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Infant and Child Health

Diarrhea and Vomiting

Home Treatment - When to Call a Health Professional

Diarrhea and vomiting may be caused by viral stomach flu or by eating unusual kinds or amounts of food. An infant's developing

digestive system sometimes will not tolerate large amounts of juice, fruit, or even milk. Breast-fed babies are less likely to develop diarrhea.

Stomach flu often starts with vomiting that is followed in a few hours (sometimes 8 to 12 hours or longer) by diarrhea. Sometimes there is no diarrhea.

Infants and children under age 4, and especially those younger than 6 months of age, need special attention when they have diarrhea or are vomiting, because they can quickly become dehydrated. Careful observation of the child's appearance and fluid intake can help prevent problems. For children age 4 and older, see Diarrhea on See Diarrhea and Vomiting on See Nausea and Vomiting.

Home Treatment

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Newborn to 2 years:

  • If the baby is breast-fed, continue breast-feeding. If the diarrhea gets worse (larger, more frequent stools), or if the child is vomiting,

    Child Car Seats

    Infant and child car seats save lives. Most provinces require them for all children under age 4 and those weighing less than 18 kg (40 lb). Children who are not in car seats can be seriously injured or killed during crashes or even abrupt stops at low speeds. For maximum safety, follow the manufacturer's recommendations for car seat use.

    All children under age 12 should be in the back seat, especially if the car has air bags.

    Infants under 9 kg (20 lb): Use an infant car seat that reclines and faces the rear.

    Children over 9 kg (20 lb) and older than 1 year: Use a toddler seat that faces the front of the car and has a shield or harness. Some infant seats can be converted to toddler seats.

    Children over age 4 and over 18 kg (40 lb): Use a booster seat that raises the child so he or she can see out of the window. Use regular lap and shoulder belts. Adjust the shoulder belt to fit across the shoulder, not the neck.

    Set a good example for your children by always wearing your own seat belt, and always insist that they buckle up.
supplement feedings with a children's oral electrolyte solution (such as Pedialyte, Gastrolyte, or a store brand).

  • If the baby is formula-fed, switch to an oral electrolyte solution. Gradually add back formula feedings within 24 hours. Start giving the usual amount of formula within another day.

  • For children over 6 months of age, you can improve the taste of the oral electrolyte solution by adding a pinch of NutraSweet or sugar-free Kool-Aid or Jell-O powder.

  • Don't use sports drinks, fruit juice, or soda to treat dehydration. These drinks contain too much sugar and not enough of the minerals (electrolytes) that are being lost.

  • Don't use oral electrolyte solutions as the sole source of fluid for more than 12 to 24 hours.

  • After 12 to 24 hours, offer the child solid foods if he or she was eating solids before. Allow the child to eat what he or she prefers; the particular food is not important. Avoid high-fibre foods, such as beans, and foods with a lot of sugar, such as juice and ice cream.

  • Protect the diaper area with Barriere cream or zinc oxide cream. Diaper rash is common after diarrhea.

Children older than 2 years:

  • Give 120 to 240 ml ( 0.5 cup to 1 cup) of a children's oral electrolyte solution each hour. Give small sips even if the child is vomiting. Add Nutra-Sweet flavourings if needed.

  • Diluted Gatorade or sports drinks may be used temporarily if the diarrhea is mild to moderate, but oral electrolyte solutions are better. Don't give fruit juice or soda.

  • Offer easily digestible foods (cooked cereal, toast, crackers) in addition to the oral electrolyte solution. Resume a regular diet within a day or so. Don't use an electrolyte solution as the sole source of fluids and nutrients for more than 24 hours.

As the child gets better, the stools will become smaller and less frequent. Some types of diarrhea may cause watery stools for 4 to 6 days. Watch for signs of dehydration (See Dehydration). You can treat the illness at home as long as the child is taking in enough fluids and nutrients, is urinating normal amounts, and seems to be improving.

When to Call a Health Professional

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  • If vomiting occurs with severe headache, sleepiness, lethargy, or a stiff neck. See "Encephalitis and Meningitis" on See Encephalitis and Meningitis.

  • If the diarrhea is bloody, tarry, or dark red.

  • If the urine becomes bloody or cola-coloured.

  • If there is blood in the vomit.

  • If signs of severe dehydration appear (also See Dehydration):

    • Sunken eyes, no tears, dry mouth and tongue.

    • Sunken soft spot (fontanelle) on an infant's head.

    • Little or no urine for 8 hours.

    • Skin that is doughy or doesn't bounce back when pinched.

    • Rapid breathing and heartbeat.

    • Sleepiness, lethargy, listlessness, and extreme irritability.

  • If a child with diarrhea or vomiting refuses to drink or cannot take in enough liquid to replace lost fluids.

  • If severe vomiting (vomiting most or all clear liquids and feedings) occurs in an infant younger than 3 months of age. In older children, call if severe vomiting continues:

    • Longer than 4 hours in an infant age 3 to 12 months.

    • 8 hours in a child age 1 to 3 years.

  • If occasional vomiting occurs without other symptoms and the child is able to keep fluids down between vomiting episodes, call if this continues longer than:

    • 1 to 2 days in an infant under 3 months of age.

    • 2 to 4 days in an infant age 3 to 6 months.

    • 1 to 2 weeks in a child age 7 months to 3 years.

  • If severe diarrhea (large loose stools every 1 to 2 hours) continues for longer than:

    • 4 hours in an infant under 3 months of age.

    • 8 hours in an infant age 3 to 6 months.

    • 1 to 2 days in a child age 7 months to 4 years.

  • If mild to moderate diarrhea continues without obvious cause or other symptoms for longer than:

    • 24 hours in an infant under 3 months of age.

    • 1 to 2 days in an infant age 3 to 6 months.

    • 4 to 7 days in a child age 7 months to 4 years.

  • If the child has a fever of 38.9°C (102°F) or higher, or a lower fever with diarrhea for more than 2 days.

  • If the child has stomach pain that:

    • Is severe.

    • Is persistent, with frequent vomiting for more than 12 hours but little or no diarrhea.

    • Starts several hours before the vomiting begins and seems like more than just stomach cramps.

    • Is localized to 1 quadrant of the abdomen, especially the lower right quadrant. See illustration on See If you have abdominal pain, it helps to tell your doctor exactly where the pain is.. This may be difficult to determine in a small child.

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