Clinical Pediatrics
Volume 48 Number 3
Parental Management of
Childhood Diarrhea
Su-Ting T. Li, MD, MPH, Eileen J. Klein, MD, MPH,
Phillip I. Tarr, MD, and Donna M. Denno, MD, MPH
The objective was to determine the prevalence of ther-
apies used by parents to manage acute diarrhea in their
children and determine extent of parental adherence to
current management guidelines and utilization of func-
tional foods. Parents (N = 623) of children with diar-
rhea were surveyed in a tertiary care pediatric emergency
department. Most (53%) treated their child’s diarrhea
with appropriate fluids, including oral rehydration
solution (52%), but 14% used treatments not recom-
mended in current guidelines (antidiarrheals, 8%; flu-
ids high in simple sugars, 6%). In addition, 13% used
functional foods (yogurt, 11%; probiotics, 4%). Children
P
ediatric diarrhea is common, with children
younger than 5 years averaging 1 to 2 episodes
per year.1,2 In the United States, most cases of
diarrhea are managed at home, but 10% of parents
seek medical care for their child’s diarrheal illness,2
accounting for approximately 2.1 to 3.7 million
physician visits annually, representing approximately
20% of all outpatient visits for children younger than
5 years.1 Although guidelines for the management of
diarrhea have been published for health care
providers, little is known about how parents manage
their child’s diarrhea before seeking medical care.
From the Department of Pediatrics, University of California
Davis, Sacramento, California (S-TTL); Division of Emergency
Medicine, Department of Pediatrics, University of Washington,
Seattle, Washington (EJK); Departments of Pediatrics and
Molecular Microbiology, Washington University School of
Medicine, St. Louis, Missouri (PIT); and Departments of
Pediatrics and Global Health, University of Washington,
Seattle, Washington (DMD).
The authors have no conflicts of interest to disclose.
Address correspondence to: Su-Ting T. Li, MD, 2516 Stockton
Boulevard, Sacramento, CA 95817; e-mail: su-ting.li@ucdmc
.ucdavis.edu.
April 2009 295-303
© 2009 SAGE Publications
10.1177/0009922808327057
http://clp.sagepub.com
hosted at
http://online.sagepub.com
whose parents did not adhere to guidelines were
older (OR 1.02; 95% CI 1.01-1.02 years) and Hispanic
(OR 2.1; 95% CI 1.1-3.9). Although most parents use
appropriate fluids to treat their children’s diarrhea,
functional foods and antidiarrheal medications were
also frequently administered. Further data on effec-
tiveness of functional foods and education regarding
avoidance of potentially harmful medications are
needed.
Keywords: diarrhea; guideline; probiotics; Lactobacillus;
yogurt; child
The 2003 Centers for Disease Control and
Prevention (CDC) guidelines on the treatment of
acute gastroenteritis in children (endorsed by the
American Academy of Pediatrics)3,4 recommend oral
rehydration solution (ORS) as the mainstay of treat-
ment. Foods with excessive simple sugars such as
juice and carbonated soft drinks are discouraged
because their high osmotic content might increase
stool output.3 Furthermore, the guidelines state that
antidiarrheal medications are “not recommended for
infants and children” and antiemetics are “usually
unnecessary.”3,4
Probiotics, defined as “live microorganisms
which when administered in adequate amounts con-
fer a health benefit on the host,”5 have received con-
siderable recent attention as potential treatments for
enteric infections.6,7 Some studies have demon-
strated that probiotics or functional foods (foods
that have an effect on physiologic processes separate
from their established nutritional function) might
reduce duration and severity of diarrhea.8-24 The
CDC guidelines recognize the potential benefits of
functional foods and probiotics and call for further
evidence of efficacy, but do not endorse their use.4
295
296 Clinical Pediatrics / Vol. 48, No. 3, April 2009
Actual parental treatments of outpatient diar-
rhea have been subjected to few studies. In a 2007
population-based survey, 33% of respondents (repre-
senting adults and children) with acute diarrhea
reported taking antidiarrheal medications,25 but age-
specific data were not provided. In a 2006 study,
