Encephalitis

Encephalitis literally means an inflammation of the brain, but it usually refers to brain inflammation caused by a virus. It's a rare disease that occurs in approximately 0.5 per 100,000 individuals — most commonly in children, the elderly, and people with weakened immune systems (i.e., those with HIV/AIDS or cancer).

Although several thousand cases of encephalitis (also called acute viral encephalitis or aseptic encephalitis) are reported to the Centers for Disease Control and Prevention (CDC) every year, experts suspect that many more may go unreported because the symptoms are so mild.

Signs and Symptoms

Symptoms in milder cases of encephalitis usually include:

• fever
• headache
• poor appetite
• loss of energy
• a general sick feeling

In more severe cases of encephalitis, a person is more likely to experience high fever and any of a number of symptoms that relate to the central nervous system, including:

• severe headache
• nausea and vomiting
• stiff neck
• confusion
• disorientation
• personality changes
• convulsions (seizures)
• problems with speech or hearing
• hallucinations
• memory loss
• drowsiness
• coma

It's harder to detect some of these symptoms in infants, but important signs to look for include:

• vomiting
• a full or bulging soft spot (fontanel)
• crying that doesn't stop or that seems worse when an infant is picked up or handled in some way
• body stiffness

Because encephalitis can follow or accompany common viral illnesses, there sometimes are signs and symptoms of these illnesses beforehand. But often, the encephalitis appears without warning.

Causes

Because encephalitis can be caused by many types of germs, the infection can be spread in several different ways.

One of the most dangerous and most common causes of encephalitis is the herpes simplex virus (HSV). HSV is the same virus that causes cold sores around the mouth, but when it attacks the brain it may occasionally be fatal. Fortunately, HSV encephalitis is very rare.

Encephalitis can be a very rare complication of Lyme disease transmitted by ticks, or of rabies spread by rabid animals.

Mosquitoes can also transmit the viruses for several types of encephalitis, including West Nile encephalitis, St. Louis encephalitis, and Western Equine encephalitis. Over the last several years in the United States, there's been concern about the spread of West Nile virus, which is transmitted to humans by mosquitoes that pick up the virus by biting infected birds.

Milder forms of encephalitis can follow or accompany common childhood illnesses, including measles, mumps, chickenpox, rubella (German measles), and mononucleosis. Viruses like chickenpox spread mostly via the fluids of the nose and throat, usually during a cough or sneeze.

Less commonly, encephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like syphilis. Certain parasites, like toxoplasmosis, can also cause encephalitis in people with weakened immune systems.

Contagiousness

Brain inflammation itself is not contagious, but any of the various viruses that cause encephalitis can be. Of course, just because a child gets a certain virus does not mean that he or she will develop encephalitis. Still, to be safe, children should avoid contact with anyone who has encephalitis.

Prevention

Encephalitis cannot be prevented except to try to prevent the illnesses that may lead to it. Encephalitis that may be seen with common childhood illnesses can be largely prevented through proper immunization. Have your child immunized according to the immunization schedule recommended by your doctor. Kids should also avoid contact with anyone who already has encephalitis.

In areas where encephalitis can be transmitted by insect bites, especially mosquitoes, kids should:

• Avoid being outside at dawn and dusk (when mosquitoes are most active).
• Wear protective clothing like long sleeves and long pants.
• Use insect repellent.

Also, all standing water around your home should be drained, including buckets, birdbaths, flowerpots, and tire swings because these are breeding grounds for mosquitoes.

To avoid tick bites:

• Limit kids' contact with soil, leaves, and vegetation.
• Have kids wear long-sleeved, light-colored shirts and long pants when outdoors.
• Check your kids and your pets frequently for ticks.

Duration

For most forms of encephalitis, the acute phase of the illness (when symptoms are the most severe) usually lasts up to a week. Full recovery can take much longer, often several weeks or months.

