September 18, 2017

Infectious diarrheal disease is a common issue in children especially those attending daycare and school. The key to successful survival of a diarrheal illness is maintaining hydration. Viral and most bacterially derived diarrheal illnesses are self limited. Knowing this, when should you worry? You should seek medical attention if your child has blood in his stools, is showing signs of dehydration, lethargy, or diarrhea past 7 days.

Here are my thoughts on diarrhea and treatment.

1) Avoid all products that slow gut motility. Your body is releasing the virus or bacteria in the loose stool. Imodium and other drugs that slow GI transit should not be used for infectious diarrhea.

2) Avoid sugar beverages that can increase the osmotic effect and worsen diarrhea.

3) Take a high quality probiotic in doses that are physician recommended. Culturelle GG is the best studied and works great for this purpose. I use one capsule twice daily for children over the age of 3 years and 1/2 capsule twice daily if they are younger.

4) Hydration is the key. Taking 1-2 teaspoons of pedialyte or ORS, oral rehydration solution, every minute for 30 minutes and then rest for 20 minutes and repeat. Increase volume as tolerated. This will prevent a bolus of fluids from upsetting your stomach and inducing emesis. The end result will be the avoidance of the ER, an IV for fluids. This also keeps your pocket book safe from the cost vultures. ORS is a homemade solution that is an excellent choice to rehydrate with. See recipe below.

5) From Dr. Weil's site - Carob powder can help soothe irritated intestines. Start with one tablespoon, mixed with some applesauce and honey to make it palatable. Take it on an empty stomach.

6) Bone broths are good for adding back nutrients as feedings restart. Slightly raw bananas, applesauce, rice and potatoes are good first foods to reintroduce. Avoid dairy and greasy foods that are irritating to the stomach.

7) Make sure to seek care for signs of significant dehydration which include: dry oral mucous membranes, not urinating in 12 hours, dizziness, absence of tears, listlessness, extreme thirst or confusion.

Make your own ORS for rehydrating:

1 quart of water
3/4 teaspoon salt
6 teaspoons sugar
stir and give

Dr. M

Hopkins Oral rehydration study
Comprehensive CDC article
ORS handout from UVA