diarrhea, sometimes called “toddler’s diarrhea.”
Medication-Related: Antibiotics commonly cause diarrhea by disrupting the normal gut bacteria. Other medications may also have diarrhea as a side effect.
Other Causes: Inflammatory bowel disease, celiac disease, irritable bowel syndrome, and other conditions can cause chronic or recurrent diarrhea. These conditions require evaluation by a pediatrician or specialist.
Recognizing Symptoms and Warning Signs
Knowing what to watch for helps parents assess the severity of their child’s illness and determine when to seek medical care.
Typical Symptoms Accompanying Diarrhea
Diarrhea often occurs alongside other symptoms, particularly when caused by infection:
Abdominal cramps or pain are common, often coming in waves before a bowel movement. Nausea and vomiting may precede or accompany diarrhea, particularly in viral gastroenteritis. Fever indicates the body is fighting an infection. Loss of appetite is common as the digestive system is upset. Fatigue and irritability result from the illness itself and from disrupted sleep.
Signs of Dehydration
The most significant concern with childhood diarrhea is dehydration, which occurs when fluid loss exceeds fluid intake. Children, especially infants and toddlers, are particularly vulnerable because of their smaller body size and higher metabolic rate.
Mild Dehydration Signs: Increased thirst, slightly dry mouth and lips, slightly decreased urine output (fewer wet diapers), and mild fatigue.
Moderate Dehydration Signs: Very dry mouth and lips, significantly decreased urination (fewer than 4-6 wet diapers in 24 hours for infants), no tears when crying, sunken soft spot (fontanelle) in infants, mild sunken eyes, and decreased activity level.
Severe Dehydration Signs (Medical Emergency): Extreme thirst or inability to drink, very dry mouth and lips, no urine output for 8 or more hours, very sunken eyes, sunken fontanelle in infants, cool and blotchy hands and feet, rapid heartbeat, rapid breathing, lethargy or unusual drowsiness, and loss of consciousness.
Severe dehydration is a medical emergency. If your child shows signs of severe dehydration, seek immediate medical care at myPediaClinic or the nearest emergency facility.
Warning Signs Requiring Immediate Medical Attention
While most childhood diarrhea can be managed at home, certain warning signs indicate the need for prompt medical evaluation:
Blood in the stool, which may appear red or black, could indicate bacterial infection or other serious conditions. High fever above 102°F (39°C) in children over 3 months, or any fever in infants under 3 months, requires evaluation. Severe or persistent abdominal pain that does not improve after passing stool needs attention. Signs of moderate to severe dehydration as described above are serious. Diarrhea lasting more than a few days without improvement should be evaluated. Vomiting that prevents keeping down any fluids requires medical care. Bile-green vomiting can indicate intestinal obstruction. Infants under 6 months with diarrhea should be seen promptly as they dehydrate more quickly. Any child who appears very ill or whose condition concerns you should be evaluated.
Treatment of Diarrhea at Home
Most cases of acute diarrhea in children can be managed at home with appropriate care. The primary goals are preventing and treating dehydration, maintaining nutrition, and providing comfort while the illness runs its course.
Fluid Replacement: The Foundation of Treatment
Replacing lost fluids is the single most important aspect of diarrhea treatment. The type and amount of fluid depends on the child’s age and the severity of fluid loss:
Oral Rehydration Solutions (ORS): Oral rehydration solutions are specially formulated to replace both fluids and electrolytes (sodium, potassium, chloride) lost in diarrhea. They are available at pharmacies under various brand names and are the gold standard for treating mild to moderate dehydration from diarrhea.
ORS should be offered in small, frequent amounts rather than large quantities at once, which may be vomited. For young children, offer a teaspoon or tablespoon every few minutes. Older children can take small sips frequently. If vomiting occurs, wait 10-15 minutes and try again with smaller amounts.
For Breastfed Infants: Continue breastfeeding frequently. Breast milk is an excellent fluid for rehydration and contains antibodies that help fight infection. Offer the breast more often than usual to replace lost fluids.
For Formula-Fed Infants: Continue regular formula unless advised otherwise by your pediatrician. Do not dilute formula. ORS can be offered between feedings for additional hydration.