Diagnosis

Doctors use several tests to diagnose encephalitis, including:

• imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), to check the brain for swelling, bleeding, or other abnormalities
• electroencephalogram (EEG), which records the electrical signals in the brain, to check for abnormal brain waves
• blood tests to confirm the presence of bacteria or viruses in the blood, and whether a person is producing antibodies (specific proteins that fight infection) in response to a germ
• lumbar puncture, or spinal tap, in which cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is checked for signs of infection

Treatment

Some children with very mild encephalitis can be monitored at home, but most will need care in a hospital, usually in an intensive care unit. Doctors will carefully monitor their blood pressure, heart rate, and breathing, as well as their body fluids, to prevent further swelling of the brain.

Because antibiotics aren't effective against viruses, they aren't used to treat encephalitis. However, antiviral drugs can be used to treat some forms of encephalitis, especially the type caused by the herpes simplex virus. Corticosteroids may also be used in some cases to reduce brain swelling. If a child is having seizures, anticonvulsants may also be given.

Over-the-counter (OTC) medications, like acetaminophen, can be used to treat fever and headaches.

Most people with encephalitis make a full recovery. In a small percentage of cases, swelling of the brain can lead to permanent brain damage and lasting complications like learning disabilities, speech problems, memory loss, or lack of muscle control. Speech, physical, or occupational therapy may be necessary in these cases.

Rarely, if the brain damage is severe, encephalitis can lead to death. Infants younger than 1 year and adults older than 55 are at greatest risk of death from encephalitis.

When to Call the Doctor

Call your doctor if your child has a high fever, especially if he or she also has a childhood illness (measles, mumps, chickenpox) or is recovering from one.

Seek immediate medical attention if your child has any of the following symptoms:

• severe headache
• convulsions (seizures)
• stiff neck
• inability to look at bright lights
• double vision
• difficulty walking
• problems with speech or hearing
• difficulty moving an arm or leg
• loss of sensation anywhere in the body
• sudden personality changes
• problems with memory
• extreme drowsiness or lethargy
• loss of consciousness

If your infant has any of the following symptoms, seek immediate medical care:

• high fever or any fever higher than 100.4° Fahrenheit (38° Celsius) in infants younger than 3 months of age
• fullness or bulging in the soft spot
• any stiffness
• floppiness or decreased tone
• lethargy
• poor appetite or reduced feeding
• vomiting
• crying that won't stop

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Measles

Measles, also called rubeola, is a highly contagious — but rare — respiratory infection that's caused by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever, cough, and runny nose.

Since measles is caused by a virus, symptoms typically go away on their own without medical treatment once the virus has run its course. But a child who is sick should be sure to receive plenty of fluids and rest, and kept from spreading the infection to others.

Signs and Symptoms

While measles is probably best known for the full-body rash that it causes, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and watery red eyes. Another marker of measles are Koplik's spots, small red spots with blue-white centers that appear inside the mouth.

The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the feet.

Measles is highly contagious. When someone with measles sneezes or coughs, he or she can spread virus droplets through the air and infect others.

Measles is very rare in the United States. Due to widespread immunizations, the number of U.S. measles cases has steadily declined in the last 50 years. There were thousands of cases of the measles in 1950, but in 2002 there were just 44. Most of the time, the cases occur in settings where there are lots of kids, some of whom haven't gotten vaccinated or whose immunity has diminished since they got the vaccine.

The most important thing you can do to protect kids from measles is to have them vaccinated according to the schedule prescribed by your doctor.

Prevention

Infants are generally protected from measles for 6 to 8 months after birth due to immunity passed on from their mothers. Older kids are usually immunized against measles according to state and school health regulations.

For most kids, the measles vaccine is part of the measles-mumps-rubella immunizations (MMR) given at 12 to 15 months of age and again at 4 to 6 years of age. Measles vaccine is not usually given to infants younger than 12 months old. But if there's a measles outbreak, the vaccine may be given when a child is 9 months old, followed by the usual MMR immunization at 12–15 months.

