II. Indications: Urgent or emergent evaluation for red flag symptoms and signs

  1. Fever
    1. Age <3 months: Temperature > 100.4 F (38 C)
    2. Age 3 to 36 months: Temperature > 102.2 F (39 C)
    3. Age over 36 months: Temperature >103.0 F (39.5 C)
  2. Caregiver report of dehydration signs
    1. See Pediatric Dehydration
    2. Decreased tearing (sensitive parent reported marker for dehydration)
    3. Decreased fluid intake
    4. Decreased urine output
      1. Age <1 year old: last urine >8 hours earlier
      2. Age >1 year old: last urine >12 hours earlier
    5. Dry mucous membranes
  3. Mental status changes (e.g. lethargy, irritability)
  4. Failure of Oral Rehydration Solution
    1. Persistent Vomiting
    2. Failure to improve with Oral Rehydration Solution
  5. Inflammatory Diarrhea signs
    1. Tenesmus
    2. Bloody Diarrhea
  6. High-risk child
    1. Younger than 6 months of age or less than 17 pounds (7-8 kg)
    2. Premature Infant
    3. Chronic comorbidity
  7. Moderate to severe Diarrhea
    1. More than 10 stools per day
    2. Substantial volume
    3. Prolonged course longer than 2 weeks
  8. References
    1. (2003) King MMWR Recomm Rep 52(RR-16): 1-16 [PubMed]

III. Indications: Routine clinical evaluation

  1. Recurrent Diarrhea or persistent Diarrhea >2 weeks
    1. Suggests parasitic Diarrhea
  2. Inflammatory Diarrhea (Bacterial Diarrhea)
    1. Flecks or streaks of blood in stool
    2. Diarrhea for longer than 1 week
      1. Not indicated for only persistent soft stools
      2. Also consider Lactose-Free Diet
    3. Mucus or pus in stool
    4. Fever for longer than 72 hours
    5. Stool Incontinence

IV. Management: Home recommendations

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