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?”
Hydration Comes First
Most children with acute diarrhoea recover with adequate hydration, continued feeding and time. The main concern is not simply the number of loose stools but whether your child is becoming dehydrated.
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 most important complication of acute diarrhoea is dehydration.
Your child's age, usual bowel pattern, stool consistency, fluid intake, urine output, vomiting and overall condition are important when assessing diarrhoea.
What Counts as Diarrhoea?
Diarrhoea means passing three or more loose or watery stools within 24 hours, or stools that are noticeably more frequent and watery than what is normal for your child.
For babies and young children, stool patterns can vary considerably. Some breastfed babies naturally have soft, loose or frequent stools, which does not necessarily mean they have diarrhoea.
What matters is a clear change from your child's usual bowel pattern, particularly if the stools become more watery, occur more frequently, or are accompanied by vomiting, fever, poor feeding or other symptoms.
Stool consistency can also provide useful information. Type 6 stools are mushy or loose, while Type 7 stools are watery. These may be consistent with diarrhoea when they represent a change from the child's normal stool pattern.
For babies: Frequency alone does not necessarily mean diarrhoea. A change from the child's usual stool pattern is more important.
Diarrhoea should therefore be considered together with your child's usual bowel habits, age, feeding pattern, stool consistency and other symptoms.
What Causes Diarrhoea?
Viral Infections
Common cause- Viral gastroenteritis
- Rotavirus
- Norovirus
- Other viral infections
Bacterial Infections
- Bacterial gastroenteritis
- Food-related bacterial infections
- Shigellosis
- Other bacterial infections
Other Causes
- Recent antibiotic use
- Temporary lactose intolerance after gastroenteritis
- Food intolerance or allergy
- Other gastrointestinal conditions
Most acute diarrhoea in children is caused by infections, particularly viral infections. Persistent or recurrent diarrhoea may have other causes and may require further assessment.
Prevent Dehydration
The most important treatment for acute diarrhoea is oral rehydration.
Offer an appropriate oral rehydration solution (ORS), particularly when stools are frequent or when vomiting is present.
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 drinks are not appropriate substitutes for ORS and may sometimes make diarrhoea worse.
What Parents Can Observe
How often your child is passing stools, how watery they are and whether this is different from their usual bowel pattern.
Whether your child is drinking normally, refusing fluids or vomiting after drinking.
Monitor how often your child urinates. For babies, fewer wet nappies can be an important warning sign.
Watch for unusual sleepiness, weakness, reduced activity, poor feeding or changes in responsiveness.
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 Malaysian guidance identify selected probiotic strains that may be considered as an adjunct to standard treatment in appropriate children.
Selected strains that may be considered include:
- Lacticaseibacillus rhamnosus GG (L. rhamnosus GG)
- Saccharomyces boulardii
- Limosilactobacillus reuteri DSM 17938
Probiotics are an optional adjunct — not a replacement for oral 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. Current Malaysian paediatric guidance states 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.
If your child is vomiting, offer small amounts of ORS frequently rather than giving a large amount at once.
In selected children with significant vomiting, a doctor may consider medicine to help facilitate oral rehydration.
Anti-vomiting medicine is not a routine treatment for diarrhoea itself and 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 viral infections.
Antibiotics should not be used routinely for childhood diarrhoea. They may be considered when there is a specific clinical indication, such as suspected bacterial infection with bloody diarrhoea or certain cases of cholera with severe dehydration.
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 or worsening diarrhoea
- A child who appears increasingly unwell
The cause may be different from ordinary viral gastroenteritis and may require further investigation or specific treatment.
How Do I Know If My Child Is Dehydrated?
Watch for the following warning signs:
- Passing urine less frequently
- Fewer wet nappies in babies
- Dry mouth or tongue
- Reduced tears
- Sunken eyes
- Poor feeding or drinking
- Increasing sleepiness or lethargy
- Weakness or reduced activity
Babies and young children can become dehydrated more quickly because they have smaller fluid reserves and may not be able to communicate thirst effectively.
When to Arrange a Paediatric Appointment
- Diarrhoea is very frequent, persistent or worsening.
- Your child has repeated vomiting.
- There is blood in the stool.
- Your child has persistent or high fever.
- Your child has significant abdominal pain.
- Your child is drinking poorly or has fewer wet nappies.
- Your child appears increasingly sleepy, weak or unwell.
Seek Urgent Medical Care If
- Your child is unable to drink.
- There are significant signs of dehydration.
- Your child has persistent vomiting and cannot keep fluids down.
- Your child is very sleepy, weak or difficult to wake.
