Sudden diarrhea and/or vomiting is usually caused by an infection in the gut. It is usually a virus but may also be caused by bacteria or a parasite. As well as the diarrhea and vomiting, the toddler may also have a fever, tummy pain, and cold symptoms (runny nose and cough).
It’s often confusing sorting out viral diarrhea from loose poo caused by food, medication, or an upper respiratory, urinary tract, or ear infection. If you are ever in any doubt about the cause of your toddler’s diarrhea seek help from your nurse practitioner, pediatrician, or nearest children’s hospital.
• Medication is not a part of treatment for most infectious diarrhea. Antibiotics are only used occasionally for a specific, diagnosed bacterial infection.
• Drugs to stop vomiting cause a range of side effects, which include spacing out, strange behavior and rolling back of the eyes. Vomiting in gastroenteritis is usually of short duration, but if it continues, it needs to be assessed, not suppressed.
• Medications such as adults take to stop the diarrhea are dangerous for toddlers and should not be used.
• Most toddlers with diarrhea are not in danger and can be treated at home with simple dietary measures.
Give small amounts of clear fluids only (2 ozs.–3ozs.) every fifteen to thirty minutes for twenty-four hours (no need to wake during the night unless you are instructed to). If you are still breastfeeding, continue breastfeeding.
| • A commercial preparation such as Pedialyte: | Make as directed. |
| • White grape juice | 1 cup to 4 cups tap water |
| • Rice water: | Boil ¾ cup of white rice in 7 cups litres of water until the water is milky—not too thick! Strain the rice and add four flat teaspoons of sugar to every 32ozs. (4 cups) of rice water. |
• A commercial preparation such as Pedialyte is not a medication. It is a fluid replacement to prevent dehydration.
• Toddlers with simple diarrhea do not need commercial preparations. Any of the other suggested fluids are fine.
• Follow the guidelines for the addition of sugar closely. A small amount of glucose or sucrose helps the toddler absorb fluid more efficiently and makes the fluid more palatable, but too much causes more diarrhea. Do not give undiluted flat lemonade—the sugar content is too high.
• After twenty-four hours of clear fluids, start your toddler back on a normal diet as soon as possible, but continue to give food in frequent, small amounts for a few days. Make sure some fat is introduced during the second twenty-four-hour period (for example, breastmilk, milk, yogurt) as constant clear fluids, fruit and veggies alone aggravate acute diarrhea.
• Sometimes toddlers develop a temporary lactose intolerance following gastroenteritis, which means their watery diarrhea comes back once full-fat milk is reintroduced. When this occurs, lactose-free milk is required for two to three weeks until the bowel recovers.
• Most toddlers respond well to these simple measures, but unfortunately there are times when the correct advice is not given or parents and health professionals underestimate the severity of the illness.
• You are worried.
• Your toddler keeps vomiting and cannot keep any fluids down or is vomiting and pooing simultaneously at an alarming rate.
• You see blood in your toddler’s poo.
• Your toddler suffers from other illnesses such as diabetes, heart disease, urinary tract infections, or is on any medication.
• Your baby is lethargic, drowsy, has a dry mouth, and is passing less urine than normal.
• You are given a diagnosis of teething (growing teeth do not cause diarrhea).
When this happens to a well, happy toddler, it is difficult to decide whether or not to start the diarrhea regime, as the toddler is likely to get very irritable and very hungry. It’s usually best to wait one or two days and see what develops.
Continuing loose poo in an otherwise well toddler can go on for some time after an episode of viral diarrhea. It’s inconvenient and messy but harmless and eventually stops.
Remember, continual bottles of juice and formula exacerbate loose poo. If your toddler is still having bottles, keep to two or less a day and juice only once a day. Try water at other times when he is thirsty. Better still, ditch the bottles.
Head colds are caused by viruses, which damage the mucous membranes of the nose and throat. This is what causes the runny nose, the sore throat and eyes, the cough, and sometimes a headache and fever. Toddlers are likely to catch around eight colds a year.
