Diarrhoea

The main risk of diarrhoea in children is dehydration (too little fluid in the body). It is important to give your child lots to drink. Once any dehydration is treated with drinks you should allow your child to eat as normally as possible.

Dehydration in children with diarrhoea is more likely to occur in babies under the age of 1 year. Dehydration can also occur if older children don’t drink much when they have diarrhoea or in any baby or child with severe diarrhoea particularly if they are being sick as well.

Most children’s diarrhoea symptoms will be mild and will get better within a few days. However, you should seek medical advice if:

• Your child is under 6 months old
• Your child has another underlying medical condition
• Your child has a high temperature
• You suspect dehydration
• Your child appears drowsy or confused
• Your child is vomiting and unable to keep fluids down
• There is blood in their diarrhoea
• Your child has severe abdominal pain
• Your child’s symptoms are not settling after 3-4 days

You can check for the signs and symptoms of dehydration here.

There are various causes of diarrhoea, but a bowel infection is a common cause in both adults and children. This is known as gastroenteritis. This can be caused by:

• Viruses – such as norovirus or rotavirus
• Bacteria like E. coli or salmonella – these can all cause food poisoning
• Parasites such as Giardia and Cryptosporidium
• Anxiety
• Drinking too much alcohol, especially beer
• Food allergy
• Appendicitis
• Damage to the lining of the intestines as a result of radiotherapy

Diarrhoea can also be a side effect of medication. The instruction leaflet that comes with your medicine should state whether diarrhoea is a possible side effect.

• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD)
• Coeliac disease
• Bile acid malabsorption
• Chronic pancreatitis
• Diverticular disease
• Bowel cancer

Persistent diarrhoea can also sometimes occur after surgery on the stomach, such as gastrectomy or surgery that shortens the bowel (bowel resection).

Since most cases of diarrhoea get better within a week you will not need to visit your GP.

You should ensure that you have plenty to drink:

• As a rough guide, drink at least 200 mls after each bout of passing diarrhoea. This is extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day but more in hot countries. The above advice of 200 mls after each bout of diarrhoea is in addition to this usual amount that you would drink.
• If you have been sick (vomited), wait 5-10 minutes and then start drinking again but more slowly. For example, a sip every 2-3 minutes but making sure that your total intake is as described above.
• You will need to drink even more if you are dehydrated.
• For most adults, fluids used to keep hydrated should mainly be water. It is best not to have drinks that contain a lot of sugar as they can make diarrhoea worse.
• Rehydration drinks are recommended mainly for people who are frail, over the age of 60, or who have underlying health problems. They are made from sachets that you can buy from pharmacies without a prescription. You add the contents of the sachet to water. Rehydration drinks provide a good balance of water, salts and sugar. They do not stop or reduce diarrhoea. However, the small amount of sugar and salt helps the water to be absorbed better from the gut into the body.

It is fine to eat small, light meals if you can. You may not feel like eating and most adults can do without food for a few days. Eat as soon as you are able – but don’t stop drinking. If you do feel like eating, avoid fatty, spicy or heavy foods at first. Plain foods such as bread, potatoes, pasta, rice, soup and boiled vegetables are good foods to try eating first.

Medicines are not usually necessary. Painkillers will not treat diarrhoea, but paracetamol can help with fever or pain. Anti-diarrhoeal medications such as loperamide are not usually recommended for acute diarrhoea as it is better to expel the infectious cause. Antibiotics are not recommended for diarrhoea if the cause is unknown as they can make the symptoms worse.

You should speak your GP if you have diarrhoea and have any of the following symptoms or situations:

• You have symptoms of dehydration
• There is blood in your stool, or your stool is dark or black
• You are persistently vomiting and unable to keep fluids down
• You have severe tummy (abdominal) pain
• You have lost a lot of weight
• You have severe symptoms, or you are getting worse
• You have a persisting high temperature (fever)
• It occurs at night and is disturbing your sleep
• You have recently taken antibiotics or have been treated in hospital
• Your symptoms do not settle after up to a week
• Infections caught abroad
• You are elderly or have other underlying health problems or a known weakened immune system You are pregnant

Some infections causing diarrhoea are very easily passed on from person to person. If you have acute diarrhoea, the following are also recommended to prevent the spread of infection to others:

• Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water and wash your hands for at least 20 seconds. Dry properly after washing.
• Don’t share towels and flannels.
• Don’t prepare or serve food for others.
• Regularly clean the toilets that you use. Wipe the flush handle, toilet seat, bathroom taps, surfaces and door handles with hot water and detergent at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time).
• Stay off work, college, etc, until at least 48 hours after the last episode of diarrhoea or being sick (vomiting).
• Food handlers: if you work with food and develop diarrhoea or vomiting, you must immediately leave the food-handling area. For most, no other measures are needed, other than staying away from work until at least 48 hours after the last episode of diarrhoea or vomiting. Some special situations may arise and sometimes longer time off is needed. Specialist advice may be needed for some uncommon causes of infectious diarrhoea. If in doubt, seek advice from your employer or GP.
• If the cause of acute diarrhoea is known to be (or suspected to be) a germ called Cryptosporidium, you should not swim in swimming pools for two weeks after the last episode of diarrhoea.

Good food hygiene including washing fruit and salad well before eating, storing and preparing food in line with recommendations, not exceeding eat by dates on fresh food, ensuring that meat and fish are cooked properly, not leaving foods that should be refrigerated out for long, washing hands before eating or handling food etc. can reduce the risk of diarrhoea caused by food poisoning.

Rotavirus commonly causes diarrhoea in children. Your baby will be offered the rotavirus vaccine. The vaccine is given as a liquid that is dropped into the baby’s mouth.

For more information you can visit the NHS website.

Travellers’ diarrhoea can be avoided by practising good food and water hygiene while abroad. If you are planning a trip abroad, you can check this by visiting the National Travel Health Network and Centre (NaTHNaC).

Please see useful information on food poisoning and the norovirus on the NHS website (formerly known as NHS Choices).

• NHS Website: Diarrhoea and vomiting
• Patient info: Diarrhoea

Videos about diarrhoea

How to wash your hands | https://www.nhs.uk

NHS | published on 24 July 2017

How to prevent dehydration | https://www.nhs.uk

NHS | published on 24 July 2017