As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor should have the most current information regarding recommendations about the measles immunization. Measles vaccine should not be given to pregnant women, or to kids with active tuberculosis, leukemia, lymphoma, or people whose immune systems are suppressed for some reason.

Also, the vaccine shouldn't be given to kids who have a history of severe allergic reaction to gelatin or to the antibiotic neomycin, as they are at risk for serious reactions to the vaccine. These kids can be protected from measles infection with an injection of antibodies called gamma globulin if it's given within 6 days of exposure — these antibodies can either prevent measles or make the symptoms less severe.

Measles vaccine occasionally causes side effects in kids who don't have any underlying health problems. In about 10% of cases the measles vaccine causes a fever between 5 and 12 days after vaccination, and in about 5% of cases the vaccine causes a rash, which isn't contagious and usually fades on its own.

Treatment

The symptoms of measles usually lasts for about 2 weeks. It is highly contagious, and 90% of people who haven't been vaccinated for measles will get it if they live in the same household as an infected person.

A child who is diagnosed with measles should be closely monitor for fever and other symptoms to detect any complications. In some cases, measles can lead to other health problems, such as croup, and infections like bronchitis, bronchiolitis, pneumonia, conjunctivitis (pinkeye), myocarditis, and encephalitis. Measles also can make the body more susceptible to ear infections or other health problems caused by bacteria.

If fever is making your child more uncomfortable, you may want to give a non-aspirin fever medication such as acetaminophen. Remember, you should never give aspirin to a child who has a viral illness since the use of aspirin in such cases has been associated with the development of Reye syndrome.

As with any viral infection, encourage your child to drink clear fluids: water, fruit juice, tea, and lemonade. These will help replace bodily fluids your child loses in the heat and sweating of fever episodes.

Use a cool-mist vaporizer to relieve cough and to soothe breathing passages. Clean the vaporizer each day to prevent mold from growing. Avoid hot-water or steam vaporizers that can cause accidental burns and scalds in children.

Kids with measles should get extra rest to help them recover. It's usually safe for a child to return to school 7 to 10 days after the fever and rash go away. But to be sure, check with your child's doctor.

When to Call the Doctor

Call the doctor immediately if you suspect that your child has measles. Also, it's important to get medical care if your child:

• is an infant and has been exposed to measles
• is taking medicines that depress the immune system
• has tuberculosis, cancer, or a disease that affects the immune system

Keep track of your child's temperature. Let the doctor know if your child has an earache, since this may be a sign of an infection.

Remember that measles is very rare, and a child who is properly vaccinated is extremely unlikely to contract the disease.

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Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common intestinal disorder that can cause cramps, gas, bloating, diarrhea, and constipation. It is sometimes called a "nervous stomach" or a "spastic colon." Certain foods can trigger the symptoms of IBS, as can emotional stress, infections, and physical trauma.

Although IBS can be uncomfortable and embarrassing for kids, it doesn't cause serious health problems. Doctors can help kids manage IBS symptoms with medications and changes in diet and lifestyle, so that kids with IBS can lead active, healthy lives.

What Causes IBS?

The specific cause of IBS is unknown, although it tends to run in families. Research has shown that kids with IBS are more sensitive to pain, discomfort, and fullness than kids without IBS. Certain foods — like milk, chocolate, caffeine, greasy foods, fast foods, and spicy foods — also tend to trigger IBS. In some cases, the triggers are never found.

Stress can also play a part in IBS in healthy kids. Some kids with IBS also tend to be particularly sensitive to stress and emotional upsets. Because nerves in the colon are linked to the brain, stress and conflict (things like family problems, moving, taking tests, going on vacation, and trauma) can affect how well the colon functions by speeding up the colon while slowing down the stomach.

What Are the Symptoms of IBS?

