Diarrhea can be caused by a variety of different germs, including bacteria, viruses, and parasites. However, children can sometimes have diarrhea without having an infection, such as when diarrhea is caused by food allergies or as a result of taking medicines such as antibiotics. A child should be considered to have diarrhea when the child's bowel movements are both more frequent than usual and looser and more watery than usual.

Children with diarrhea may have additional symptoms including nausea, vomiting, stomachaches, headache, or fever. Children who are not toilet trained and have diarrhea should be excluded from childcare settings regardless of the cause.

Diarrhea is spread from person to person when a person touches the stool of an infected person or an object contaminated with the stool of an infected person and then ingests the germs, usually by touching the mouth with a contaminated hand. Diarrhea can also be spread by contaminated food. For more information on how to prevent food borne diseases, see the information sheet, " Food borne Diseases in the Child Care Setting" in this section. Children in diapers and childcare providers who change their diapers have an increased risk of diarrheal diseases.

To prevent diarrheal diseases from spreading in the childcare setting: Exclude any child or adult who has diarrhea until these symptoms are gone.

Make sure that everyone in the child care setting practices good hand washing technique.

Wash your hands after using the toilet, helping a child use the toilet, and diapering a child and before preparing, serving, or eating food.

Have children wash their hands upon arrival at your child care facility, after using the toilet, after having their diapers changed (an adult should wash an infant's or small child's hands), and before eating snacks or meals.

Disinfect toys, bathrooms, and food preparation surfaces daily.

Use disposable paper towels for hand washing.

Notify parents of children who have been in direct contact with a child who has diarrhea. Parents should contact the child's physician if their child develops diarrhea.

Use disposable table liners on changing tables and disinfect tables after each use.

If at all possible, the person who prepares and/or serves food should not change diapers.

If possible, different caregivers in a room separate from toilet-trained children should care for diapered children.

Use diapers with waterproof outer covers that can contain liquid stool or urine, or use plastic pants

Make sure that children always wear clothes over diapers.

Notify the local health department if two or more children in one classroom or home have diarrhea within a 48-hour period. Also notify the local health department if you learn that a child in your care has diarrhea due to Shigella, Campylobacter, Salmonella, Giardia, Cryptosporidium, or Escherichia (E). coli. Any child with prolonged or severe diarrhea or diarrhea with fever, or a known exposure to someone with infectious diarrhea, should be seen by a health care provider.

© January 1997