- What Is Diarrhea?
- What Causes Diarrhea In Infants?
- What Are The Symptoms Of Diarrhea In Babies?
- When To Rush The Baby To The Doctor?
- How Is Diarrhea Treated?
- What Are The Complications Of Untreated Infant Diarrhea?
- Caring For An Infant With Diarrhea
- What To Feed A Baby With Diarrhea?
- How To Prevent Diarrhea In Infants?
Diarrhea in infants is agonizing. The little one loses her energy in no time, becomes weak, and all your efforts to replenish her lost fluids seem to be futile. The moment she drinks milk she soils the diaper, depending on the severity of the condition, of course.
Diarrhea can occur in infants of any age, and comes with collateral complications. MomJunction helps you understand the reasons behind diarrhea in babies and suggests ways to manage the condition and help your baby feel better.
What Is Diarrhea?
Diarrhea is repeated bouts of watery stool occurring multiple times in a day. The World Health Organisation defines it as the passage of three or more watery stools in a day (1). Paste-like or runny baby poop, or passing multiple firm (normal) stools in a day is not diarrhea.
An acute diarrhea is caused by a virus or bacteria. A recurrent diarrhea is when the infant passes loose stools due to an internal biochemical problem such as a food allergy.
The American Academy of Pediatrics defines the severity of diarrhea on the following scale (2):
- Mild diarrhea is two to five watery stools in a day
- Moderate diarrhea is six to nine watery stools in a day
- Severe diarrhea is ten or more watery stools in a day
There are several conditions that can trigger diarrhea in babies.
What Causes Diarrhea In Infants?
Following are the reasons behind the watery stools:
1. Stomach or intestinal infection:
Infections of the gastrointestinal tracts, caused mostly due to virus and bacteria, can lead to food poisoning and diarrhea. These microbes could enter through contaminated or under-cooked food.
- Rotavirus, which affects even newborns, causes acute gastroenteritis, eventually leading to cough and diarrhea (3). According to the WHO, rotavirus infection is the leading cause of infant mortality, but it can be prevented through immunization (4).
- Adenovirus are a group of viruses that infect different parts of the body including the inner linings of the gastrointestinal tract. They can easily spread through coughing, sneezing, and coming in contact with a contaminated surface. The infection caused is so severe that a baby’s diarrhea could last for two weeks or more (5), and leads to severe dehydration.
- Salmonella bacteria affects stomach and intestine, causing severe diarrhea (6). The infections spread through contaminated food and water, or surfaces. Babies tend to put objects in their mouth, which exposes them to the risk of contracting the virus.
- E.coli or Escherichia coli causes severe stomach pain and diarrhea, and can lade the baby’s stools with mucus and blood (7). The bacteria spreads through contaminated food and poor sanitation.
- Parasitic infection, caused by microscopic parasites, affects the gastrointestinal tract causing diarrhea. Giardia lamblia is one such parasite that spreads through contaminated water and food (8)(9).
2. Food intolerance or allergy:
If a baby is allergic to some food, it means that his immune system mounts an attack against it. In case of food intolerance, the baby’s digestive system cannot digest the food, causing discomfort in the gastrointestinal tract. For example, galactosemia is a genetic condition where the baby’s stomach is unable to process galactose (milk sugar) that is found even in human milk (10). This means the newborn cannot have breastmilk and has to rely on formula. (11).
3. Inflammatory bowel disease:
It is a group of gastrointestinal diseases caused by genetic anomalies that lead to painful inflammation of the inner lining of the digestive tract. Ulcerative colitis and Crohn disease are inflammatory bowel diseases that can affect infants (12), causing persistent diarrhea. Inflammatory bowel disease is genetic and has no treatment. Medications should be taken every day to for relieving the intensity of the symptoms (13).
4. Fruit juice:
Fruits juices come loaded with nutrients, but sometimes they can be too much to handle for an infant’s little body. Poor absorption and nutrient overload expel these excess nutrients in the form of watery diarrhea (14). The American Academy of Paediatrics recommends against giving fruits juices to babies below one year (15). Whole fruits are better as they are rich in fiber and have tolerable levels of nutrient concentration.
5. Heat exhaustion:
Babies are poor at adjusting to extreme temperatures. If the baby is in a hot climate for long he may suffer from dehydration and headaches due to loss of body water. In extreme cases, he may also have abdominal cramps and diarrhea (16). The baby must be in cool or moderate temperatures and should be given adequate fluids.
Infant diarrhea can be a side effect of antibiotics as they act against bacteria. They kill the good intestinal bacteria, and digestion becomes difficult (17). The baby’s condition improves when the antibiotic course is concluded.
Diarrhea in babies can last from a couple of days to weeks depending on the intensity of the condition. This makes it imperative to know what to expect when a baby is going through a bout of diarrhea.
What Are The Symptoms Of Diarrhea In Babies?
Diarrhea is a symptom in itself but you can differentiate it from a normal stool through these attributes:
- Baby poops more than normal: A healthy, breastfed infant will have at least six stools a day. It can be more depending on the nursing schedule, with the baby pooping after every breastfeeding session. Formula-fed infants tend to pass stool fewer times that is around four times in a day. The frequency of pooping decreases after two months. Each infant’s schedule is different from the other poops differently. But if there is a sudden increase in the number of stools and the stools are visibly watery, then it is likely that the baby is suffering from diarrhea.