Kids with IBS usually have at least two of the following symptoms for at least 3 months over the preceding year:

• pain or discomfort that is relieved after a bowel movement
• pain or discomfort that is accompanied by changes in how often the child has to go to the bathroom
• pain or discomfort that is accompanied by changes in the way the child's stool (poop) normally looks. Some kids get constipated and their stools become hard (and difficult to pass); other kids develop diarrhea.

How Is IBS Diagnosed?

There is no specific test to diagnose IBS. Doctors usually diagnose it by taking the child's full medical history (including any family history of IBS) and by doing a physical exam. Answering questions about things like gas and diarrhea can be embarrassing, so assure your child that the doctor deals with issues like this every day and needs the information to help your child feel better.

The doctor will probably also ask about your child's environment at home and at school, and may suggest that you help your child keep a food diary to determine if certain foods or substances trigger IBS symptoms.

Most of the time, doctors don't need medical tests to diagnose IBS, but sometimes they order blood and stool tests and X-rays to rule out other intestinal problems.

How Is IBS Treated?

There's no cure for IBS. But many things can help reduce your child's IBS symptoms, including:

• Dietary changes. Some kids with IBS find that careful eating helps reduce or eliminate IBS symptoms. You might avoid serving very large meals, drinks with caffeine, spicy or fatty foods, or other foods that seem to trigger the symptoms.
• Lifestyle changes. If the symptoms appear to be related to stress, talk to your child about what you can do to help manage pressures related to school, home, or friends.
• Regular exercise and stress reduction. Exercise can foster good digestion and it's also a great stress release. If your child suffers from anxiety or depression, your doctor might advise a consultation with a child psychologist or another therapist.
• Medications. Doctors sometimes prescribe medications to treat the individual symptoms of IBS, such as laxatives to relieve constipation, anti-diarrhea medications, muscle relaxants, or antidepressants. Talk with your doctor before giving your child any over-the-counter medications for IBS symptoms.
  
  A number of new medicines targeting the neurotransmitter serotonin are now available to treat IBS, but must be used carefully in certain children and adolescents.
• Stress reduction and coping strategies. Hypnosis, breathing exercises for relaxation, and psychotherapy are becoming increasingly popular and safe ways to manage IBS.

Though IBS isn't life threatening, it can affect quality of life. It's important to talk with the doctor about ways to manage IBS symptoms to help your child lead an active and healthy life.

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Cold Sores

Cold sores are small and painful blisters that can appear around the mouth, face, or nose. They are sometimes referred to as fever blisters, and they're caused by herpes simplex virus type 1 (HSV-1). Kids can get cold sores by kissing or sharing eating utensils with an infected person.

Usually, HSV-1 cause cold sores in the mouth or face, and herpes simplex virus type 2 (HSV-2) causes lesions in the genital area, resulting in genital herpes. But sometimes, HSV-1 can cause genital lesions as well, especially if someone has received oral sex from an infected partner.

Colds sores in the mouth are very common, and many kids get infected with HSV-1 during the preschool years. The sores usually go away on their own within about a week.

Symptoms

Most kids who get cold sores get infected by eating or drinking from the same utensils as someone who is infected with the herpes virus or by getting kissed by an infected adult.

The cold sores first form blisters on the lips and inside the mouth. The blisters then become sores. In some cases, the gums become red and swollen. In other cases, the virus also leads to a fever, muscle aches, eating difficulties, a generally ill feeling, irritability, and swollen neck glands. These symptoms can last up to 2 weeks.

After a child is initially infected, the virus can lie dormant without causing any symptoms. But it can reactivate later, typically after some sort of stress like a cold, an infection, hormonal change, menstrual periods, or even before a big test at school. If the virus is reactivated it can cause tingling and numbness around the mouth and a blister.

Treatment

Cold sores from HSV-1 usually go away on their own within 5 to 7 days. Although no medications can make the infection go away, some treatments are available that can shorten the length of the outbreak and make the cold sores less painful.

Cool foods and drinks can help relieve discomfort, and acetaminophen may also ease the pain. Aspirin should not be given to kids with viral infections since it has been associated with Reye syndrome.