only 10% of children with diarrhea were given ORS,
whereas 3% were given antidiarrheals (bismuth sub-
salicylate and/or loperamide) and 0.3% were given
probiotics.2 However, most of the children in that
study had only mild diarrhea, and only 10% were
evaluated by a medical provider. For the subset of
children with diarrhea seeking emergency depart-
ment care, presumably with more severe illness, it is
not known what therapies parents tried at home
before the visit. This is important because the use of
ORS is more important in children with severe diar-
rhea to prevent and treat dehydration. In addition,
parents may be more likely to give antidiarrheals for
more severe diarrhea and these drugs could poten-
tially be more harmful in these situations (eg, when
bacterial infection is more likely).
We tested the hypothesis that an appreciable
subset of patients with diarrhea presenting to the
emergency department did not adhere to recom-
mended guidelines for diarrhea, and that there is
already adoption of functional food therapies before
seeking medical attention.
Methods
This study was part of a larger study to identify eti-
ologies of community-acquired childhood diarrhea.
All patients younger than 21 years of age who had a
complaint that included diarrhea who presented to a
single tertiary care children’s Emergency Department
(ED) at the Children’s Hospital and Regional
Medical Center in Seattle, Washington, were eligi-
ble for inclusion. As part of the larger study, only
patients who were able to produce a stool sample in
the ED were included. Parents who could not com-
plete a survey in English or Spanish were excluded.
Consecutive patients were recruited beginning in
November 2003 for the 24-month study period.
Parents were asked to complete a short standardized
questionnaire, to determine demographic data (child’s
age, gender, race/ethnicity, zip code of residence),
symptoms (duration of diarrhea, number of stools in
the last 24 hours, bloody diarrhea, abdominal pain,
vomiting, fever), and diarrhea treatments (ORS, lop-
eramide, bismuth subsalicylate, Lactobacillus, yogurt,
Lactobacillus acidophilus milk, or other therapies).
The Institutional Review Board at Children’s
Hospital and Regional Medical Center, Seattle,
Washington, and the Human Subjects Committee at
Washington University, St. Louis, Missouri approved
this study.
Variables
Medications were considered to be any prescription
and/or nonprescription pharmaceuticals that parents
indicated they used to treat their child’s diarrhea. Diet
changes were any nutrient alteration that parents
indicated they used to treat their child’s illness (eg,
the BRAT—bananas, rice, applesauce, toast—diet,
“constipating foods,” fiber, and lactose-free diet).
Fluids specifically recommended for intake by
children with gastroenteritis in the CDC guidelines
included ORS, breast milk, and formula. Fluids
explicitly discouraged in the guidelines included
those high in simple sugars (juice, soda, popsicles,
or sports drinks). Fluids not mentioned in the guide-
lines were considered “unaddressed.”
Parents were considered to be nonadherent to
CDC guidelines if they indicated they treated their
child’s diarrhea with medications explicitly not rec-
ommended by the guidelines (antidiarrheal medica-
tions) or oral fluids high in simple sugars, even if
they also used a recommended additional fluid
(Table 1).
Parents were considered to have given “unad-
dressed” treatments if they indicated they adminis-
tered medications not addressed by the guidelines
(ie, acid suppression, antiemetics, or dicyclomine),
diet changes, fluids not addressed by the guidelines,
or functional foods (yogurt or probiotics). Antiemetics
were considered as not addressed by the guidelines
because the CDC guidelines described them as “usu-
ally unnecessary,” but did not specifically state that
they should not be used. Antipyretics (acetaminophen
or ibuprofen) were not included in the study as their
use for concomitant fever or discomfort is common,
they are not mentioned in the guidelines and there
is no evidence to indicate that they have any direct
impact on diarrheal disease.
All other parents were considered adherent to
guidelines even if they did not specifically state they
used ORS.