For Older Children: In addition to ORS, offer water, clear broths, or diluted juices. Avoid sugary drinks, full-strength juice, and sodas, which can worsen diarrhea due to their high sugar content.
Fluids to Avoid: Avoid sports drinks, which are formulated for exercise-related fluid loss and do not have the correct balance of electrolytes for diarrhea. Avoid sugary drinks, full-strength fruit juice, and caffeinated beverages, which can draw more water into the intestines and worsen diarrhea.
Dietary Management
Previous recommendations to restrict food during diarrhea have been revised. Current guidelines emphasize continuing nutrition while replacing fluids:
Continue Regular Diet: Once rehydration is underway, children should resume their regular diet as tolerated. There is no need to restrict food to clear liquids or follow a rigid BRAT (bananas, rice, applesauce, toast) diet, though these foods may be well-tolerated and can be included.
Foods That May Help: Complex carbohydrates like rice, bread, cereals, and crackers are usually well-tolerated. Lean proteins such as chicken, fish, or eggs provide nutrition. Cooked vegetables and fruits are easier to digest. Yogurt with live cultures may help restore beneficial gut bacteria.
Foods to Limit or Avoid: High-sugar foods and drinks can worsen diarrhea. High-fat foods may be harder to digest. Spicy or heavily seasoned foods may irritate the digestive tract. In some children, dairy products may worsen symptoms temporarily due to transient lactose intolerance, though continuing dairy is usually fine if tolerated.
Do Not Force Food: Loss of appetite is common during illness. Offer small, frequent meals rather than large portions. Focus on fluids first, then gradually reintroduce foods as appetite returns.
Managing Symptoms
Fever and Discomfort: If your child has fever or discomfort, acetaminophen (paracetamol) or ibuprofen can help. Follow age-appropriate dosing guidelines and consult your pediatrician if you are unsure.
Diaper Rash Prevention: Frequent loose stools can irritate the skin, leading to painful diaper rash. Change diapers frequently, clean the area gently with warm water rather than wipes during acute illness, and apply a barrier cream or ointment with each diaper change.
Rest: Encourage rest, though children may naturally be less active when ill. Do not force bed rest if the child feels well enough to play quietly.
Medications: What to Use and What to Avoid
Anti-Diarrheal Medications: Over-the-counter anti-diarrheal medications such as loperamide (Imodium) are generally NOT recommended for young children. These medications can have serious side effects in children and may prolong certain infections by preventing the body from eliminating the pathogen. Do not give these medications to children without specific guidance from a pediatrician.
Probiotics: Some evidence suggests that certain probiotic strains may help reduce the duration and severity of infectious diarrhea. Probiotics are generally safe and may be worth considering. Ask Dr. Medhat Abu Shaaban at myPediaClinic for recommendations on appropriate probiotic products.
Zinc Supplements: The World Health Organization recommends zinc supplementation for children with diarrhea in developing countries, where zinc deficiency is common. In well-nourished populations, the benefit is less clear, but zinc supplementation is safe and may help reduce diarrhea duration.
Antibiotics: Antibiotics are NOT appropriate for most cases of childhood diarrhea, which are caused by viruses that do not respond to antibiotics. In fact, antibiotics can worsen diarrhea by disrupting beneficial gut bacteria. Antibiotics may be prescribed for specific bacterial infections, but only after evaluation by a healthcare provider.
When to See a Doctor
While most childhood diarrhea can be managed at home, there are situations when professional medical evaluation is necessary.
Infants Under 6 Months
Young infants dehydrate quickly and are more vulnerable to serious illness. Any infant under 6 months with diarrhea should be evaluated by a pediatrician promptly. Do not wait to see if the condition improves on its own.
Signs of Dehydration
If your child shows signs of moderate dehydration despite your best efforts at fluid replacement, seek medical care. Signs of severe dehydration require immediate emergency care.
Blood in the Stool
Blood in the stool (which may appear red, maroon, or black and tarry) can indicate bacterial infection, inflammatory bowel disease, or other conditions requiring evaluation. Contact your pediatrician if you notice blood in your child’s stool.
