Diarrhea is one of the commonest ailments and a frequent cause of hospitalization in children. Though it’s usually self-resolving, not managing the condition properly due to lack of knowledge may lead to serious consequences, including death in certain instances. At present we are consulting Dr. Maheshaka Wijayawardena, Consultant Paediatrician, Base Hospital, Wathupitiwala, to give our readers a broader view on this important topic.
Diarrhea is defined as the increased frequency of stool passage, more than 3 times per day, associated with change of consistency of stools. This can be both short and long lasting, but in this week’s article, we focus more on short lasting diarrhea, also known as acute gastroenteritis.
Acute gastroenteritis is mainly viral in origin. In addition, it can be caused by bacteria and rarely, by other parasites such as amoeba.
Children with acute gastroenteritis usually present with increased frequency of stools, either watery, or mucoid stools which might be bloodstained, vomiting, fever, features of dehydration and rarely, convulsions.
Dehydration is the main worrying complication in children having diarrhea. Children are more prone to dehydration when compared to adults and severe dehydration can cause lasting consequences such as brain damage and even death, if not managed properly. A dehydrated child can present with sunken eyes, increased thirst, dry skin with reduced elasticity, reduced urine output and in case of severe dehydration, unconscious and in shock.
The management of acute gastroenteritis mainly involves adequate oral hydration to compensate for the fluid losses in the form of diarrhea and vomiting. Oral Rehydration Solutions such as jeewanie, rice kanjee, king coconut water and fresh fruit juices are found to be better alternatives to water, in a child having diarrhea. Carbonated drinks and cola drinks should be avoided.
Dehydration is the main worrying complication in children having diarrhea
Intravenous fluid such as saline may be required for a very ill child who cannot tolerate oral fluids. Diarrhea will harm the healthy bacteria in the child’s gut, so probiotics (live healthy bacteria) and prebiotics (food for favorable bacteria) are prescribed to promote the growth of healthy bacteria. Zinc supplementation are also prescribed as they are known to shorten the duration of diarrhea and hence, the hospital stay.
If the diarrhea is bacterial in origin, an antibiotic may be required. In addition, if the child is having vomiting, medication to stop vomiting are prescribed. Anti diarrheal medication have no benefit in management of acute gastroenteritis.
Management at home
Home management of a child with diarrhea is also based on keeping the child well hydrated, explains Dr.Wijayawardena. Loss of appetite is normal in an ill child but parents should take caution to keep child hydrated with adequate amounts of fluid (given in small amounts frequently if the child is vomiting). One of the signs of dehydration is the reduced amount of urine passed. So, be alert about a reduction of the amount of urine when managing a child with diarrhea at home.
“The belief that feeding a child during a diarrheal illness can aggravate diarrhea has no scientific basis and should be discouraged,” cautions Dr. Wijayawardena. In addition to normal feed, yoghurt with prebiotics is recommended as it aids in recovering the normal bacterial flora in the gut.
Loose and watery stools may last up to two weeks following a diarrheal illness. If the child is clinically well, this is no cause for concern.
In addition to dehydration, other complications such as electrolyte imbalances in the blood, seizures and kidney failure can rarely occur with acute gastroenteritis. Furthermore, temporary lactose intolerance, causing diarrhea following ingestion of lactose containing products such as breast milk and dairy products can occur in some children. “In children who are on exclusive breastfeeding, breast milk may have to be temporarily replaced with a non-dairy based milk product (lactose - free) such as soy milk”, states Dr.Wijayawardena.
Malnutrition is also a complication of diarrheal illness, commonly seen in children who are having frequent episodes of gastroenteritis.
Most diarrheal illnesses are transmitted through feco-oral route; through food and water contaminated with feces. Therefore good hygiene practices such as frequent hand washing, drinking boiled-filtered water, eating cleanly prepared, home-cooked food reduces the risk of diarrheal illness. Vaccines such as Rota virus vaccine also reduce the risk of diarrheal illness.
Keeping the child at home for at least 48 hours after the last episode of diarrhea and avoiding swimming pools for at least two weeks after the illness will help reduce risk of spread of the virus to other children, concludes Dr.Wijayawardena.
All diarrheal illnesses are not acute gastroenteritis. Rarely, abdominal pathologies and even brain tumors and meningitis can present as diarrheal illness. Therefore if the child is ill, seeking medical advice is important.
If the child is lethargic and is having reduced urine output, or having mucoid diarrhea which is blood stained, take the child to the hospital immediately.
Risk of dehydration is high in a child having a diarrheal illness. Keep the child hydrated with frequent small fluid volumes.