Table 1. Classification of Guideline Adherence
Adherent to Guidelines Nonadherent to Guidelines
Oral rehydration therapy Antidiarrheal medications
Breast milk, formula Fluids high in simple sugars
A priori, we selected potentially confounding
variables for multivariate analysis: patient demo-
graphics (age, gender, race/ethnicity, median house-
hold income [estimated using Census zip code
tabulation areas, data]),26 and illness characteristics
(duration of diarrhea, number of stools in the 24
hours before the visit, bloody diarrhea, abdominal
pain, vomiting, fever). Because individual level
household income or insurance status was not col-
lected, median household income was estimated
using zip code tabulation areas, which has been
shown to be in useful when individual data are not
available.26-28
A patient was considered to have a fever if (1)
the parents reported a temperature ≥101.3°F
(38.5°C) or (2) the parents reported a fever but did
not record or obtain a temperature. The survey
allowed parents to select more than one race/eth-
nicity category to characterize their child. Children
were considered multiracial if more than one cate-
gory was selected.
A separate analysis was conducted where certain
fluids (water/ice, tea, rice water, and broth) that are
explicitly recommended along with ORS, breast milk,
and formula in the World Health Organization (WHO)
guidelines3 were classified in the adherent (instead of
“unaddressed”) category. We also did a subanalysis of
predictors of functional food use, where, in addition
to the possible confounders above, we included non-
adherence to guidelines (use of antidiarrheal med-
ications or oral fluids high in simple sugars).
Statistical Analysis
Univariate statistics were used to describe the over-
all population. Bivariate descriptive statistics used
unpaired, 2-sample t tests for continuous variables
and χ2 tests for categorical variables. Multivariate
logistic regression was used to model predictors for
nonadherence to guidelines and functional food use.
In addition, both areas of guideline nonadherence
Parental Management of Diarrhea / Li et al 297
Not Addressed by Guidelines
Functional foods
Other medications
Diet changes
Other fluids
were modeled separately (antidiarrheal medications
and oral fluids high in simple sugars).
A subgroup analysis was performed in children
younger than 5 years of age with acute diarrhea last-
ing less than 14 days because acute gastroenteritis
guidelines often refer to this age group.
Results
Overall Results
Between November 2003 and October 2005, a total
of 3269 patients had a complaint of diarrhea; 623
(19%) were eligible for study inclusion, agreed to
participate, and were able to submit a stool sample
and completed the survey while in the ED. Table 2
presents the patient and illness characteristics of the
study sample. Whereas 36 (6%) of respondents
reported a diagnosis of a chronic illness, only 1 indi-
cated having a gastrointestinal-related condition
(“colitis”).
Guideline Adherence
Table 3 presents parental previsit treatments. Most
(53%; 329/623) parents treated their child’s illness
with appropriate fluids (ORS, breast milk, or formula),
including 52% (321/623) who gave ORS. When the
additional fluids recommended in the WHO guide-
lines (water/ice, tea, rice water, and broth) were
included as adherent instead of “unaddressed,” 57%
were considered to have given appropriate fluids.
However, 14% (87/623) of parents used addi-
tional treatments discouraged by the guidelines. A
total of 8% (51/623) of parents treated their child’s
diarrhea with antidiarrheal medications and 6%
(38/623) used oral fluids high in simple sugars to
treat their child’s diarrhea.
Overall, 17% (104/623) of parents reported using
treatments that were neither specifically endorsed
nor explicitly discouraged in the guidelines, such as
298 Clinical Pediatrics / Vol. 48, No. 3, April 2009

