Diarrhea has many causes ranging from excess juice intake to serious infectious causes. Your child’s physician should be made aware of the diarrhea and will provide guidelines regarding when your child should be seen regarding this problem.
Most pediatricians do not recommend routine use of anti-diarrhea medications in children. There are several reasons for this:
- There is concern that diarrhea, when of an infectious cause, is useful means that the body has of expelling harmful substances. Therefore, slowing diarrhea may slow the discharge of harmful factors from within the bowel. These harmful factors may be in the form of viruses and bacteria themselves, toxins produced by these organisms, or inflammatory products manufactured by the body’s white blood cells to fight the infection. There do exist certain bacteria (e.g. E.coli, Shigella), which manufacture very harmful substances which may be absorbed into the blood stream, nevertheless, there is very little evidence to either support or dismiss the concern that anti-diarrheal medications will worsen the outcome of these illnesses.
- There is concern that the use of anti-diarrheal agents will take the focus away from the more concerning issue of hydration. When children have episodes of vomiting and diarrhea, the most important issue, after ensuring that there is not a serious cause, is that they drink plenty of oral rehydration solutions (such as pedialyte, kao-electrolyte, ricelyte, or store-brand equivalent). Drinking any fluid, including these solutions, will actually increase stool volume. Improper focus away from the more important aspect of the illness might adversely impact the delivery of adequate oral fluid volumes to the child.
- Anti-diarrheal agents are less effective in small children. This is especially true of loperamide in very young children.
- Diarrheal episodes in children tend to last much longer than they do in adults. To continue to provide relief, children might need to take anti-diarrheal agents for a longer period with consequent increase in the risk of side effects.
- Anti-diarrheal agents slow bowel movements, but may not slow fluid losses. The fluid simply sits within the bowel, but does not get into the blood stream where it needs to be to provide hydration to the body. When a child is weighed to help assess hydration fluid sitting within the bowel will add to the child’s weight giving the false impression of adequate hydration.
Lactose intolerance is one cause of diarrhea for which an over-the-counter medication (lactase enzyme) is routinely recommended. Lactase enzyme (solitary active ingredient in some Dairy-ease, and Lactaid products) replaces deficient natural lactase in those who are “intolerant” and along with dairy avoidance when possible results in reduction of the diarrhea.
When lactose intolerance is not present, and when recommended by your child’s physician, the following anti-diarrhea medications are available over-the-counter:
- Attapulgite (solitary active ingredient in some Donnagel and some kaopectate products).
Attapulgite has been shown to be effective in reducing diarrhea. It works by absorbing fluid within the bowels; the result is fewer more formed stools. Its ability to slow fluid or electrolyte losses in the stool is less clear, but there is some suggestion that it is helpful in this regard also. Attapulgite is not absorbed into the body, thus there is very low risk of side effects.
- Bismuth Subsalicylate (solitary active ingredient in some Pepto-Bismol products).
Bismuth subsalicylate is a multifunctional gastrointestinal medication. It has proven to be helpful in treatment of both diarrhea as well as nausea. It has anti-inflammatory, anti-microbial (kills some bugs which may cause diarrhea and other abdominal symptoms), as well as absorptive properties.
While multifunctional, bismuth subsalicylate is not as effective as loperamide in treatment of diarrhea symptoms. One advantage over other agents, however, is its preventative role. For adolescents who are traveling out of the country, Bismuth salicylate is effective (although not 100%) in the prevention of “traveler’s diarrhea”.
The salicylate portion of the compound is chemically related to aspirin, which probably accounts for some of its anti-inflammatory effects. While this is somewhat helpful for diarrhea, the downside is that there is an uncertain risk of Reye syndrome, a rare but serious liver illness. For this reason it should not be used in those children under the age of fourteen who may have influenza or chicken pox. Because influenza may be accompanied by diarrhea, bismuth subsalicylate should not be used unless discussed by with your child’s physician.
- Calcium polycarbophil (solitary active ingredient in some Mitrolan products).
Calcium polycarbophil is a special resin that avidly absorbs and holds water within the bowel. When the water is from diarrhea the result is that the excreted stool has more substance; this is largely a cosmetic effect. Nevertheless, the result is fewer more formed bowel movements. The effects are slow, and there may be some bloating, but otherwise there are few side effects attributable to this unabsorbed medication.
- Lactobacilli (solitary active ingredient in some DDS-Acidophilus, Lactinex and Probiata products).
Various Lactobacilli species including acidophilus have proven to reduce diarrhea when taken with diarrhea causing antibiotics, or when diarrhea is caused by rotavirus. The means by which the probiotic bacteria have their effect is not yet certain. Pasteurized yogurt (the bacteria has been killed) is not as effective as live Lactobacilli, but may have some effect.
- Loperamide (solitary active ingredient in some Imodium products).
Loperamide is a very effective anti-diarrhea agent. It is approved for usage of children over 6 years of age. However, it is an opiate and thus it should be limited to infrequent use. While it has been shown to effectively reduce symptoms of diarrhea (liquid stools, frequent stools) it has not been shown to reduce fluid and electrolyte losses.