Diarrhea in babies and toddlers: what to feed

Is it diarrhea?

Diarrhea means poop that is suddenly looser, more watery and more frequent than usual. The WHO defines it as 3 or more loose or liquid poops a day, or more often than is normal for that child. Soft, pasty poop in a breastfed baby isn’t diarrhea, and neither is frequent, formed poop (WHO).

Most diarrhea in young children is caused by viruses and goes away on its own (AAP), usually within 5 to 7 days (NHS).

If poop turns very loose, watery or full of mucus after new foods, the AAP suggests slowing down with solids and talking to your doctor if it carries on. See baby poop after starting solids.

Keep up milk feeds

Fluids matter most. The AAP says the most important part of treating diarrhea is preventing dehydration.

• Breastfeeding: carry on. The AAP says breastfeeding should continue, and many breastfed babies stay hydrated with frequent feeds alone. If your baby is also being sick, offer small feeds more often (NHS).
• Formula: keep giving it at its usual strength. Never make it weaker (NHS).
• Cow’s milk (over 12 months): most children with mild diarrhea can keep having it (AAP). If milk or formula seems to make them bloated or gassy, ask your doctor before pausing it or switching to lactose-free milk.

Carry on with solids

The AAP says fasting is not a treatment for diarrhea, and most children with mild diarrhea don’t need to change their diet at all.

• Mild diarrhea, no vomiting: offer your child’s usual foods and let them eat as much or as little as they want (AAP).
• Diarrhea with vomiting: the AAP says to pause your child’s usual diet while they take small, frequent amounts of oral rehydration solution, usually for only 1 to 2 days, then slowly go back to their usual foods as the vomiting eases. Keep breastfeeding.
• Very watery poop every 1 to 2 hours, with signs of dehydration: call your doctor. The AAP says your child may need to stop solid food for a short time (a day or less) and focus on fluids, on your doctor’s advice.
• The BRAT diet isn’t needed. The AAP says bananas, rice, applesauce and toast are no longer considered useful. With mild diarrhea, aim for a normal diet for your child’s age within about 24 hours (AAP). The WHO also says to keep giving nutrient-rich foods, including breast milk.

Offer familiar foods in a safe form for your child’s age, such as soft banana, plain yogurt, oatmeal, chicken, sweet potato or lentils. Hold off on brand-new foods and first tastes of allergens until your child is well.

Poop may stay loose for a while. The AAP says that’s fine as long as your child is more active, eating better, peeing more often and showing no signs of dehydration.

Oral rehydration solution: only as your doctor advises

Oral rehydration solution (ORS) is a store-bought drink with the right balance of water, salts and sugar to replace what diarrhea takes out (AAP, WHO).

• Most children with mild diarrhea don’t need it (AAP).
• It helps with moderate diarrhea, or diarrhea with vomiting. Give it in small amounts, often, as your pediatrician, GP or pharmacist directs (AAP).
• Don’t make your own at home. The AAP says use only a ready-made solution.

For more on fluids, vomiting and medicines, see feeding a sick baby.

Drinks to skip

• Fruit juice, soda and fizzy drinks can make diarrhea worse (NHS). The AAP adds soups, sports drinks and boiled milk: they have the wrong amounts of sugar and salt and may make your child sicker.
• Juice can cause diarrhea in the first place. The AAP says too much juice or sweet drinks can cause ongoing loose poop in toddlers (“toddler’s diarrhea”), and that toddlers should mainly drink water and milk. No juice at all under 12 months (AAP). See juice for babies.
• No medicine to stop diarrhea for young children, and no homemade remedies (AAP). Ask your doctor first (see below for age limits).

Signs of dehydration

Call your child’s doctor right away if you see any of these (AAP). In the UK, call 111 if a child under 5 has signs of dehydration, such as fewer wet nappies (NHS).