Table 2. Patient and Diarrhea Illness Characteristics

Total Number (%); Subgroup <5 Years With
Variable N = 623 Acute Diarrhea; N = 478

Patient characteristics
Age (years)
Mean (SD) 2.5 (0.3) 0.7 (1.1)
Median 1.3 1.1
Range 0-19 0-5
Male 343 (55.1) 253 (52.9)
Race/ethnicity
Caucasian 259 (41.6) 190 (39.8)
Hispanic/Latino 179 (28.7) 150 (31.4)
African American 44 (7.1) 31 (6.5)
Asian/Pacific Islander 59 (9.5) 48 (10.0)
Multiracial 22 (3.5) 18 (3.8)
Other 45 (7.2) 30 (6.3)
Don’t know 15 (2.4) 11 (2.3)
Median household income by zip code
Mean (SD) 53 509 (14 087) 53 463 (13 939)
Median 50 958 49 531
Illness characteristics
Diarrhea onset (days)
Mean (SD) 13.6 (7.5) 3.4 (2.9)
Median
Number of stools/last 24 hours
Mean (SD) 8.4 (0.5) 8.5 (6.1)
Median 7 7
Fever 215 (34.5) 177 (37.0)
Abdominal pain 313 (50.2) 207 (43.3)
Vomiting 457 (73.4) 364 (76.2)
Bloody stools 107 (17.2) 59 (12.7)

antiemetics, fluids not addressed by the guidelines,
dietary changes, or functional foods. (Table 3). A
total of 13% (80/623) gave their child functional
foods. Of the 80 children who used functional
foods, 70 used yogurt (88%) and 24 (30%) used a
probiotic. It is unknown if the yogurt consumed con-
tained live cultures.
Characteristics Associated With
Adherence to Guidelines
Table 4 presents the relative frequencies of patient
and illness characteristics and their adherence to
guidelines. Children in all groups were similar in
race/ethnicity, median household income based on
Census zip code data, duration of diarrhea, stool fre-
quency, and history of vomiting. Children in the
adherent group were more likely to be older (P <
.001), have abdominal pain (P < .001) and/or bloody
stools (P = .002); than children in the nonadherent
group. Children using therapies not addressed by
the guidelines were more likely to be older (P <
0.001), male (P = .006), and have fever (P = .02).
After including in the model patient age, sex,
race/ethnicity, median income based on zip code
data, duration of diarrhea, number of stools in the
24 hours before presentation, bloody diarrhea,
abdominal pain, vomiting and fever, children of non-
adherent parents were more likely to be older (odds
ratio, OR 1.02; 95% confidence interval, 95% CI
1.01-1.02). For each additional year of age of their
child, parents had a 2% increased odds of not adher-
ing to guidelines. In addition, nonadherent parents
were more likely to identify their ill child as
Hispanic/Latino than Caucasian (OR 2.1; 95% CI
1.1-3.9). Children who were given antidiarrheal
medications to treat their diarrhea (OR 1.02; 95%
CI 1.01-1.02) and children who drank oral fluids
high in simple sugars (OR 1.01; 95% CI 1.001-
1.019) were more likely to be older.
 Parental Management of Diarrhea / Li et al 299

Table 3. Treatment of Diarrhea Prior to Presentation at Emergency Department

Subgroup <5 Years With Acute
Diarrhea Treatment Total Number (%); N = 623 Diarrhea; N = 478

Adherent to guidelinesa 432 (69.3) 364 (76.2)

