When does my baby, infant or toddler have diarrhoea? When there is a significant increase from the usual bowel movement frequency, associated with a change in the character of the bowel movement to a liquid consistency.

Consult a doctor when your baby/infant/toddler has diarrhoea in the presence of any of the following :

• If he or she is not drinking for more than a few hours or is vomiting repeatedly or is having many watery stools (risk of rapid dehydration)
• The presence of dehydration (dry mouth; being thirsty; absence of tears when crying; sunken eyes, no urine/wet diapers for 4-6 hours)
• If he or she has fever
• Blood-containing bowel movements
• Severe tummy pain
• If the diarrhoea does not stop within 5 days

Consult a doctor in the case of:

• Bile (yellow-green) or blood-tinged (red or brown) vomit
• Forceful vomiting in a newborn
• An infant not drinking or not holding down anything for more than a few hours
• Accompanying diarrhoea, which poses the risk of rapid dehydration
• Presence of dehydration (see signs of dehydration under “Excessive crying”)
• Vomiting more than twice in 24 hours
• Continued vomiting despite the use of an anti-emetic (a medicine used for vomiting and nausea)
• Severe tummy pain
• A distended tummy
• Bloody bowel movements
• Fever higher than 39 °C
• Headache

Consult a doctor:

• If your baby, infant or toddler is inconsolable and has cried for more than two hours
• If you’ve used substances of abuse during your pregnancy
• If the crying might be related to an injury or a fall
• If there are signs localizing a possible source of pain: an unexplained bruise, not moving an arm or leg, fiddling with an ear, a bulge in the groin area, the passage of hard stools, diarrhoea or a testicular swelling.
• If there are symptoms suggesting a systemic illness or infection: fever, rash, not drinking or feeding well, being less active than usual, or not responding in the usual way.
• If there are any of these danger signs: vomiting; bulging or sunken fontanel (the soft area on top of a baby’s head); signs of dehydration (dry mouth; being thirsty; absence of tears when crying; sunken eyes, no urine/wet diapers for 4-6 hours); a distended tummy; bloody bowel movements.
  

Immediately consult a doctor if :

• Your baby stopped breathing, requiring some form of stimulation or resuscitation to recover
• Your child is breathing too fast: above 50 times per minute in babies and infants and above 40 times per minute in toddlers
• There are abnormal breath sounds, like an audible sound on taking in a breath (stridor) or an audible whistling noise when breathing out (wheezing).
• There are any of the following signs indicating that breathing has become hard work and that your little one may eventually tire: your baby struggles to finish the usual volume of a feed; the presence of chest wall indrawing (the soft tissues above the collar bones, between the ribs or below the ribcage sinks into the chest during breathing); use of the neck and/or abdominal muscles to breathe
• There is a blue hue to lips, tongue or nails (very late sign - call the ambulance rather, as there is an urgent need for oxygen)
  

In the following scenarios, a baby or toddler needs to be seen urgently by a doctor :

• Recent travel to a malaria-risk area
  
• The presence of a predisposing chronic medical condition with a risk of recurrent or serious infections (HIV infection, primary immunodeficiency; immunodeficiency due to chemotherapy; vesico-ureteric reflux with recurrent kidney infections; presence of an indwelling medical device/catheter/shunt/stent)
  
• Age less than 3 months
• Ill-appearing infant or toddler
• Very high fever (armpit >39.4°C; ear (eardrum) & forehead >40°C)
• A fever lasting longer than 3 days
• Fever associated with an epileptic seizure
• Fever associated with a new skin rash

Consult your doctor in the presence of any of the following:

• A background of recent head trauma or contact with a case of meningitis
  
• Any of the following underlying medical conditions : sickle cell disease, immune deficiency, cancer, a bleeding tendency, neurofibromatosis, tuberous sclerosis or a heart lesion
  
• A headache in a child younger than three years
• A headache that has a sudden and severe
• A headache that doesn’t respond to medication
• A headache that is localized to the back of the head
• A headache that localizes to the same area with each headache episode
• A headache that is progressive in nature
• A headache that shows a change in the severity, frequency or quality from before
• A headache that increases with coughing or straining
• A headache that wakes up a child at night or that is present on awakening in the morning
• A headache that occurs more than once a month
• A headache associated with:
  

Fever, neck stiffness or neck pain, sensitivity to light
Recurrent vomiting
Confusion, irritability, change in behaviour or personality
A change in vision, double vision, a new-onset squint, a new-onset of slurry speech, loss of balance, unsteadiness, an abnormal walking pattern, weakness of an arm, leg or one side of the face or deterioration in dexterity
The occurrence of an epileptic seizure
A non-blanching rash

Constipation occurs when bowel movements occur less frequently than normal despite a good intake of food and/or if stools are hard, large and/or difficult or painful to pass.Constipation occurs when bowel movements occur less frequently than normal despite a good intake of food and/or if stools are hard, large and/or difficult or painful to pass.
When are bowel movements too few?
When there is a significant decrease from the usual bowel movement frequency (for example usually having 1-2 bowel movements per day and then skipping two days despite a good intake of food). Newborn babies pass approximately four soft/liquid stools per day in the first week of life, with breastfed babies passing more in comparison to formula-fed babies. Young infants below three months of age usually pass 2-3 stools per day. The frequency of bowel movements in breastfed babies has a wide range of normality: from having a bowel movement shortly after each feed to having one (large) bowel movement every seven days. An infant with the latter infrequent normal pattern should be distinguished from the infant who is not getting enough : the former shows good weight gain despite the infrequent bowel movements. Formula-fed babies shouldn’t go more than three days without a bowel movement. Toddlers should have 1-2 bowel movements per day, depending on intake.
When to consult a doctor when your baby or toddler is constipated:

• Severe tummy pain
• A distended tummy
• Vomiting
• In an infant less than four months of age: no bowel movement within 48 hours of his/her normal pattern or the presence of hard stools
• Poor appetite and/or losing weight
• Presence of blood in the bowel movement
• Having repeated episodes of constipation
• No stool passed within 24 hours of starting laxative treatment