This study was carried out in the southern Punjab, Pakistan to outline the causes of childhood iarrhea as perceived by mothers and, especially, to assess perceptions of mothers on childhood diarrhea in relation to hygiene practices and drinking water and sanitation facilities. Two hundred households in ten villages were randomly selected. Information was obtained from mothers, through a questionnaire, in-depth interviews, and direct observations. The focus was on obtaining information from mothers of children that were below five years of age. Causes of diarrhea reported by mothers were categorized in seven different domains. Causes relating to the digestive system, especially consumption of too much food were the most important, followed by causes pertaining to contamination and those pertaining to the humoral theory of ‘hot’ and ‘cold’. The mother’s health status was perceived as determining the health of her child through her breast milk. Through in-depth interviews, diarrhea as a symptom of envy and malice was brought up. The study draws the attention to the complexity and heterogeneity of beliefs, attitudes and practices concerning diarrhea and hygiene. This makes it difficult to come up with general rules for health education campaigns. Rather, in health education, the outstanding ‘good’ and ‘bad’ behavior should be selected and should be the focus. On the other hand, the heterogeneity in beliefs, attitudes and practices prevailing in the community could make mothers more receptive to new ideas than when a small set of rigid cultural norms would dominate the thinking on disease transmission and hygiene. The study found that despite the mother’s central role as caretaker one should not operate on the traditional mother-child relationship but also include the husband-wife relationship, and target other individuals involved in setting norms within the household or within the nearby community.