Appropriate fluids (oral rehydration solution, 329 (52.8) 276 (57.7)
breast milk, or formula)
Oral rehydration solution 321 (51.5) 269 (56.3)
Not adherent to guidelines 87 (14.0) 49 (10.3)
Oral fluids high in simple sugarsb 38 (6.1) 27 (5.7)
Medications not recommended (antidiarrheal medications) 51 (8.2) 22 (4.6)
Loperamide 15 (2.4) 5 (1.1)
Bismuth subsalicylate 29 (4.7) 12 (2.5)
Attapulgite 10 (1.6) 5 (1.1)
Not addressed by guidelines 97 (15.6) 65 (13.6)
Fluids not addressed by guidelinesc 58 (9.3) 43 (9.0)
Diet changesd 19 (3.0) 10 (2.1)
Medications not addressed by guidelinese 13 (2.1) 3 (0.6)
Antiemetics 5 (0.8) 3 (0.6)
Acid suppression (H2 blockers or proton pump inhibitors) 2 (0.3) 0 (0)
Dicyclomine 2 (0.3) 0 (0)
Functional foods 80 (12.8) 51 (10.7)
Lactobacillus 24 (3.9) 12 (2.5)
Yogurt 70 (11.2) 45 (9.4)
a
Parents were considered adherent to guidelines, even if they did not specifically state they used ORS, breastmilk or formula, if they
did not treat their child’s diarrhea with items considered not adherent to guidelines (oral fluids high in simple sugars, antidiarrheal
medications) and items not addressed in the guidelines (fluids not specifically specified in the guidelines, diet changes, medications
not addressed by guidelines, functional foods).
b
Oral fluids high in simple sugars included juice, soda, popsicles, and Gatorade.
c
Fluids not addressed by guidelines included water/ice, tea, rice water, broth, milk, and soy milk.
d
Diet changes included BRAT (bananas, rice, applesauce, toast) diet, “constipating foods,” fiber, and lactose free diet.
e
Medications not explicitly recommended or disproved of by guidelines included antiemetics, acid suppression, and dicyclomine.
Acetaminophen and ibuprofen were not included.

When the definition of guideline adherence was
expanded to include those using fluids additionally
approved by WHO guidelines, there was no change in
risk factors associated with nonadherence. Further-
more, when the definition of guideline adherence was
even further expanded to include those using treat-
ments not specifically addressed by the guidelines,
children of parents who were nonadherent to guide-
lines remained more likely to be older (OR 1.02; 95%
CI 1.01-1.02) and Hispanic (OR 2.1; 95% CI 1.1-3.9).
Characteristics Associated With Use of
Functional Foods
Children who consumed functional foods were more
likely to be Caucasian (P < .001), drink fluids high
in simple sugars (P < .001), and use antidiarrheal
medications (P < .001).
After including in the model patient (age, sex,
race/ethnicity, median income based on zip code),
diarrhea illness (duration of diarrhea, number of
stools in the last 24 hours, bloody diarrhea, abdom-
inal pain, vomiting, fever), and treatment (fluids
high in simple sugars, antidiarrheal medications)
characteristics, children who received fluids high in
simple sugars (OR 3.1; 95% CI 1.2-7.9) or antidiar-
rheal medications (OR 5.9; 95% CI 2.6-13.2) were
also more likely to be given functional foods com-
pared with children who did not receive fluids high
in simple sugars or antidiarrheal medications. In
addition, children with longer duration of diarrhea
prior to presentation were more likely to have used
functional foods (OR 1.01; 95% CI 1.001-1.01).
Subgroup Analyses
After restricting our analysis to children younger
than 5 years of age with diarrhea of less than 14 days
duration, 478 children remained in the sample.
Results were similar to those obtained in all children
300 Clinical Pediatrics / Vol. 48, No. 3, April 2009

Table 4. Patient, Diarrhea Illness, and Diarrhea Treatment Characteristics Associated with Nonadherence to
Guidelines
Odds Ratio (95% Confidence Interval); Compared With Adherent to Guidelines

Not Adherent Not Adherent Not Addressed Not Addressed

to Guidelines to Guidelines by Guidelines by Guidelines
Variable (Unadjusted) (Adjusteda) (Unadjusted) (Adjusteda)

