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On Call: Diarrhea Danger?

Q. My mother says that if my child gets diarrhea, he should see the doctor right away in case he gets dehydrated. Is that true?

Not necessarily, assuming he's more than 6 months old (with really small infants, you should check in with the doctor). Most cases of diarrhea just need to run their course. But do call the doctor if your child's in a lot of pain, or if the diarrhea lasts more than a week, is bloody, and is accompanied by a high fever, vomiting (more than once), or a rash on the body (though diaper rash is perfectly normal during diarrhea).

Your mother is right about one thing: Dehydration is the biggest risk from diarrhea, so I try to make sure all the parents in my practice know the signs of it, which include:

  • Dry mouth, and/or lack of tears when your child cries
  • A decrease in urination (infants should urinate every four to six hours, older children every six to eight). Sometimes when you're changing diapers frequently due to diarrhea, it can be hard to tell if they've peed. Checking the outside front of the diaper -- it'll feel a little warm or fuller -- rather than the inside helped me to tell with my own babies.
  • Irritability
  • Excessive sleepiness
  • Weakness, or decreased activity
  • In infants, a sunken soft spot on their head
  • A rapid heart rate (felt by putting your hand on the front of the chest), or rapid breathing

If you notice any of these, call the doctor right away. But if not, just make sure he drinks lots of fluids to make up for what he's losing. Breastfed babies should continue to nurse as often as possible. Oral rehydration solutions such as Pedialyte or Rehydralyte are easily absorbed -- and a good option for all ages  -- though if kids don't like the taste, clear fluids such as watered-down juices or broth are fine alternatives. Cow's milk and formula are less absorbable, but if that's all he'll drink, they're okay. Gradually offer starchy foods like white rice, crackers, toast, and cereal as you ease him back into his usual diet.

Avoid giving soft drinks, juice (unless diluted), or sweet sports drinks since too much sugar, even natural sugars, can make diarrhea worse. If your child wants only water, make sure he has a little something to eat with it. Given alone, it can lead to a dangerous electrolyte abnormality.