Diarrhoea in Children

“My child has diarrhoea. What should I give?”
“Does my child need antibiotics?”
“Should I give probiotics?”
“My child keeps vomiting and cannot drink. What should I do?”

Diarrhoea is very common in children. Acute gastroenteritis, particularly viral gastroenteritis, is one of the most common causes.

Most children recover with adequate hydration, continued feeding and time.

The main concern is not simply the number of loose stools.

The most important complication of acute diarrhoea is dehydration.

What Counts as Diarrhoea?

Diarrhoea means passing stools that are looser or more watery than usual, often more frequently than normal.

For babies, remember:

Some babies naturally have soft or frequent stools.

What matters more is a clear change from the child's usual stool pattern.

Type 6 and Type 7 stools (mushy or watery stools) usually indicate diarrhoea, as the stool has passed through the bowel too quickly and contains excess fluid. Persistent diarrhoea may increase the risk of dehydration, especially in young children. 

“What Causes Diarrhoea?”

Common causes include:

• Viral gastroenteritis
• Bacterial gastroenteritis
• Food-related infection
• Recent antibiotic use
• Temporary lactose intolerance after gastroenteritis
• Food intolerance or allergy

Less commonly, persistent or recurrent diarrhoea may be related to another gastrointestinal condition and requires further assessment.

“My Child Has Diarrhoea. What Should I Do First?”

Prevent Dehydration

The most important treatment is oral rehydration.

Offer an appropriate oral rehydration solution (ORS), particularly when stools are frequent or there is vomiting.

If your child is vomiting:

Give small amounts frequently rather than a large amount at once.

Continue breastfeeding and normal milk feeds.

Once your child is able to eat, continue age-appropriate normal foods rather than unnecessarily fasting.

Avoid relying on:

• Fizzy drinks
• Very sugary drinks
• Undiluted fruit juice

These can sometimes make diarrhoea worse.

“Does My Child Need Probiotics?”

Sometimes, but not every probiotic is the same.

Evidence suggests that the benefit of probiotics in acute gastroenteritis is strain- and dose-specific.

The 2023 ESPGHAN position paper and Malaysia CPG Guidelines on the Management of Acute Diarrhea in Children (2026) identifies certain strains that may be considered as an adjunct to standard treatment.

Current evidence supports the use of the following probiotic strains as adjuncts in the treatment of acute diarrhoea in children:

• Lacticaseibacillus rhamnosus GG (L rhamnosus GG) 
• Saccharomyces boulardii 
• Limosilactobacillus reuteri DSM 17938

Therefore:

Probiotics are an optional adjunct—not a replacement for rehydration.

“Is There Medicine to Reduce the Diarrhoea?”

In selected children, doctors may consider medicines that reduce stool output as an adjunct to rehydration.

Diosmectite (Smecta)

Diosmectite may help reduce stool output and duration of acute diarrhoea.

The current Malaysian Paediatric Protocols state that diosmectite may be used as an adjunct in acute gastroenteritis in children over 2 years of age.

Racecadotril (Hidrasec)

Racecadotril may also be considered as an adjunct to oral rehydration in appropriate children.

It is not a substitute for ORS.

These medicines are not necessary for every child with diarrhoea.
Whether they are appropriate depends on the child's age, severity of diarrhoea and overall clinical condition.

“My Child Is Vomiting Too. Does My Child Need Medicine for Vomiting?”

Vomiting can make oral rehydration difficult.

In selected children with significant vomiting, medicine may be considered by a doctor to help facilitate oral rehydration.

It is not a routine treatment for diarrhoea itself, and it is not necessary for every child who vomits.

The decision depends on the child's age, degree of dehydration, vomiting severity and other clinical factors.

“Does My Child Need Antibiotics?”

Usually, no.

Most acute diarrhoea in children is caused by viruses, and antibiotics will not help.

The Malaysian Paediatric Protocols state that antibiotics should not be used routinely and are reliably helpful in selected situations such as bloody diarrhoea/probable shigellosis and suspected cholera with severe dehydration.

Antibiotics may therefore be considered when there is a specific clinical indication.

Diarrhoea ≠ antibiotics.

“My Child Has Blood or Mucus in the Stool. Is That Different?”

Yes.

Blood in the stool is not typical of simple viral gastroenteritis and deserves medical assessment.

Seek medical advice especially if there is:

• Blood in the stool
• High or persistent fever
• Significant abdominal pain
• Frequent diarrhoea
• A child who appears increasingly unwell

The cause may be different from ordinary viral gastroenteritis and may require further investigation or specific treatment including antibiotics.

“How Do I Know If My Child Is Dehydrated?”

Look for:

• Passing urine less frequently
• Dry mouth or tongue
• Reduced tears
• Sunken eyes
• Poor feeding or drinking
• Increasing sleepiness or lethargy
• Weakness or reduced activity

For babies, fewer wet nappies can be an important warning sign.

The younger the child, the more quickly dehydration can develop.

When Should I Bring My Child to See a Paediatrician?

Arrange a medical assessment if:

• Diarrhoea is very frequent, persistent or worsening
• There is repeated vomiting
• There is blood in the stool
• There is persistent or high fever

What to Expect During the Consultation

At our clinic, we first assess:

Hydration → Severity → Possible Cause → Appropriate Treatment

Depending on the clinical assessment, we may provide:

• Oral rehydration advice
• Assessment and treatment of dehydration
• Probiotics when appropriate
• Diosmectite or racecadotril when indicated
• Anti-vomiting medicine when significant vomiting is preventing oral rehydration
• Further investigations when clinically indicated
• Antibiotics only when there is an appropriate indication

If your child requires further investigation or hospital-based management, we can arrange referral to the appropriate paediatric subspecialist or hospital.

Our goal is not simply to stop the diarrhoea. It is to keep your child hydrated, identify the cause and provide the right treatment when needed.