Age (years); mean (SD) 1.02 (1.01-1.03) 1.02 (1.01-1.02) 1.01 (1.00-1.01) 1.01 (1.00-1.01)
Male 1.3 (0.8-2.1) 1.2 (0.7-2.1) 1.4 (0.9-2.3) 1.4 (0.8-2.4)
Race/ethnicity
Caucasian, not Hispanic 1.00 (reference) 1.00 (reference) 1.00 (reference) 1.00 (reference)
Hispanic/Latino 1.1 (0.6-1.8) 1.9 (1.0-3.7) 0.5 (0.3-0.9) 0.7 (0.4-1.5)
African American 0.3 (0.1-1.1) 0.6 (0.1-2.3) 0.2 (0.1-0.8) 0.4 (0.1-1.5)
Asian/Pacific Islander 0.7 (0.3-1.6) 1.1 (0.4-3.0) 0.5 (0.2-1.1) 0.5 (0.2-1.5)
b
Multiracial 0.24 (0.03-1.81) 0.5 (0.1-1.8) 0.5 (0.1-2.4)
Other 0.6 (0.2-1.7) 0.5 (0.1-1.9) 0.5 (0.2-1.4) 0.5 (0.1-1.4)
Don’t know 0.4 (0.1-3.1) 0.8 (0.1-8.0) 0.7 (0.2-3.1) 0.7 (0.1-5.8)
Median household income by zip code 1.0 (1.0-1.0) 1.0 (1.0-1.0) 1.0 (1.0-1.0) 1.0 (1.0-1.0)
(continuous variable)
Diarrhea onset (continuous variable) 1.01 (0.99-1.02) 1.00 (0.97-1.03) 1.01 (1.00-1.02) 1.03 (1.01-1.05)
Number of stools/last 24 hours 1.01 (0.97-1.05) 1.00 (0.95-1.04) 1.00 (0.96-1.04) 1.00 (0.95-1.04)
(continuous variable)
Fever 1.4 (0.9-2.2) 1.7 (1.0-3.0) 1.7 (1.1-2.7) 1.8 (1.0-3.0)
Abdominal pain 3.2 (1.9-5.2) 1.6 (0.9-3.0) 1.3 (0.9-2.1) 1.0 (0.6-1.6)
Vomiting 1.3 (0.8-2.3) 1.9 (0.9-3.9) 1.4 (0.9-2.4) 1.4 (0.7-2.7)
Bloody stools 2.2 (1.3-3.8) 1.7 (0.9-3.5) 0.9 (0.5-1.7) 0.8 (0.4-0.9)
a
Analysis adjusted for the following potential confounders: patient demographics (age, gender, race/ethnicity, median household income), and
illness characteristics (duration of diarrhea, number of stools in the 24 hours before the visit, bloody diarrhea, abdominal pain, vomiting, fever).
b
Could not estimate due to collinearity.

with diarrhea. Parents of older children (OR 1.06;
95% CI 1.03-1.08) and those with children with
diarrhea of longer duration (OR 1.16; 95% CI 1.04-
1.30) were less likely to adhere to guidelines. For
each additional year of age of their child, parents
had a 6% increased odds of not adhering to guide-
lines and for each additional day of diarrhea in their
child, parents had a 16% increased odds of not
adhering to guidelines. In addition, children who
were given antidiarrheal medications were more
likely to be older (OR 1.06; 95% CI 1.02-1.10) and
Hispanic/Latino (OR 3.6; 95% CI 1.2-10.8).
Children who used functional foods were also
more likely to use antidiarrheal medications (OR 5.0;
95% CI 1.6-16.1). For each additional day of diarrhea
before presentation, there was a 20% increased odds
of use of functional foods (OR 1.2; 95% CI 1.1-1.3).
Discussion
Most children with acute diarrhea in our study appro-
priately received ORS before visiting the pediatric
ED, but treatment with remedies not recommended
by the CDC were common. Our study found a larger
percentage of children given antidiarrheal medica-
tions than the 3% previously reported for all children
with diarrhea in the community,2 likely reflecting the
more severe diarrhea in our pediatric ED population.
If health care providers do not provide advice for
parents on management of common ailments such
as diarrhea, or provide inconsistent advice, parents
may rely on other sources of advice such as friends,
family, the Internet, and the media, to treat their
child.29,30 Recently, Bender et al31 reported that pedi-
atric emergency physicians often rely on intravenous
volume expansion in mild to moderate dehydration
associated with acute gastroenteritis, which would
not conform to current guidelines, and such prac-
tices send discordant messages to families regarding
the value of the official recommendations.
Yogurt was the most common functional food
used by our families; but its effectiveness for treat-
ment of diarrhea has been subject to few studies.8,23
One study demonstrated reduced diarrhea duration
in children given yogurt,23 and an Indian study
demonstrated reduced diarrhea duration in children
given yogurt containing probiotics compared with