High Fever
Fever above 102°F (39°C) accompanying diarrhea, especially if it persists more than a day or two, warrants medical evaluation. Any fever in an infant under 3 months is a medical emergency.
Severe or Persistent Symptoms
Seek medical care if your child has severe abdominal pain, especially if constant rather than crampy, persistent vomiting that prevents keeping down fluids, diarrhea that does not improve after several days, diarrhea that worsens or returns after seeming to improve, or any symptom that concerns you as a parent.
Specific Circumstances
Contact your pediatrician if your child has underlying health conditions that may be affected by diarrhea, if diarrhea occurred after travel to areas with high rates of infectious disease, if multiple family members are ill (which may indicate a common source), or if your child attends daycare or school and you need guidance on when they can return.
What to Expect at the Doctor’s Visit
When you bring your child to myPediaClinic for evaluation of diarrhea, Dr. Medhat Abu Shaaban will take a detailed history including duration and frequency of diarrhea, stool characteristics, associated symptoms such as fever, vomiting, and pain, fluid intake and urine output, dietary history and recent foods, recent travel or sick contacts, and any medications the child is taking.
A physical examination will assess hydration status, look for signs of specific causes, and evaluate overall condition. Depending on the findings, tests may be ordered, including stool tests to identify bacteria, viruses, or parasites, blood tests if dehydration or other concerns exist, and additional tests if chronic diarrhea or underlying conditions are suspected.
Treatment will depend on the cause and severity of illness and may include oral or intravenous rehydration, specific medications for certain infections, dietary recommendations, and guidance on home care and follow-up.
Preventing Diarrhea in Children
Many cases of childhood diarrhea can be prevented through appropriate hygiene practices, safe food handling, and vaccination.
Hand Hygiene
Proper handwashing is the single most effective way to prevent the spread of infectious diarrhea. Teach children to wash hands thoroughly with soap and water for at least 20 seconds after using the bathroom, before eating, after touching animals, and after playing outside. Adults should wash hands before preparing food, after changing diapers, and after contact with anyone who is ill.
Safe Food Handling
Prevent food-borne illness by cooking foods to appropriate temperatures, especially poultry, meat, and eggs. Wash fruits and vegetables thoroughly before eating. Keep raw meats separate from other foods during storage and preparation. Refrigerate perishable foods promptly. Do not consume foods past their expiration dates. Use clean water and ice.
Safe Water Practices
When traveling to areas where water safety is uncertain, drink only bottled or purified water. Avoid ice cubes made from tap water. Use bottled or purified water for brushing teeth. Be cautious with fresh salads and raw foods that may have been washed in contaminated water.
Vaccination
The rotavirus vaccine has dramatically reduced the incidence of severe rotavirus gastroenteritis. This oral vaccine is given in infancy as part of the routine immunization schedule. Ensure your child receives all recommended vaccines on schedule. Discuss vaccination at your visits to myPediaClinic.
Avoiding Spread in the Household
When a family member has infectious diarrhea, take steps to prevent spread to others. The ill person should wash hands frequently and thoroughly. Clean and disinfect frequently touched surfaces, including doorknobs, faucets, and toilet handles. Do not share towels, washcloths, or eating utensils. Wash soiled clothing and bedding in hot water. Keep the ill person home from school or daycare until they have been symptom-free for at least 24-48 hours or as advised by your healthcare provider.
Breastfeeding
Breastfeeding provides significant protection against infectious diarrhea in infants. Breast milk contains antibodies and other immune factors that help protect against infections. Exclusive breastfeeding for the first 6 months, followed by continued breastfeeding with complementary foods, is recommended by health authorities worldwide.
Special Considerations
Certain situations require additional attention when managing childhood diarrhea.
Antibiotic-Associated Diarrhea
Diarrhea is a common side effect of antibiotic use, occurring because antibiotics disrupt the normal balance of beneficial bacteria in the gut. This type of diarrhea is usually mild and resolves after the antibiotic course is completed.
To manage antibiotic-associated diarrhea, continue the prescribed antibiotic unless instructed otherwise by your doctor—stopping early can lead to antibiotic resistance. Consider giving probiotics, which may help restore beneficial bacteria. Ensure adequate fluid intake. Contact your pediatrician if diarrhea is severe or accompanied by fever, as this could indicate Clostridioides difficile (C. diff) infection, which requires specific treatment.
