Baby Diarrhea

Overview

Diarrhea (diarrhoea) means your baby is passing stools that are much looser or more watery than usual, and often more often than usual. For a baby, this usually means three or more watery stools in a day, or a clear change from their normal pattern. It is very common in babies and young children, and most episodes settle within a few days. The main thing to watch for is not the diarrhea itself, but whether your baby is keeping enough fluid in.

Yes, it is very common. Almost every baby will have diarrhea at some point, and it is one of the most frequent reasons parents contact a doctor or health visitor.

It affects babies and young children most often, especially those under 2 years old. Babies who are formula fed, who attend childcare, or who have not had the rotavirus vaccine tend to get it more often. Breastfed babies are generally a little more protected, but they can still get it.

Symptoms

Common symptoms

• Stools that are much looser, more watery, or more frequent than usual
• A change in the colour or smell of the stools
• Tummy pain or cramping, often shown by pulling up the legs and crying
• Being irritable, unsettled, or more sleepy than usual
• Vomiting or spitting up more than usual
• A mild fever
• Feeding less than usual, or refusing feeds
• Sore bottom from frequent nappies

Symptoms in children

• Signs of dehydration: fewer wet nappies, a dry mouth, no tears when crying, sunken eyes, or a sunken soft spot on the head in young babies
• Being floppy, very sleepy, or hard to wake
• Sunken eyes or a pinched-looking face
• Skin that stays in a fold when gently pinched (a sign of fluid loss)
• Fast breathing or a weak cry
• Blood or mucus in the stool
• Green vomit or a swollen, tender tummy
• Weight loss over a few days

Symptoms in older adults

• This article is about babies, so this section does not apply to your baby.
• If you also care for an older adult with diarrhea, they can lose fluid quickly too, and their risk is higher if they take water tablets or blood pressure medicines.
• Encourage extra fluids and ask a pharmacist or doctor for advice early.

Causes

Main causes

• Viral infections of the tummy, such as rotavirus or norovirus, which are the most common cause
• Bacterial infections picked up from food, water, or animals
• Parasites, which are less common and often linked to travel
• Antibiotics or other medicines upsetting the balance of the gut
• A food allergy or intolerance, such as to cow's milk protein
• A sudden change in diet, or too much fruit juice or sugary drink
• Teething and other minor illnesses can sometimes loosen stools, though this is often blamed more than it should be

Risk factors

• Not having had the rotavirus vaccine
• Being around other children in childcare or playgroups
• Poor hand washing at home, especially after nappy changes
• Travel to places with less safe drinking water
• Recent antibiotics
• A weakened immune system or being born prematurely
• Drinking untreated water or unpasteurised foods

When to see a doctor

See a doctor urgently if:

• Any sign of dehydration, such as fewer wet nappies, a dry mouth, or no tears
• Your baby is under 6 months old
• Blood in the stool
• Vomiting that will not stop and preventing any fluids from staying down
• A fever in a baby under 3 months old, or a high fever that worries you
• Your baby seems very sleepy, floppy, or is not feeding

Book a routine appointment if:

• Diarrhea lasting more than 7 days
• Diarrhea that keeps coming back
• Poor weight gain or weight loss
• You are unsure how to keep your baby hydrated
• You want to check whether a change in formula or diet is needed

Diagnosis

A doctor or health professional will usually diagnose diarrhea just by asking about your baby's stools, feeding, and wet nappies, and by checking your baby for signs of dehydration. They will weigh your baby and look at their tummy, mouth, and general alertness. Most of the time no tests are needed.

Tests that may be done

• A stool sample, if there is blood, mucus, or a lot of diarrhea that is not settling
• A urine sample, to check for a urinary infection or dehydration
• Blood tests, only if your baby is very unwell or needs hospital care
• Weighing your baby to track fluid loss and growth

What to expect at your appointment

The appointment is usually quick and gentle. Your baby will be weighed, their nappy will likely be checked, and you will be asked how many wet nappies they have had in the last 24 hours. You may be given a plan for extra fluids and asked to come back if things do not improve. If your baby is very young or shows signs of dehydration, you may be sent to hospital for a few hours of monitoring and fluids.