those receiving heat-treated yogurt with no live bac-
teria.8 We do not know if the yogurt reported in our
study contained active cultures or was heat-treated.
Parents who gave their children antidiarrheal
medications to treat their diarrhea were more likely
to report using functional foods, which might reflect
interventional parental biases. It is unknown if par-
ents who want to treat their child’s diarrhea with a
medication are less likely to use an antidiarrheal
medication if they were informed of its potential
harmful effects and offered a putatively safer alter-
native, such as functional foods. Alternatively, the
simultaneous use of antidiarrheals and functional
foods might reflect previous health care encounters
where such therapies might have been recom-
mended or prescribed. However, most of the med-
ications used in the present study were available
without a prescription. We do not know the reason-
ing underlying use of functional foods but propose
that this is an area for further analysis.
There are several limitations to our study. We
were unable to compare characteristics of our study
population and potentially eligible subjects who
were excluded due to inability to produce stool in
the ED. This ED cohort probably had more severe
diarrhea than children presenting with diarrhea to
other venues, or those not seeking care for this ill-
ness, so our data might not apply to all children with
diarrhea. In addition, it is possible that the group of
children studied had more severe diarrhea than oth-
ers presenting to the ED, because one of the inclu-
sion criteria was ability to produce a stool sample
during their time in the ED, and patients with less
severe diarrhea might be less likely to produce a
stool sample while on site. Moreover, the frequency
of nonadherence to guidelines and prevalence of
functional food use to treat diarrhea reflect the pop-
ulation sick enough to present at a pediatric ED for
treatment of their diarrhea illness. Also, it is not
known if this single institution study can be gener-
alized to other populations. It is also possible that
the prevalence of guideline adherence and func-
tional food use among children of parents who com-
pleted the survey differs from the prevalence among
children of parents who did not. Nonetheless, this
study does demonstrate that functional food use is
common and associated with use of other nonstan-
dard treatment for diarrhea, such as using antidiar-
rheal medications and fluids high in simple sugars.
Our data have implications for primary care
practice. Because the use of medications and other
Parental Management of Diarrhea / Li et al 301
nonstandard treatments for diarrhea in children is
so common, particularly in children with more
severe illness, the optimal treatment of diarrhea
with ORS and early refeeding and avoidance of
potentially harmful medications should be rein-
forced at acute and well child visits, via advice calls,
and in educational literature. The increased likeli-
hood of Hispanic/Latino children to use antidiar-
rheal medications might reflect previous cultural
practices,32-35 and educational efforts might need to
consider these factors. In addition, because func-
tional foods are clearly used in the general child-
hood population, assessment of the safety and value
of this treatment needs to be evaluated. Future
research on functional foods should study the effi-
cacy of probiotic-containing yogurt or acidophilus
milk in decreasing diarrhea frequency and duration.
Randomized studies of functional foods will also
need to address the high likelihood that many fami-
lies will have already given some of these interven-
tions. Because yogurt and acidophilus milk contain
lactose, which might temporarily worsen diarrhea, it
would be important to test the efficacy of functional
foods with and without lactose.14,36,37
In summary, most parents treat their child’s
diarrhea with appropriate oral fluids, but an appre-
ciable subset treat such illnesses with oral fluids
high in simple sugars and/or use medications, diet
changes, or functional foods that are either not rec-
ommended or not addressed by current guidelines.
Providers should consider using routine visits to
advise parents about the best way to treat common
illnesses, such as diarrhea, or parents might treat
these illnesses with ineffective and potentially
harmful therapies.
Acknowledgments
This study was supported by a grant from the U.S.
Department of Agriculture: NRI 0202238. We thank
Valerie Hoffman, Jody Mooney, Kelly Wood, and the
Children’s Hospital and Regional Medical Center
Emergency Department Nurses for their assistance
with this project.
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