Fortunately, most cases of intestinal problems aren't serious, and the vast majority of them resolve without any medical intervention. The culprit in most cases is viral, meaning that the infection will get better without any antibiotics. This also means that doing additional blood or stool laboratory tests is not only unnecessary but impractical. Plus, not many parents look for the opportunity to collect their toddler's stool sample and send it to the laboratory for analysis.
Treating a toddler who has the runs can be extremely frustrating. You have to make sure that your child is drinking enough fluid to prevent getting dehydrated. And you cannot use any antidiarrheal medication for your child.
The best fluid to offer your child initially is water. If she is unable to keep water down, she will not be able to drink anything else. It is essential to offer the fluid slowly, perhaps one teaspoon at a time. You cannot allow your child to gulp the fluid down, even if she is very thirsty. Doing so will only overwhelm an irritated stomach and cause her to throw everything back up.
Antidiarrheal medications that are made for adults, such as Imodium and Lomotil, are dangerous for children. Excessive doses of these medications can suppress normal breathing in children younger than two years old, and children have died from taking these medications. Pediatricians never recommend the use of these products for children with diarrhea caused by stomach viruses.
Once your child is able to drink water slowly, the next best thing is to offer some standard oral rehydration solution. Many commercial products will do the trick, but the one that tastes best is called Liquilyte. This is a standard rehydration solution made by Gerber, the famous baby food manufacturer. The well-known Pedialyte tastes horrible in comparison. (Try it yourself if you haven't lately. You'll find that it tastes pretty much like sea water, so don't be surprised if your child refuses Pedialyte.)
Juices and sport drinks like Gatorade or Powerade should be avoided. Even though they do provide fluid and some salt, they also contain too much sugar. Taking an excessive amount of these types of drinks can sometimes worsen and prolong diarrhea. Soft drinks are bad for the body at any time, and times of stomach problems are no exception.
Most physicians now recommend early reintroduction of solid foods to children with vomiting and diarrhea. Doing so shortens the course of the illness and prevents excessive weight loss. Numerous studies have shown that introduction of solids (including dairy products) does not induce more diarrhea or increase stool volume. For the same reason, if you're breastfeeding, you should continue to do so during the diarrheal episodes.
While it is a good idea to avoid high-fat foods, you should not withhold all food from a child with vomiting and diarrhea. If your child refuses solids, do not force him to eat. On the other hand, if he asks for solid foods, you should allow him to eat. Remember to offer small portions at first because his stomach will still be sensitive from the infection.
Pins and Needles
Many parents and doctors have developed the habit of using an intravenous solution to rehydrate any child who has dehydration, even if the dehydration is mild. People are jumping the gun by pulling out the needle and sticking children on a routine basis, even if these children could drink fluid by mouth. For this situation, the advancement of medical technology may actually be a disservice. Oral rehydration protocols used in developing countries are in fact a safer alternative to intravenous fluids.
Most parents regard IV hydration as a completely risk-free procedure, but this is far from the truth. The process of inserting a needle into a vein carries a small but real risk of infection, and pumping fluid directly into the vein can carry the risk of introducing air into the bloodstream. This could potentially be a dangerous situation.
If your child can drink fluid by mouth slowly and is not severely dehydrated, there is absolutely no need to put an IV into your child and load up the body with fluid via a needle. Even though IV fluid has its place in reversing severe dehydration, parents tend to put the pressure on the doctor to immediately resort to IV fluid or even hospitalization. When push comes to shove, some doctors might figure it's easier to give in to parental demand and carry out the unnecessarily invasive medical intervention.
To BRAT or Not to BRAT
Should your child avoid dairy products or milk when she has diarrhea? Theoretically, it sounds reasonable. Scientists know that the tissue responsible for digesting milk sugar is located on the surface of the intestine. During a diarrheal illness, the surface of the intestine gets somewhat damaged. In the past, physicians intuitively assumed that children's ability to digest milk during and after a diarrhea is impaired.
This may sound good on paper, but thank goodness that someone actually looked into this and tried to prove its validity. It turns out that this assumption is incorrect. In fact, those children who kept their diet pretty much the same during an episode of vomiting and diarrhea (including taking in dairy products) actually got better faster than those who had their diet restricted.
Babies who are drinking milk should stay on their usual milk when they have diarrhea. You should not dilute the formula or breast milk in any way during a diarrheal illness, and you should not feed your baby water until she is six months old.
The age-old wisdom of a BRAT (bread, rice, apple sauce, toast) diet in rehabilitating an irritated intestine has never had any scientific backing, yet doctors and nurses around the world still give this advice every day. Correcting the assumption that this is the best diet for a diarrheal child is a daunting task for a pediatrician, especially given that most parents at one time or another have heard this BRAT advice from a health professional. It is a great deal more difficult to discredit information that comes from a fellow health-care worker, and this old-school (and incorrect) way of thinking is ingrained in many parents' minds.
The best way to feed your diarrheal child is to continue his usual diet while excluding any fluids high in sugar (such as juice, soda, sport drinks). Unnecessarily restricting your child's diet during a bout of diarrhea is harmful.