- Smelly and mucus-laden stool could indicate diarrhea: If an infant has mucous-like and foul-smelling stool, then it could indicate diarrhea. Infant stools are yellow to brownish-yellow in color. The color of a baby’s stool could depend on the food eaten. Also, a baby could excrete a greenish colored stool due to the liver bile that passes into the gastrointestinal tract, and is absolutely normal.
Watery stools are a sure-shot indicator of diarrhea, and maybe accompanied by symptoms such as abdominal cramps, fever, etc., depending on the underlying cause of diarrhea. These symptoms indicate that you must take your baby to a doctor.
When To Rush The Baby To The Doctor?
The following conditions demand prompt medical attention:
- Baby’s stool has blood or a reddish blood clot.
- The baby is irritable, has little energy, and appears drowsy all the time.
- The infant has not urinated for more than three hours, which could be a sign of dehydration.
- The baby drools less than normal due to dry mouth.
- The baby has diarrhea and a body temperature of over 100.4°F (38°C).
The American Academy of Pediatrics recommends medical intervention in any case of diarrhea in infants below three months (18).
How Is Diarrhea Treated?
A doctor initiates the treatment once reason behind diarrhea is diagnosed. The medication varies according to the problem and its severity. For instance, if the baby has diarrhea due to a bacterial infection, then antibiotics would be prescribed. Over-the-counter medications such as Pepto-Bismol and Kaopectate are available to treat diarrhea. However, the US Food and Drug Administration recommends against them as they contain chemical compounds that may harm the baby (19). It is best to consult a doctor to avoid any complications to the infant.
What Are The Complications Of Untreated Infant Diarrhea?
Diarrhea may not come alone always. It could, sometimes, lead to further complications, such as:
- Dehydration: The baby loses a lot of water, causing fluid and electrolyte imbalance in the body. Such condition leads to dehydration, and severe dehydration can make the baby lose as much as 3% of her body weight. More serious outcomes are disorientation and unconsciousness.
- Diaper rash: Babies develop diaper rash from frequent pooping and wiping (20). Diaper rashes can get sore and troublesome and pose a challenge.
The baby’s treatment needs to be complimented with home care for the little one to recover soon.
Caring For An Infant With Diarrhea:
Here are three simple ways to care for the baby when she is suffering from diarrhea:
- Give plenty of fluids: Besides breastmilk and water, you must supplement the electrolyte loss with oral rehydration salt (ORS) solution. Give two tablespoons of ORS solution to the baby every 30 minutes or as per the directions of your doctor. Also, babies less than six months should not be given ORS unless directed by a doctor. However, breastmilk is always a safe option and the American Academy of Pediatrics recommends frequent breastfeeding to an exclusively breastfed infant during diarrhea (21).
- Small and regular meals: Diarrhea exhausts a baby, and food is vital for providing adequate calories. Exclusively breastfed babies rely only on breastmilk for nourishment. So, increase the frequency of feeding. For older infants, you can prepare small solid meals that can be fed once in every three to four hours.
- Maintain diaper hygiene: Hygiene is a must and during diarrhea episodes to keep the diaper area dry and clean. Wash the baby’s bottom with soapy water, wipe it clean with sterilized baby wipe, and then wait until it is completely dry before wrapping a fresh diaper. You can also use an antibacterial diaper cream after consulting a pediatrician.
What To Feed A Baby With Diarrhea?
If the baby is younger than six months, then you can safely feed breastmilk or milk-based formula except in the case of lactose intolerance diarrhea. In such cases, the doctor will prescribe a non-milk based or hydrolyzed protein formula that is easy to digest (22). If the baby is older than six months, you can feed (23):
- Mashed bananas
- Boiled and mashed potatoes
- Plain white rice porridge
- Cooked and tender root vegetables such as carrots and beetroots
- Baby cereals made from wheat or oatmeal
- Meat stock/broth
You can give fruits to a baby with diarrhea, but remove the skin and seeds as they are hard to digest. Formula-fed babies can continue feeding the normal way.
Here are some food items that you must avoid in infant diarrhea:
- Cow’s milk and dairy products such as cheese and butter
- Foods with milk and high sugar content such pastries, cream biscuits, etc.
- Fruit juice
- Fried and greasy foods
- Some fruits and vegetables that form a lot of gas in the gastrointestinal tract or stomach, such as peas, chickpeas, green leafy vegetables, broccoli, prunes, and spices such as peppers
Remember to feed the infant several small meals in a day instead of three or four large meals. The baby must also have adequate rest, which combined with hydration and medication will surely help the little one recover easily. Diarrhea can be a tough phase, but it is easily preventable.
How To Prevent Diarrhea In Infants?
There are some simple ways to keep diarrhea at bay.
- Maintain good hygiene around the baby. Infants tend to put things in mouth, thus ingesting diarrhea-inducing pathogens. Keep the infant’s surrounding and toys clean. Wash the baby’s hands regularly.
- Give hygienically prepared food. Feed the infant with properly cleaned and cooked vegetables and fruits. Never give frozen foods, including frozen vegetables, as they could contain bacteria that may not harm adults, but affect infants. If a baby consumes cow’s milk, then boil and cool the milk before feeding. Make sure the water you drink is clean either through purification or boiling.
- Family members should maintain healthy personal hygiene. Wash your hands before you handle any of the baby’s items. It helps prevent transmission of germs from you to the baby.
A baby’s poop is an indicator of her overall health. So do not throw that diaper right away! Take a look at it, and if you have the slightest suspicion of diarrhea, then promptly take your baby to a doctor. Care, rehydration, and appropriate medication are all that the baby needs to glide through diarrhea and be healthy and happy.
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