When It's Time to Change, The D's Edition: Diarrhea Do’s & Don’t’s and Diaper Rash

By: Michelle Place, CRNP-P
Sometimes baby’s stools are on the other end of the spectrum and come out much looser than usual. Most often this is the result of a virus. 
Avoid Dehydration
The most important thing you can do is make sure your baby remains well hydrated because they lose a lot of extra fluid in these watery stools. They may not want to eat as usual so if you need to push anything, push fluids. You can continue breast/formula feeding plus you can offer water or pedialyte. Avoid large amounts of juice which can make diarrhea worse. You want to make sure your baby continues to make urine.They should have a wet diaper 3-4 times in a 24 hour period. They do not have to be huge, heavy, wet diapers there just needs to be some urine. 
What About Food?
If your baby is not vomiting along with the loose stools it is fine to feed them through it. The B.R.A.T. diet consists of foods that will help firm up your child’s stools and includes Bananas – Rice – Applesauce – Toast. You may want to avoid spicy foods. If diarrhea worsens or your baby seems very gassy or bloated you should avoid dairy products or switch temporarily to a lactose-free formula until diarrhea resolves.
How Long Will This Last?
Once diarrhea starts it can take up to 2 weeks for your baby’s stools to get back to their normal texture. In the intestine there are fingerlike projections of tissue called villi that act to increase the surface area for absorption of nutrients and fluid as digested food passes through. When a stomach bug occurs, the villi flatten out and the digested food rushes through the intestine so fast there is not time for all of the fluid to be absorbed. It takes a good 2 weeks for these villi to pop back in place in order to slow the flow back to it’s normal pace. In the meantime, here is what you should do (and what you should not) when your child has diarrhea:

  • Do:
  1. If it is mild: continue normal diet including breast milk or formula, you may need to feed smaller portions of bland foods. Follow the B.R.A.T. diet.
  2. Watch for dehydration: decreased urine output, no tears, fever, dry mouth, no playful periods, or sunken eyes
  3. Use: replacement fluids like pedialyte
  4. Offer probiotics: you can buy them over the counter or feed your child yogurt
  5. Report: blood in the stool or high fever (> 102 F)
  • Don’t:
  1. Make your own replacement fluid
  2. Use over the counter “anti-diarrhea” medications like Imodium or Pepto-Bismol

Diaper Rash

  • In a given 2 month period more than half of babies 4-15 months old develop diaper rash at least once 
  • First sign: redness or small bumps on skin surfaces which are in direct contact with the diaper
  • Once the surface of the skin is damaged it is more vulnerable to further irritation and infection from bacteria and yeast
  • Usually diaper rash occurs less frequently in breastfed babies
  • Occurs more frequently in:
  1. Babies 8-10 months old, due to changes in diet
  2. After diarrhea due to irritation from frequent stools
  3. Treatment with antibiotics because drugs encourage the growth of yeast
  4. Babies who are not kept clean and dry
  • What to do:
  1. Frequent diaper changes; super absorbent diapers wick moisture away from the skin which decreases diaper rash
  2. Keep open to the air as much as possible
  3. Avoid wipes- especially those containing alcohol or fragrances
  4. Cleanse with a soft cloth and plain water; use soap only when necessary
  5. Use a spray bottle and gently pat dry, do not rub
  6. Soak in an oatmeal/baking soda bath
  7. Use an oil-based barrier=ointment, zinc oxide or petroleum jelly; thick and pasty; you do not need to completely remove all zinc from baby’s skin with each diaper change
  8. Call MD if:
  • It is not going away or looks worse 2-3 days after treatment
  • Develops blisters or pus-filled sores
  • Rash is bright red with red spots at the edges
  • Develops fever
  • The rash is very painful