Treatment

The main treatment is to replace the fluid and salts your baby is losing, and to keep feeding them normally. Babies with diarrhea who keep feeding tend to recover faster than those who are starved. Medicines to stop diarrhea are not given to babies, because they can be harmful. Most babies can be looked after at home with careful fluid and nappy watching.

Self-care at home

• Keep breastfeeding as often as your baby wants, and offer extra feeds
• Keep offering their usual formula, made up as normal, in smaller but more frequent amounts
• Offer oral rehydration solution, which you can buy from a pharmacy, in small sips often, especially if your baby is vomiting or has lots of watery stools
• Avoid fruit juice, fizzy drinks, and sugary squash, as these can make diarrhea worse
• Do not give water alone to a young baby as a replacement for milk
• Use a barrier cream at every nappy change and let the bottom air dry when you can
• Wash your hands and your baby's hands often, and clean the changing area well
• Keep a simple note of wet nappies, feeds, and stools so you can see the pattern clearly

Medical treatments

Treatment is mostly about fluids. Health professionals may give oral rehydration solution and, if your baby is very dehydrated, fluids through a drip in hospital. If an infection is found and is serious, doctors may prescribe treatment for the infection, but this is not needed for most babies. In some countries, health services recommend a short course of zinc supplement alongside rehydration, as it can shorten diarrhea. Never give your baby any medicine for diarrhea without asking a doctor or pharmacist first.

When is surgery considered?

Surgery is not needed for ordinary baby diarrhea. Very rarely, a serious complication such as a blocked or twisted bowel can cause severe tummy swelling and green vomit, and that would need emergency hospital care. If you see those signs, call your local emergency number straight away.

Living with this condition

The day-to-day focus is simple: fluids in, wet nappies out. Offer small, frequent feeds rather than one big feed, and expect to change more nappies than usual, sometimes through the night. Keep your baby comfortable and warm, and keep them at home away from other children until they have been free of diarrhea for two days. This helps stop it spreading.

Lifestyle tips

• Keep your baby at home from nursery or groups until 48 hours after the last loose stool
• Have oral rehydration solution at home so you are not caught out at night
• Set up a simple changing station with cream, nappies, and a bin nearby
• Wash your hands after every nappy change, and before preparing feeds
• Ask family or friends for help so you can rest too

Diet and exercise

Continue milk feeds as normal. If your baby is already eating solid food, offer plain, easy foods such as rice, potato, banana, bread, and yogurt, and avoid fatty or very sugary foods. There is no need to stop giving food if your baby is hungry. Exercise is not a concern for a baby with diarrhea; rest and cuddles are enough. Gentle play and tummy time can continue when your baby seems up for it.

Mental health and emotional wellbeing

It is normal to feel worried, exhausted, and even a bit helpless when your baby is unwell. Too little sleep and constant nappy checks can wear anyone down. Remind yourself that most babies recover quickly, and ask for practical help if you can. If you are feeling overwhelmed, very anxious, or low, tell your doctor, health visitor, or midwife, or contact a local mental health support line or crisis service. You do not have to manage alone, and help is available.

Prevention

It cannot always be prevented, but you can greatly reduce the chances with good hand washing, safe food and water, clean feeding equipment, and keeping up to date with vaccines.

Vaccines

The rotavirus vaccine is offered to babies in many countries, including on the NHS schedule in the UK, given by mouth in the first few months of life. It protects against one of the most common causes of severe baby diarrhea. Ask your doctor or health visitor about your local schedule.

Screening programmes

There is no routine screening for diarrhea. However, your baby is weighed and checked at routine health reviews, which is a good moment to raise any worries about their stools or feeding.

Complications

If left untreated

• Dehydration, which is the most common and most serious complication
• An imbalance of salts in the body, which can be dangerous in very young babies
• Weight loss and slower recovery if feeds are stopped for too long
• A sore, broken bottom from frequent nappies
• A temporary difficulty digesting milk sugar after the infection clears
• Rarely, a seizure caused by losing too much fluid

Long-term outlook

The outlook for most babies is excellent. With continued feeding and extra fluids, nearly all babies are back to normal within a week. The key is recognising dehydration early, so keep checking those wet nappies and ask for advice if you are worried. If you are ever unsure, contact your doctor or your local emergency number.

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