- Your child has severe abdominal pain.
- There is significant blood in the stool.
- Your child is rapidly getting worse or appears seriously unwell.
Frequently Asked Questions About Diarrhoea in Children
What Should I Give My Child for Diarrhoea?
The most important treatment is oral rehydration. Offer an appropriate oral rehydration solution (ORS), especially when diarrhoea is frequent or accompanied by vomiting. Continue breastfeeding and age-appropriate milk feeds, and resume normal foods as tolerated.
What Counts as Diarrhoea in a Child?
Diarrhoea generally means three or more loose or watery stools within 24 hours, or stools that are noticeably more frequent and watery than normal for your child. In babies, frequency alone does not necessarily mean diarrhoea because some babies naturally have soft or frequent stools.
Does My Child Need Antibiotics for Diarrhoea?
Usually, no. Most acute diarrhoea in children is caused by viral infections, which do not improve with antibiotics. Antibiotics may be considered when there is a specific clinical indication, such as certain bacterial infections or suspected cholera with severe dehydration.
Are Probiotics Helpful for Children With Diarrhoea?
Some probiotics may provide a modest benefit as an adjunct to standard treatment, but the evidence is strain- and dose-specific. Selected strains may be considered in appropriate children. Probiotics should not replace oral rehydration.
Can I Give Medicine to Stop My Child's Diarrhoea?
Some medicines, such as diosmectite or racecadotril, may be considered as adjuncts in selected children. They are not necessary for every child and should not replace oral rehydration. The appropriate treatment depends on your child's age, symptoms, severity and clinical condition.
What If My Child Is Vomiting and Cannot Drink?
Give small amounts of ORS frequently rather than offering a large amount at once. If vomiting is persistent and your child cannot keep fluids down, medical assessment may be needed. In selected cases, a doctor may consider medication to reduce vomiting and help the child tolerate oral rehydration.
How Do I Know If My Child Is Dehydrated?
Warning signs include passing urine less frequently, fewer wet nappies in babies, dry mouth or tongue, reduced tears, sunken eyes, poor drinking or feeding, increasing sleepiness or lethargy, weakness and reduced activity.
Is Blood in My Child's Stool Normal With Diarrhoea?
No. Blood in the stool is not typical of simple viral gastroenteritis and should be medically assessed. Depending on the clinical situation, further investigation or specific treatment may be needed.
When Should I Take My Child to See a Paediatrician?
Arrange a medical assessment if diarrhoea is frequent, persistent or worsening, your child has repeated vomiting, blood in the stool, persistent or high fever, significant abdominal pain, reduced drinking or fewer wet nappies, or appears increasingly unwell.
When Is Childhood Diarrhoea an Emergency?
Seek urgent medical care if your child cannot drink, has significant dehydration, persistent vomiting with inability to keep fluids down, severe abdominal pain, significant blood in the stool, is very sleepy, weak or difficult to wake, or is rapidly getting worse.
Key Takeaways
- The main concern with acute diarrhoea is dehydration.
- Oral rehydration solution (ORS) is the most important treatment for preventing and treating dehydration.
- Continue breastfeeding, milk feeds and age-appropriate foods as tolerated rather than unnecessarily fasting your child.
- Most childhood diarrhoea does not require antibiotics.
- Antibiotics should be reserved for situations where there is an appropriate clinical indication.
- Some probiotics may be considered as an adjunct, but their effects are strain- and dose-specific.
- Medicines such as diosmectite or racecadotril may be considered in selected children but are not substitutes for ORS.
- Persistent vomiting can make rehydration difficult and may require medical assessment.
- Blood in the stool, significant abdominal pain, persistent fever or a child who appears increasingly unwell should not be ignored.
- Babies and young children can become dehydrated quickly when they are losing fluids and unable to drink enough.
Paediatric Diarrhoea Assessment in Johor Bahru
Southern Child Specialist Clinic in Johor Bahru provides paediatric consultations for children with diarrhoea, vomiting, gastroenteritis, dehydration and other childhood gastrointestinal symptoms.
Our paediatric doctor can assess your child's symptoms, duration, stool pattern, hydration status, associated symptoms, recent food or medication history and possible causes, and advise whether further investigation or treatment may be appropriate.
Need a Paediatric Assessment?
Contact Southern Child Specialist Clinic to arrange a paediatric consultation.
Book a Paediatric Appointment If your child cannot drink, has significant dehydration, persistent vomiting, severe abdominal pain, significant blood in the stool, is difficult to wake, or appears seriously unwell, seek emergency medical care without delay.