Call the doctor if your child:

• has another health condition that has weakened the immune system, which could allow the HSV infection to spread and cause problems in other parts of the body
• has sores that don't heal by themselves within 7 to 10 days
• has any sores near the eyes
• gets cold sores frequently

Since the virus that causes cold sores is so contagious, it's important to prevent it from spreading to other family members. Precautions to take with kids who have cold sores include:

• keeping their drinking glasses and eating utensils separate from those used by other family members and washing these items thoroughly after use
• teaching them not to kiss others until the sores heal
• having them wash their hands frequently and as soon as possible after touching the cold sores
• trying to keep them from touching their eyes — if HSV infects the eyes, it can be very serious

If you're caring for a child with a cold sore, you also should be diligent about washing your hands frequently so that you don't contract the virus or spread it to others.

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Is It a Cold or The Flu

Back from school you are having a sore throat, cough, and high fever — could it be the flu that's been going around? Or is it just a common cold?

Typically, the flu (also known as influenza) has symptoms that make a child feel worse than symptoms associated with a common cold, but it's not always that easy to tell the difference between the two.

Symptoms Guide

To help determine whether your child's fighting the flu or combating a cold, review these questions:

Flu vs. Colds: A Guide to Symptoms
Questions	Flu	Cold
Was your child's onset of illness …	sudden?	slow?
Does your child have a …	high fever?	no (or mild) fever?
Is your child's exhaustion level …	severe?	mild?
Is your child's head …	achy?	headache-free?
Is your child's appetite …	decreased?	normal?
Are your child's muscles …	achy?	fine?
Does your child have …	chills?	no chills?

If most of your answers fell into the first category, chances are that your child has the flu. If your answers usually belonged in the second category, it's most likely a cold.

But don't be too quick to brush off your child's illness as just another cold. The important thing to remember is that flu symptoms can vary from child to child (and they can change as the illness progresses), so if you suspect the flu, call the doctor. Even doctors often need a test to tell them for sure if your child has the flu or not since the symptoms can be so similar!

Some bacterial diseases, like strep throat or pneumonia, can also look like the flu or a cold. It's important to get medical attention immediately if your child seems to be getting worse, is having any trouble breathing, has a high fever, has a bad headache, has a sore throat, or seems confused.

While even healthy kids can have complications of the flu, kids with certain medical conditions are at more of a risk. If you think your child might have the flu, get in touch with the doctor.

Treatment

Some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant also can be dangerous. For a severely ill child or one with other special circumstances, a doctor may prescribe an antiviral medicine that can ease flu symptoms, but only if it's given within 48 hours of the onset of the flu.

Most of the time, you can take care of your child by offering plenty of fluids, rest, and extra comfort.

And if the doctor says it's not the flu? Ask whether your child should get a flu shot.

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Infectious Diarrhea

Most kids battle diarrhea from time to time, but the good news is that it's often caused by infections that don't last long and usually are more disruptive than dangerous. Still, it's important to know what to do to relieve and even prevent diarrhea.

Causes of Diarrhea

Diarrhea — frequent runny or watery bowel movements (poop) — is usually brought on by gastrointestinal (GI) infections caused by viruses, bacteria, or parasites.

The specific germs that cause diarrhea can vary among geographic regions depending on their level of sanitation, economic development, and hygiene. For example, developing countries with poor sanitation or where human waste is used as fertilizer often have outbreaks of diarrhea when intestinal bacteria or parasites contaminate crops or drinking water.

In developed countries, including the United States, diarrhea outbreaks are more often linked to contaminated water supplies, person-to-person contact in places such as child-care centers, or "food poisoning" (when people get sick from improperly processed or preserved foods contaminated with bacteria).

In general, infections that cause diarrhea are highly contagious. Most cases can be spread to others for as long as someone has diarrhea, and some infections can be contagious even longer.