Chronic and Recurrent Diarrhea
If your child has persistent diarrhea lasting more than two weeks, or experiences recurrent episodes of diarrhea, further evaluation is needed to identify underlying causes. Possibilities include lactose intolerance, celiac disease, inflammatory bowel disease, food allergies or intolerances, irritable bowel syndrome, and chronic infections such as giardia.
Dr. Medhat Abu Shaaban at myPediaClinic can coordinate appropriate testing and management, or refer to a pediatric gastroenterologist if specialized evaluation is needed.
Toddler’s Diarrhea
Toddler’s diarrhea (functional diarrhea) is a common condition in children ages 1 to 5 years characterized by several loose stools per day, often containing undigested food particles, but with normal growth and no other symptoms. It is not caused by infection or disease.
Contributing factors may include excessive juice or fluid intake, inadequate fat in the diet, or fast intestinal transit time. Management includes limiting juice intake to 4-6 ounces per day, ensuring adequate fat in the diet, and continuing regular meals. This condition typically resolves on its own as the child grows older.
Diarrhea in Children with Special Health Needs
Children with chronic health conditions may need special consideration when they develop diarrhea. Conditions such as diabetes, kidney disease, heart conditions, and immune deficiencies can complicate the management of diarrhea and dehydration. If your child has a chronic health condition and develops diarrhea, contact your pediatrician promptly for guidance.
Frequently Asked Questions About Childhood Diarrhea
How long does diarrhea usually last in children?
Most cases of acute diarrhea in children last between 3 and 7 days. Viral gastroenteritis, the most common cause, typically resolves within a week. However, some children may have loose stools for a week or two after the acute illness resolves. Diarrhea lasting more than two weeks is considered persistent and should be evaluated by a pediatrician. If your child’s diarrhea is not improving after several days, is worsening, or is accompanied by concerning symptoms like blood in the stool, high fever, or signs of dehydration, contact myPediaClinic for evaluation by Dr. Medhat Abu Shaaban.
Should I give my child anti-diarrheal medication?
Over-the-counter anti-diarrheal medications like loperamide (Imodium) are generally NOT recommended for young children. These medications can have serious side effects in children and may actually prolong certain infections by preventing the body from eliminating the pathogen causing the illness. Instead of anti-diarrheal medications, focus on keeping your child hydrated with oral rehydration solutions and continuing their regular diet as tolerated. If you feel your child needs medication, consult Dr. Medhat Abu Shaaban at myPediaClinic before giving any anti-diarrheal products. In certain specific situations, a pediatrician may recommend these medications, but they should only be used under medical supervision.
What should my child eat when they have diarrhea?
Current recommendations emphasize continuing a normal, age-appropriate diet during diarrhea rather than restricting food. Once rehydration is underway, offer your child their regular foods. There is no need to limit intake to the BRAT diet (bananas, rice, applesauce, toast), though these foods are well-tolerated and can be included. Good food choices include complex carbohydrates like rice, bread, and crackers, lean proteins like chicken or fish, cooked vegetables, and yogurt with live cultures. Avoid high-sugar foods and drinks, which can worsen diarrhea. Do not force food if your child has no appetite—focus on fluids first, and offer small, frequent meals as appetite returns. Breastfeeding should continue for infants, and formula-fed babies should continue their regular formula.
When should I take my child to the doctor for diarrhea?
While most childhood diarrhea can be managed at home, you should seek medical care at myPediaClinic if your child is under 6 months old, shows signs of dehydration such as decreased urination, dry mouth, no tears, or lethargy, has blood in their stool, has a fever over 102°F (39°C), has severe or persistent abdominal pain, has vomiting that prevents keeping fluids down, has diarrhea lasting more than several days without improvement, has diarrhea that worsens or returns after improvement, or appears very ill or you are concerned. Trust your parental instincts—if something seems wrong, it is always appropriate to seek medical evaluation. Dr. Medhat Abu Shaaban is available to assess your child and provide appropriate treatment.
