Traveler’s Diarrhea (Infant/Toddler)

Traveler’s diarrhea is an infection in the intestinal tract. It's usually caused by bacteria called E. coli. These bacteria are often found in water supplies in less developed countries. The local people of those countries are immune to E. coli and don’t get sick. Tourists who drink water or eat foods that were washed or prepared with this water may become very ill.

The illness begins 1 to 3 days after exposure. It can last up to 5 days, or sometimes longer. Symptoms include fever, vomiting, stomach cramps, and watery diarrhea. There may be blood or mucus in the stool. Mild cases will get better without treatment. Antibiotics are used for more severe cases.

The main danger from this illness is dehydration. This is the loss of too much water and minerals from the body. When this happens, body fluids must be replaced. This can be done with oral rehydration solution (ORS). Oral rehydration solution is available at pharmacies and most grocery stores.

Home care

Follow all instructions given by your child’s healthcare provider.

If giving medicine to your child:

  • Don’t give over-the-counter diarrhea medicines unless your child’s healthcare provider tells you to.

  • If antibiotics were prescribed, make sure your child takes them every day until they are finished. Don’t stop giving them if your child feels better. Antibiotics must be taken as a full course.

  • You can use acetaminophen or ibuprofen to control pain and fever. Or you can use other medicine as prescribed. Don’t give aspirin to anyone under 18 years of age who has a fever. This may cause liver damage and a life-threatening condition called Reye syndrome.

  • Sometimes your child's healthcare provider will prescribe medicine to stop the vomiting. Give it only as directed. If the vomiting continues with taking the medicine, contact your child's healthcare provider.

To prevent the spread of illness:

  • Remember that washing with soap and water is the best way to prevent the spread of infection.

  • Wash your hands before and after caring for your sick child.

  • Clean the toilet after each use.

  • Dispose of soiled diapers in a sealed container.

  • Keep your child out of day care until your child's healthcare provider says it's OK.

  • Wash your hands before and after preparing food.

  • Wash your hands after using cutting boards, countertops, and knives that have been in contact with raw foods.

  • Keep uncooked meats away from cooked and ready-to-eat foods.

  • Keep in mind that people with diarrhea or vomiting should not prepare food for others.

Giving liquids and feeding

The main goal while treating vomiting or diarrhea is to prevent dehydration. This is done by giving small amounts of liquids often. Liquids are the most important thing. Don’t be in a rush to give food to your child.

If your baby is breastfed:

  • Keep breastfeeding. Feed your child more often than usual.

  • If diarrhea is severe, give oral rehydration solution between feedings.

  • As diarrhea decreases, stop giving oral rehydration solution and resume your normal breastfeeding schedule.

If your baby is bottle-fed:

  • Give small amounts of fluid at a time, especially if your child is vomiting. Give fluid 1 to 2 ounces every 30 minutes. This may improve symptoms.

  • Give full-strength formula or milk. If diarrhea is severe, give oral rehydration solution between feedings.

  • If giving milk and the diarrhea is not getting better, stop giving milk. In some cases, milk can make diarrhea worse. Try soy or rice formula.

  • Don’t give apple juice, soda, or other sweetened drinks. Drinks with sugar can make diarrhea worse.

  • If your child is doing well after 24 hours, resume a regular diet and feeding schedule.

  • If your child starts doing worse with food, go back to clear liquids.

If your child is on solid food:

  • Keep in mind that liquids are more important than food right now. Don’t be in a rush to give food.

  • Don’t force your child to eat, especially if he or she is having stomach pain, cramping, vomiting, or diarrhea.

  • Don’t feed your child large amounts at a time, even if he or she is hungry. This can make your child feel worse. You can give your child more food over time if he or she can tolerate it.

  • Give small amounts at a time, especially if your child is having stomach cramps or vomiting.

  • If you are giving milk to your child and the diarrhea is not going away, stop the milk. In some cases, milk can make diarrhea worse. If that happens, use oral rehydration solution instead.

  • If diarrhea is severe, give ORS between feedings.

  • If your child is doing well after 24 hours, try giving solid foods. These can include cereal, oatmeal, bread, noodles, mashed carrots, mashed bananas, mashed potatoes, applesauce, dry toast, crackers, soups with rice noodles, and cooked vegetables.

  • For a baby over 4 months, as they feel better, you may give cereal, mashed potatoes, applesauce, mashed bananas, or strained carrots, during this time. A baby over 1 year may have crackers, white bread, rice, and other starches.

  • If your child starts doing worse with food, go back to clear liquids.

  • You can resume your child's normal diet over time as he or she feels better. If the diarrhea or cramping gets worse again, go back to a simple diet or clear liquids.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. If a stool sample was taken or cultures were done, call the healthcare provider for the results as instructed.

Call 911

Call 911 if your child has any of these symptoms:

  • Trouble breathing

  • Confusion

  • Extreme drowsiness or trouble walking

  • Loss of consciousness

  • Rapid heart rate

  • Stiff neck

  • Seizure

When to call your child's healthcare provider

Call your child’s healthcare provider right away if any of these happen:

  • Belly pain that gets worse

  • Constant lower right belly pain

  • Repeated vomiting after the first 2 hours on liquids

  • Occasional vomiting for more than 24 hours

  • Continued severe diarrhea for more than 24 hours

  • Blood in stool

  • Refusal to drink or feed

  • Dark urine or no urine for 8 hours, no tears when crying, sunken eyes, or dry mouth

  • Fussiness or crying that cannot be soothed

  • Unusual drowsiness

  • New rash

  • More than 8 diarrhea stools within 8 hours

  • Diarrhea lasts more than 1 week on antibiotics

  • A child has a fever (see Fever and children, below)

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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