Diarrheal infections can be spread through:

• dirty hands
• contaminated food or water
• some pets
• direct contact with fecal matter (i.e., from dirty diapers or the toilet)

Anything that the infectious germs come in contact with can become contaminated. This includes toys, changing tables, surfaces in restrooms, even the hands of someone preparing food. Kids can become infected by touching a contaminated surface, such as a toilet or toy, and then putting their fingers in their mouths.

A common cause of diarrhea is viral gastroenteritis (often called the "stomach flu," it also can cause nausea and vomiting). Many different viruses can cause viral gastroenteritis, which can pass through a household, school, or day-care center quickly because it's highly infectious. Although the symptoms usually last just a few days, affected kids (especially infants) who are unable to get adequate fluid intake can become dehydrated.

Rotavirus infection is a frequent cause of viral gastroenteritis in kids. Rotavirus, which usually causes explosive, watery diarrhea, infects almost all children in the United States by the time they're 4 or 5 years old, although not all will show symptoms. Rotavirus commonly causes outbreaks of diarrhea during the winter and early spring months, especially in child-care centers and children's hospitals.

Another group of viruses that can cause diarrhea in children, especially during the summer months, are enteroviruses, particularly coxsackievirus.

Many different types of bacteria and parasites can cause GI and diarrhea. Here are a few that you may have heard about:

• E. coli bacteria: Most E. coli infections are spread through contaminated food or water, such as undercooked hamburgers or unwashed fruit that came into contact with animal manure. E. coli infections, which usually affect kids during their first few years of life, also can be spread via contaminated swimming water and petting zoos.
• Salmonella enteritidis bacteria: In the United States, these bacteria (found in contaminated raw or undercooked chicken and eggs) are a major cause of food poisoning, especially during summer.
• Campylobacter bacteria: Infants and young adults are most commonly affected by these infections, especially during the summer. The bacteria are often found in raw and undercooked chicken.
• Shigella bacteria: Shigella infection (called shigellosis) spreads easily in families, hospitals, and child-care centers. Kids 2 to 4 years old are the most likely to be infected.
• Giardia parasite: Infection with Giardia (called giardiasis) is easily spread through child-care settings and contaminated water supplies, especially water parks and pools (the bacteria are resistant to chlorine treatment), children's "touch tanks" in aquariums and museums, and contaminated streams or lakes.
• Cryptosporidium parasite: Found especially in drinking and recreational water, this parasite often is the culprit behind diarrhea epidemics in child-care centers and other public places. Cryptosporidiosis often causes watery diarrhea that can last for 2 weeks or more.

Diarrheal infections are a normal part of childhood for many kids, but diarrhea can be a symptom of a number of non-infectious diseases and conditions, especially when it lasts several weeks or longer. It can indicate food allergies, lactose intolerance, or diseases of the gastrointestinal tract, such as celiac disease and inflammatory bowel disease.

Signs and Symptoms

Symptoms typically start with crampy abdominal pain followed by diarrhea that usually lasts no more than a few days. Infections with many of the viruses, bacteria, and parasites that cause diarrhea also can bring on other symptoms, such as:

• fever
• loss of appetite
• nausea
• vomiting
• weight loss
• dehydration

In cases of viral gastroenteritis, kids often develop fever and vomiting first, followed by diarrhea.

Preventing Diarrhea

Although it's almost impossible to prevent kids from ever getting infections that cause diarrhea, here are some things to help lessen the likelihood:

• Make sure kids wash their hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrheal infections that are passed from person to person. Dirty hands carry infectious germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, or put any part of their hands into their mouths.
• Keep bathroom surfaces clean to help prevent the spread of infectious germs.
• Wash fruits and vegetables thoroughly before eating, since food and water also can carry infectious germs.
• Wash kitchen counters and cooking utensils thoroughly after they've been in contact with raw meat, especially poultry.
• Refrigerate meats as soon as possible after bringing them home from the supermarket, and cook them until they're no longer pink. After meals, refrigerate all leftovers as soon as possible.
• Never drink from streams, springs, or lakes unless local health authorities have certified that the water is safe for drinking. In some developing countries, it may be safer to drink only bottled water and other drinks rather than water from a tap. Also, exercise caution when buying prepared foods from street vendors, especially if no local health agency oversees their operations.
• Don't wash pet cages or bowls in the same sink that you use to prepare family meals.
• Keep pets' feeding areas (especially those of reptiles) separate from family eating areas.

