When should parents worry about their child's frequent stools? When parents ask me about this, I always respond by asking the parents what their stool patterns are like -- since not everyone has the same idea about what is normal.

Once convinced it is an unusual pattern, we discuss what causes frequent stools and when to worry.

Dr. Leon Reinstein of Duke Children's helps us to understand what we should consider when it comes to diarrhea in children.

-- Dennis Clements MD, PhD, MPH

Leon J. Reinstein, MD

What is diarrhea?

Diarrhea is an increase in the number of stools (bowel movements) per day and an increase in the looseness of stools. Mild diarrhea may vary from one to three stools a day; severe diarrhea can consist of up to 20 stools a day.

In general, diarrhea is a common problem that may last only a few days and disappear on it’s own. Usually related to a viral or bacterial gastroenteritis, an infection causing diarrhea, abdominal cramping, vomiting and fever.

Diarrhea may be:

• Acute (lasting less than two weeks): usually related to bacterial or viral infections, it may also be a reaction to medications such as antibiotics
• Chronic (lasting longer than two weeks): related to conditions such as an irritable bowel syndrome, parasites or an inflammatory bowel disease such as Crohn’s disease, ulcerative colitis or Celiac disease

How did my child get diarrhea?

• By ingesting contaminated food or water
• By touching the stool of an infected person
• When touching an object contaminated with the stool of an infected person, and then ingesting the germs

What are the symptoms of diarrhea?

Your child may experience one or many of the symptoms associated with diarrhea:

• Cramping
• Abdominal pain
• Bloating/distended abdomen
• Nausea
• Urgent need to used the restroom Fever
• Bloody stools

These symptoms may be a sign of other conditions. Always consult your child's physician.

When do I worry about diarrhea?

You should always call your child’s physician if your child is less than six months of age or has other symptoms such as:

• Abdominal pain
• Blood in the stool
• Frequent vomiting
• Unable to eat or drink
• High fever
• Diarrhea longer than two weeks
• Any signs of dehydration such as:

o   Dry mouth

o   Weight loss

o   Extreme thirst

o   Frequent and persistent diarrhea

o   Urinates less frequently

o   Sunken eyes or depressed “soft spot”

o   No tears when crying

o   Difficulty staying awake

What are treatments for diarrhea?

Treatment will be determined by your child’s physician. Most causes of diarrhea will not need treatment. It will depend on the age of your child and the cause of diarrhea. Treatment involves replacing lost fluids and is geared to prevent complication of dehydration.

Administration of anti- diarrhea medication is strongly discouraged. Antibiotics are used only in specific infections.

It is important to maintain oral hydration and a regular diet as much as possible. Avoid sodas or sports drinks. Give Pedialyte or Gatorade as alternatives.

Infant and children at times may require an admission to the hospital if unable to maintain adequate oral intake.

How do I protect my family?

Diarrhea is easily spread to others in the family. Take the following precautions:

• Everyone in the family should wash their hands with soap and water after using the bathroom, handling diapers, or preparing foods
• Change diapers away from where food is being prepared or eaten
• Keep dirty diapers in a covered container away from children or pets
• Clean the bathroom thoroughly every day
• If your child is in day care, inquire about their policy on caring for sick children

Always remember to wash your hands.

-- Leon J. Reinstein, MD, is a pediatric gastroenterologist with Duke Children's.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.