How do I prevent dehydration in my child with diarrhea?
Preventing dehydration is the most important aspect of managing childhood diarrhea. Offer oral rehydration solution (ORS), available at pharmacies, in small, frequent amounts—a teaspoon or tablespoon every few minutes for young children. Continue breastfeeding if your infant is breastfed, offering the breast more frequently. For formula-fed infants, continue regular formula and offer ORS between feedings. Older children can have ORS, water, clear broths, or diluted juices. Avoid sugary drinks, full-strength juice, and sodas, which can worsen diarrhea. Monitor for signs of dehydration including decreased urination, dry mouth, absence of tears, and unusual tiredness. If your child shows these signs or cannot keep fluids down due to vomiting, seek medical care promptly.
Is diarrhea in children contagious?
Most cases of infectious diarrhea in children are highly contagious. Viral gastroenteritis, the most common cause of childhood diarrhea, spreads easily from person to person through contact with stool or vomit, contaminated hands, surfaces, food, or water. Children can spread the infection before symptoms appear and for days to weeks after symptoms resolve. To prevent spread, ensure thorough handwashing after using the toilet and before eating, clean and disinfect contaminated surfaces, wash soiled laundry in hot water, avoid sharing towels or utensils, and keep ill children home from school or daycare until they have been symptom-free for 24-48 hours or as recommended by your healthcare provider. The rotavirus vaccine helps prevent one of the most contagious forms of viral gastroenteritis.
Should I continue giving my child milk when they have diarrhea?
In most cases, you can continue giving milk and dairy products to children with diarrhea. The old recommendation to avoid dairy has been revised based on research showing that most children tolerate it well. Breast milk should definitely be continued, and formula-fed babies should continue their regular formula without dilution. For older children, if they tolerate milk without worsening symptoms, it can be continued. However, some children may develop temporary lactose intolerance after a bout of gastroenteritis, in which case dairy may worsen symptoms. If you notice that milk seems to worsen your child’s diarrhea, try reducing or temporarily eliminating dairy and see if symptoms improve. Yogurt with live cultures is often well-tolerated and may help restore beneficial gut bacteria. Discuss any dietary concerns with Dr. Medhat Abu Shaaban at myPediaClinic.
What causes chronic diarrhea in children?
Chronic diarrhea, lasting more than four weeks, can have various causes that require medical evaluation. Common causes include lactose intolerance, where the body cannot properly digest the sugar in milk. Celiac disease, an autoimmune reaction to gluten, causes intestinal damage and diarrhea. Inflammatory bowel diseases like Crohn’s disease or ulcerative colitis can cause chronic diarrhea, often with blood. Food allergies or intolerances may cause ongoing digestive symptoms. Irritable bowel syndrome can cause alternating diarrhea and constipation. Chronic infections, particularly parasitic infections like giardia, can persist if untreated. Toddler’s diarrhea (functional diarrhea) causes loose stools in otherwise healthy young children. If your child has persistent or recurrent diarrhea, schedule an evaluation with Dr. Medhat Abu Shaaban at myPediaClinic to identify the cause and appropriate treatment.
Expert Care for Your Child at myPediaClinic
Diarrhea in children, while common, can be concerning for parents. Understanding how to manage the condition at home, recognizing warning signs, and knowing when to seek professional care empowers you to keep your child safe and comfortable. At myPediaClinic in Dubai, Dr. Medhat Abu Shaaban and our caring team are here to support you through childhood illnesses and provide expert guidance on all aspects of your child’s health.
Whether your child has a routine case of viral gastroenteritis that needs home care guidance, a more serious case requiring medical intervention, or chronic symptoms that need investigation, we are here to help. Our patient-centered approach means we take time to listen to your concerns, thoroughly evaluate your child, and provide clear explanations and treatment plans.
Do not hesitate to reach out if you have concerns about your child’s gastrointestinal health. Early evaluation and appropriate treatment can prevent complications and help your child recover more quickly. We are proud to be your partner in keeping your child healthy and thriving.
Contact myPediaClinic today for expert pediatric care. Call us or visit mypediaclinic.com to schedule an appointment with Dr. Medhat Abu Shaaban. Your child’s health is our priority.