• fewer wet diapers than usual (for babies, the AAP uses fewer than 6 a day)
• a dry mouth
• fewer tears when crying
• a sunken soft spot (fontanelle) on top of the head
• playing less than usual

Signs of severe dehydration include being very fussy or very sleepy, sunken eyes, cool or discolored hands and feet, wrinkled skin, and peeing only once or twice a day (AAP). Call 911 or go to the emergency room.Call 999 or go to A&E.Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department.

When to call the doctor

Call your pediatrician, GP or health visitor if your child has diarrhea and:

• is under 12 months old and you’re worried about them (NHS)
• stops breastfeeding or bottle feeding (NHS), or won’t eat or drink (AAP)
• has blood in their poop, or bleeding from the bottom (AAP, NHS)
• has a fever for more than 24 hours and is under 2 years old (AAP), or a fever of 38°C (100.4°F) or higher for more than 5 days (NHS), or a fever with repeated vomiting (AAP)
• is under 3 months old with a temperature of 100.4°F (38°C) or higher: call right away, day or night (AAP; in the UK, call 999, see below)
• is vomiting for more than 12 to 24 hours (AAP), or keeps being sick and can’t keep fluids down (NHS)
• has a swollen tummy, severe tummy pain, a rash that fades when you press it, or yellow skin or eyes (AAP)
• has very watery poop every 1 to 2 hours or more often (AAP)
• has had diarrhea for more than 7 days (NHS)

Trust your instincts. If you think something is seriously wrong, get help.

When to get emergency help

Call 911 or go to the emergency room if your child:Call 999 or go to A&E if your child:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your child:

• has green or yellow-green vomit, vomits blood, or has vomit that looks like coffee grounds (NHS). The AAP names vomit that looks green, tinged with blood or like coffee grounds.
• has a sudden, severe tummy ache (NHS)
• is floppy, very sleepy, hard to wake or not responding as usual (NHS)
• is struggling to breathe, or breathing very fast (NHS)
• has swollen lips, tongue or throat, or trouble swallowing or talking (NHS)
• has blue, gray, pale or blotchy skin, lips or tongue (on brown or black skin, this may be easier to see on the palms or soles) (NHS)
• has skin that feels cold or clammy (NHS)
• has a rash that doesn’t fade when you press it (NHS)
• has a stiff neck, or pain when looking at bright lights (NHS)
• has a weak, high-pitched or nonstop cry (NHS)
• has a seizure (fit) (NHS)
• vomits again and again a few hours after eating a food, which can be FPIES, a delayed food reaction (see FPIES)
• hasn’t had a wet diaper or peed in 12 hours (NHS)
• is under 3 months old with a temperature of 38°C or higher, or 3 to 6 months old with 39°C or higher (NHS)is under 3 months old with a temperature of 100.4°F (38°C) or higher and you can’t reach your doctor right away (AAP)
• shows signs of severe dehydration (AAP)

Stopping it spreading

Wash your hands with soap and water often, especially after diaper changes, and keep your child home until there’s been no diarrhea or vomiting for at least 2 days (NHS). If it may have come from food, see food poisoning in babies. If diarrhea keeps coming back after certain foods, talk to your doctor: see food allergy vs intolerance and FPIES. If your baby vomits once or twice a few hours after a food and is alert and like themselves, call your pediatrician or GP; vomiting again and again is on the emergency list above.

Where US and UK advice differs

• Water. The NHS says babies on formula or solid food can have small sips of water between feeds. The AAP says that with severe diarrhea, children should avoid drinks very low in salt, like water and tea, and use an oral rehydration solution as their doctor directs.
• Anti-diarrhea medicine. The AAP says over-the-counter anti-diarrhea medicines aren’t recommended under 2 years, and to ask your doctor at any age. The NHS says not to give children under 12 medicine to stop diarrhoea, and to give loperamide under 12 only if a doctor prescribes it.
• Fever in young babies. Under 3 months, the AAP says call your doctor right away; the NHS says call 999 (see the emergency list above).
• Who to call. In the US, call your pediatrician’s office.In the UK, call NHS 111 or use 111 online. They can arrange a call back from a nurse or doctor.Call your doctor or your local health advice line.