When to Call the Doctor

Call your doctor if your child has diarrhea and is younger than 6 months old or has:

• a severe or prolonged episode of diarrhea
• fever of 102°F or higher
• repeated vomiting, or refusal to drink fluids
• severe abdominal pain
• diarrhea that contains blood or mucus

Call the doctor immediately if your child seems to be dehydrated. Signs of dehydration include:

• dry or sticky mouth
• few or no tears when crying
• eyes that look sunken into the head
• soft spot (fontanelle) on top of the head that looks sunken
• lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow urine)
• lack of urine for 12 hours in an older child (or only a very small amount of dark yellow urine)
• dry, cool skin
• lethargy or irritability
• fatigue or dizziness in an older child

Caring for Your Child

Mild diarrhea is usually no cause for concern as long as your child is acting normally and drinking and eating enough. Mild diarrhea usually passes within a few days and kids recover completely with care at home, rest, and plenty of fluids.

A child with mild diarrhea who isn't dehydrated or vomiting can continue eating and drinking the usual foods and fluids, including breast milk or formula for infants and milk for kids over 1 year old. In fact, continuing a regular diet may even reduce the duration of the diarrhea episode, while also offering proper nutrition. Of course, you may want to give a child smaller portions of food until the diarrhea ends.

Antibiotics or antiviral medications are not prescribed for cases of diarrhea caused by bacteria and viruses because most kids recover on their own. But antibiotics are sometimes given to very young children or those with weak immune systems to prevent a bacterial infection (such as salmonellosis) from spreading through the body.

If the illness is caused by a parasite, it can be treated with antiparasitic medicines to cure or shorten the course of the illness. The doctor may order a stool test, in which a stool sample will be examined in the laboratory to see which specific germ is causing the diarrhea (bacteria, virus, or parasite).

Although you may be tempted to give your child an over-the-counter anti-diarrhea medication, don't do so unless your doctor gives the OK.

The primary concern when treating a diarrhea is the replacement of fluids and electrolytes (salts and minerals) lost from the body from diarrhea, vomiting, and fever. Depending on the amount of fluid loss and the severity of vomiting and diarrhea, your doctor will probably instruct you to:

• Continue your child's regular diet and give more liquids to replace those lost while the diarrhea continues if there are no signs of dehydration.
• Offer additional breastmilk or formula to infants.
• Use an oral rehydration solution (ORS) to replace lost fluids in non-dehydrated children.

Many of the "clear liquids" used by parents or recommended by doctors in the past are no longer considered appropriate for kids with diarrhea. Don't offer: plain water, soda, ginger ale, tea, fruit juice, gelatin desserts, chicken broth, or sports drinks. These don't have the right mix of sugar and salts and can even make diarrhea worse. Infants and small children should never be rehydrated with water alone because it doesn't contain adequate amounts of sodium, potassium, and other important minerals and nutrients.

Doctors often recommend that kids who show signs of mild dehydration be given oral rehydration solutions to replace body fluids quickly. These are available in most grocery stores and pharmacies without a prescription. Brand-name solutions often end in "lyte." Your doctor will tell you what kind to give, how much, and for how long. Never try to make your own ORS at home unless your doctor says it's OK and gives you a precise recipe.

In some cases, kids with severe diarrhea may need to receive IV fluids at the hospital for a few hours to help combat dehydration.

The best way to manage your child's diarrhea depends on how severe it is, what germ caused it, and your child's age, weight, and symptoms. So be sure to ask your doctor for recommendations about treatment.

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