Ask Dr. Marla: My eight-month-old has had diarrhea for more than four weeks. What should we do?

By Dr. Marla Shapiro on June 13, 2013
My eight-month-old daughter has had diarrhea for more than four weeks. We have bounced around from walk-in clinic, to our family doctor, to the hospital trying to get to the bottom of it, but with no success. Diagnoses have ranged from teething to a virus. She has had fevers on and off and is pulling and poking at her right ear. Since she is not dehydrated, the doctors have all said she is fine and it will resolve itself. Do you have any advice?

Answer:

There really are two parts to this answer. First, the most important thing is have continuity of care rather than the fragmented care you have had. You have – in your words – bounced around to different healthcare situations and in many of these, there is no continuity of care and no one who sees the whole picture. If you had been seeing one physician throughout her illness, it would be clearer if this was all one illness or a series of episodic unrelated illnesses.

The second part of the question is about diarrhea – what is it and what is causing it. The Hospital for Sick Children describes diarrhea as frequent bowel movements that are loose or watery. First I would find out exactly what you mean when you say diarrhea. You may have been asked similar questions to these:
  • How many bowel movements is she having each day?
  • What is their consistency?
  • What were her bowel movements like before? • Did the change in bowel movements coincide with a dietary change or travel abroad?
  • Are there any other signs such as an ongoing fever and if so, how high is it?
  • Is anyone else at home experiencing a change in their bowel movements?
  • Has your child lost any weight?

Possible causes

Diarrhea is typically caused by a virus, bacteria or parasite. It is often caused by an infection that involves the lining of the intestines. While other primary illnesses might have loose stools associated with it, teething and ear infections will not cause ongoing diarrhea for more than the four weeks you are noting.

Antibiotics can also cause diarrhea. (Was your child given an antibiotic prior to these complaints?) Medical conditions called malabsorption syndromes can also affect food absorption from the bowels. It is most critical to make sure that your child is well nourished and hydrated.

You have not said your child has been vomiting or described mucus or blood in the stool, which is very reassuring. You can continue a normal diet at this time.

Next steps

Go back to your primary care provider. Document how many stools a day your child is having, any other signs such as blood or mucus in the stool and any relation between bowel movement and time of eating. Your physician might refer your child to a gastroenterologist to make sure there is no issue with malabsorption or any other underlying cause of the ongoing loose stool.

Got a health question? Submit it to Dr. Marla.

Originally published in ParentsCanada magazine, July 2013.

By Dr. Marla Shapiro| June 13, 2013

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