Complications from head colds, such as ear or chest infections, are more common in toddlers. As well, the extra mucus generated by a cold and the cough often seem to hang around forever in toddlers, even after the cold gets better.
Head colds without a fever are not helped a great deal by any of the various medications commonly suggested.
Viruses are the cause of most head colds, so antibiotics (which fight bacteria) are unlikely to do a lot. Antibiotics can cause diarrhea and yeast infections, so their use often complicates head colds in toddlers rather than having any beneficial effect.
Over-the-counter drugs which dry up the mucus may help.
Unfortunately there is no magic potion to make colds get better quicker. Treatment always involves relieving the symptoms.
• Try a vaporizer. Despite the fact that research shows vaporizers make very little difference, lots of the parents I talk to find they help.
• A little Vicks Vapor Rub rubbed onto your toddler’s chest after a warm bath will make you both feel better (I can still remember my mother doing that).
• If your toddler has a head cold with a fever above 100.5°F and/or is feeling miserable, use one of the acetaminophen or ibuprofen preparations to help him feel better and bring the fever down. Dress him lightly, give extra fluids, and use the above medication every four hours until the fever subsides or he is feeling better.
• The mucus trickling down the back of your toddler’s throat is usually the cause of the coughing that accompanies a head cold. If there is a lot of coughing, check in with your doctor to make sure there is no chest infection.
• It’s wise to consult your doctor if you are worried or if your toddler has breathing difficulties, wheezes, or suddenly refuses to eat or drink.
Impetigo is a bacterial infection of the skin. There are two forms. The most common in the toddler years occurs when a lesion on the skin becomes infected, usually because the toddler scratches it. The lesion has a crusty appearance, underneath which is a moist red area. The lesion slowly enlarges and spreads. Often pus is present and other lesions may start to appear.
Impetigo is more likely to appear on exposed parts of the body (arms, legs, and face) and is often associated with itchy eczema or with a graze or an insect bite that has been picked or scratched.
Impetigo can also appear as large blisters which erupt, leaving moist areas with a brown crust that continues to expand rapidly.
Impetigo is highly infectious but responds rapidly to oral and local antibiotics. See your pediatrician immediately.
Pneumonia is a viral or bacterial infection that causes swelling and blockage of sections of the lung. It is also often referred to as a chest infection.
Pneumonia occurs at all ages but is more common in babies and toddlers.
Pneumonia may follow a mild infection of the nose and throat. It can be tricky to diagnose initially as the symptoms vary greatly and can be very subtle. For example, neck stiffness, lack of energy and loss of appetite, fever and tummy pains. Other symptoms include rapid breathing, grunting while breathing, and a bluish tinge around the mouth. A chest X-ray is usually needed to confirm the diagnosis.
Antibiotics are used when bacteria cause the infection. Serious pneumonia needs hospitalization for intravenous therapy to administer fluids and antibiotics (if appropriate). Acetaminophen is used for pain and fever. Recovery usually takes seven to ten days.
Ringworm is not actually a worm but a spreading area of infected skin. A fungus causes the infection. Ringworm can be found in different areas of the body (hair, skin, nails, torso, feet) and looks different depending on where it is located. A variety of fungi can be responsible for causing ringworm, including some that can be transmitted from infected animals (particularly cats, dogs, and goats). The two most common forms of ringworm in toddlers are of the skin or scalp.
Ringworm on the skin tends to be oval-shaped (hence the name) scaly patches. The outer edge is usually reddish and clearly defined. The edges may contain pus or fluid or may be dry and scaly or moist and crusty (take your pick). The center of the patch is clear and may look as if it is healing.
The infection causes hairless patches of varying manifestations depending on the specific infecting fungus. There may be itching, redness, scaling, and pus or large pus-filled swellings.
Correct diagnosis is crucial and diagnosis may require microscopic identification to detect the type of fungus involved. Ringworm of the skin responds to the application of a local antifungal preparation. Ringworm infections of the scalp usually need oral medication, as local preparations cannot get to the base of the hair follicles where the fungus is lurking.
Treatment also includes examination and treatment of household pets if appropriate.
