Baby Diarrhea and Dehydration: Fluids, Food and Warning Signs

What counts as diarrhea

• Breastfed babies normally have loose, seedy, yellow stools, often many a day. That isn't diarrhea.
• Diarrhea is a clear change: more frequent and much more watery stools, sometimes leaking out of the diaper, often with a cold, fever or vomiting.
• Most cases are viral stomach bugs and last 5-7 days, sometimes up to 2 weeks. The rotavirus vaccine has made the most severe kind much rarer.

Keep fluids going

• Breastfed babies: keep nursing, more often if they'll take it.
• Formula-fed babies: keep giving regular formula made the usual way. Don't dilute it.
• If stools are frequent and watery, or there's vomiting too, add an oral rehydration solution (ORS) from the pharmacy. It has the right balance of salt and sugar.
• Give ORS in small, frequent amounts with a spoon, syringe or cup, which stays down better than big gulps.
• Skip juice, soda, sports drinks and plain water as the main fluid for babies. Sugary drinks can make diarrhea worse.

Food

• Once your child is hungry, go back to their usual foods. Eating helps the gut heal.
• A strict bland diet isn't needed. Starchy foods, yogurt, vegetables and lean protein are all fine.
• Go easy on very sugary or fatty foods for a few days.

Watch for dehydration

Early signs: - Fewer wet diapers or darker urine. - Dry lips and mouth, fewer tears when crying. - Less energy than usual, more fussiness.

Serious signs: - No wet diaper for 6-8 hours in a baby, or 12 hours in a toddler. - Sunken eyes or a sunken soft spot on the head. - Cool, blotchy hands and feet, fast breathing, or very sleepy and hard to wake.

Medicines and probiotics

• Don't give anti-diarrhea medicines to babies or young children unless the pediatrician says to.
• Experts in North America don't recommend probiotics for stomach bugs in children; studies haven't shown a clear benefit.

Diaper area care

Frequent watery stools burn skin. Change diapers quickly, rinse with water, pat dry, and use a thick barrier cream (see the diaper rash guide).

Stopping the spread

• Wash hands with soap and water after every diaper and before food. Hand sanitizer doesn't work well against norovirus.
• Clean surfaces with a bleach-based cleaner.
• Most childcare programs ask children to stay home until stools fit in the diaper or toilet and any fever is gone. Caregivers who get sick should keep up their own fluids too.

When to check in

• Ask the pediatrician if diarrhea lasts more than a week, a baby under 6 months has it, or your child is losing weight.
• See them the same day for blood or mucus in stools, a fever with diarrhea in a baby 3 to 6 months old, or early signs of dehydration that aren't improving with ORS. Any fever of 100.4°F (38°C) or higher (rectal) under 3 months needs a call right away.
• If your child has serious dehydration signs or is hard to wake, call 911 or go to the ER.