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Instructions

• Instructions for new users

Call 911 Now If:

• Signs of shock (very weak, limp, not moving, unresponsive, gray skin, etc.)

Call Your Doctor Now If:

• Your child looks or acts very sick
• Signs of dehydration (e.g. no urine in > 8 hours, no tears with crying and very dry mouth)
• Blood in the stool
• Fever > 104°F (40°C)
• Age < 12 weeks with fever > 100.4°F (38°C) rectally
• Abdominal pain present > 2 hours
• Vomiting clear liquids 3 or more times
• Age < 1 month with 3 or more large diarrhea stools
• Passed more than 8 diarrhea stools in the last 8 hours
• Severe diarrhea while taking a medicine that could cause diarrhea (e.g. antibiotics)

Call Your Doctor Within 24 Hours If:

• You think your child needs to be seen
• Mucus or pus in the stool for > 2 days
• Loss of bowel control in a toilet trained child occurs 3 or more times
• Fever > 3 days
• Close contact with someone who has bacterial diarrhea
• Contact with reptile (snake, lizard, turtle) in previous 14 days

Call Your Doctor During Weekday Hours If:

• You have other questions or concerns
• Diarrhea persists > 2 weeks or is a recurrent problem

Home Care (Read "Call Your Doctor…" first):

Mild Diarrhea

Continue regular diet. Eat more starchy foods. Drink more fluids. (Exception: avoid all fruit juices and soft drinks because they make diarrhea worse).

Formula-Fed Infants (less than 1 year old) with Frequent, Watery Diarrhea

Start Oral Rehydration Solutions (ORS) (special fluid for diarrhea):

• Start ORS (Infalyte, KaoLectrolyte or Pedialyte) for frequent, watery diarrhea (Note: formula is fine for average diarrhea)
• Use ORS alone for 4 to 6 hours to prevent dehydration. Offer unlimited amounts
• If ORS not available, use formula (unlimited amounts) until you can get some. Avoid Jello water, sports drinks, or fruit juice

Returning to Formula

• Get back to formula by 6 hours at the latest (Reason: needs the calories)
• Use full-strength formula (Reason: it contains adequate water)
• Offer the formula more frequently than you normally do
• Lactose: Regular formula is fine for most diarrhea. Lactose-free formulas (soy formula) are only needed for watery diarrhea persisting > 3 days
• Extra ORS: also give 2-4 oz. of ORS for every large watery stool
• Infants > 4 months old: also give rice cereal, strained bananas, mashed potatoes, etc.

Breastfed Infants with Frequent, Watery Diarrhea

• Continue breastfeeding at more frequent intervals. Add solids as for formula-fed
• Offer 2-4 oz. ORS between feedings for each large stool (especially if urine is dark)

Older Children (over 1 year old) with Frequent, Watery Diarrhea

• Offer unlimited FLUIDS: If taking solids, give water or ¼ strength Kool-Aid. If refuses solids, give milk or formula
• Avoid all fruit juices and soft drinks. (Reason: make diarrhea worse)
• ORS is rarely needed, but for severe diarrhea, also give 4-8 oz. of ORS for every large watery stool
• SOLIDS: Starchy foods are absorbed best. Give cereals (especially rice cereal), oatmeal, bread, crackers, noodles, mashed potatoes, rice, carrots, applesauce, strained bananas, etc. Pretzels or salty crackers can help meet sodium needs
• Yogurt: Give 2-6 oz. of active culture yogurt twice a day. (Reason: restores healthy bacteria to GI tract)

Diaper Rash

Wash buttocks after each stool to prevent a bad diaper rash. Consider applying a protective ointment (e.g. petroleum jelly) around the anus to protect the skin.

Contagiousness

Your child can return to day care or school after the stools are formed and the fever is gone. The school-aged child can return if the diarrhea is mild and the child has good control over loose stools.

Expected Course

Viral diarrhea lasts 5-7 days. Always worse on day 1 and 2.

Call Your Doctor If:

• Signs of dehydration occur
• Diarrhea persists > 2 weeks
• Your child becomes worse or develops any of the "Call Your Doctor…" symptoms