All You Need To Know
Pediatric Diarrhea is an extremely common problem in children aged five years or below. In the US & Canada, babies experience an annual average of two such episodes of increased bowel movements each day. Usually not a severe manifestation, Pediatric Diarrhea can be Acute or Chronic.
Diarrhea in kids is defined as an increase in the number of stools (bowel movements), i.e., more than three stools every 24 hours, or the presence of stools looser than normal for children of or below the age of five.
Diarrhea is babies can either be acute or chronic. Acute Diarrhea occurs for less than a total of 3 weeks, whereas if it lasts longer than 3 weeks, it is termed as Chronic Diarrhea.
Acute Pediatric Diarrhea
Acute diarrhea in children usually lasts for 24-48 hours and goes away; in rare cases, it may persist for 3 weeks.
Acute pediatric diarrhea is generally caused by bacterial infection via contaminated food or water. Rarely, viral infections can also prove to be a cause.
Chronic Pediatric Diarrhea
Chronic diarrhea in babies lasts for more than 3 weeks on average.
The causes of chronic diarrhea in kids range from intestinal diseases like ulcerative colitis, Crohn’s disease, or celiac disease to other health problems like irritable bowel syndrome (IBS). Parasites such as Giardia can also be responsible for causing chronic pediatric diarrhea.
Usually, if your child has diarrhea for over 2 days, call your doctor, as it might turn out to be something serious.
The symptoms of pediatric diarrhea are pretty straightforward.
The primary symptom of diarrhea is a watery stool, which may or may not be accompanied by blood. Stool floating on water indicates that it’s rich in fat content.
Diarrhea stool may also be accompanied by:
● Urgency with bowel movements
● Abdominal pain and/or bloating (swelling)
● Stomach cramps
● Rectal pain and irritation
● Stomach upset and nausea and/or vomiting
● Fecal incontinence
● Fever and/or malaise
● Loss of body fluids (dehydration) and/or weight loss
Dehydration is a significant cause for concern in children with diarrhea because of their inability to consume sufficient fluid orally to compensate for losses in body fluids through stools. Signs of dehydration may include a decrease in either urine output or episodes of wetting diapers, dark yellow urine, dry lips and mouth, lack of tears while crying, increased irritability or fussiness, decreased energy levels, and/or increased sleep cycles.
Physicians predict dehydration to be the greatest complication of diarrhea, especially in babies with a weaker immune system. The resultant dehydration can be mild, moderate, or severe. Mild dehydration is merely the loss of body fluids via stool. Moderate or severe dehydration can increase the stress on the heart and lungs of young children. In worst-case scenarios, it can lead to hypovolemic shock, which is life-threatening.
Believe it or not, but diarrhea is the body’s natural way of getting rid of germs and foreign organisms. Hence, infections being its leading cause makes a lot of sense. Infections can be bacterial or viral.
Common bacteria causing diarrhea in babies include Salmonella, whereas common viral infections are caused by rotavirus. Sometimes, protozoan parasites like Giardia can also cause infections leading to pediatric diarrhea.
Viral infections cause viral gastroenteritis, which manifests in the form of diarrhea with loose, watery stools, stomachache, vomiting, fever, and headache for a good week or two. Preventing fluid loss is an essential aspect of treating this sickness.
1. Feed infants additional breast milk.
2. Offer oral rehydration solution (ORS) to young children. Plain water lacks enough potassium, sodium, and additional micronutrients to restore their electrolyte balance.
3. Popsicles, though it may seem strange, may provide for a great way to introduce fluids into the system of a child vomiting and in need of rehydration.
4. Call your doctor to take his opinions on how much fluid your child needs to intake, how to make sure they’re getting the same, when to give them the same, and ways to check for signs of dehydration.
Travelers’ diarrhea also occurs due to bacterial, viral, or parasitic infections and mostly affects children rather than adults. Kids who travel a lot or visit a foreign land are at risk of contracting travelers’ diarrhea caused by contaminated food and/or water. Make sure to let your child’s healthcare provider know of this, as he might ask for a stool test to be conducted.
Food poisoning may commonly cause diarrhea in babies, with symptoms like vomiting manifesting quickly and going away within 24 hours. Treatment guidelines for this form of diarrhea are the same as for the above - keep your kid hydrated and consult a doctor.
Food Allergies & Intolerance
Several food allergies also often cause diarrhea-like symptoms, along with skin rashes, belly pain, poor growth, nausea, and vomiting.
Intolerance to food like milk (Lactose intolerance) or gluten (Gluten intolerance or Celiac disease) is infamous for causing diarrhea along with a plethora of other symptoms
Some individuals are unable to digest lactose, a sugar present in milk and dairy products, which can lead to chronic diarrhea. Other symptoms include abdominal pain and distention, excessive bloating and belching (burping), and gas.
Gluten Intolerance (Celiac Disease)
Estimated to occur once in every 133 individuals, Celiac disease presents with chronic symptoms like constipation, diarrhea, malnourishment, decreased energy, and abdominal distension. Children with autoimmune disorders like type I diabetes, and Down’s syndrome, are at increased risk for Celiac disease.
Several medications like certain antibiotics and laxatives infamously cause diarrhea as a side-effect, both in kids as well as in adults.
Diarrhea caused by medications is usually mild and can be treated easily at home by:
1. Keeping your child hydrated.
2. Offer probiotics like yoghurt with live culture to your kid. Cultures and probiotics replenish the good bacteria in the gut and help ease symptoms of diarrhea caused by antibiotics that kill both good and bad bacteria.
3. If the antibiotic therapy prescribed to your baby is causing the diarrhea, make sure to call your doctor and discuss this with him rather than taking the call on stopping the course all by yourself.
Risk factors for developing diarrhea through infectious causes include foreign travel, swimming in ponds and lakes, attending daycare, foster home and school, amongst other minor ones.
Several intestinal diseases that notoriously aid in the development of diarrhea are:
● Inflammatory bowel disease (IBD), a group of intestinal disorders.
● Irritable bowel syndrome (IBS), a functional bowel disease.
● Crohn’s disease, an autoimmune disease.
● Ulcerative colitis.
To summarize, the main causes of acute & chronic pediatric diarrhea are given in the table:
Acute Diarrhea Chronic Diarrhea
● Bacterial infections
● Viral infections
● Parasitic infestations ● Giardiasis (post-infectious diarrhea)
● Improper liquid diet (chronic non-specific diarrhea)
● Gluten intolerance (celiac disease)
● Inflammatory bowel disease (Crohn’s disease & ulcerative colitis)
● Lactose intolerance
● Irritable bowel syndrome (IBS)
● Antibiotic therapy (antibiotic-associated colitis)
● Food allergies
It is customary for doctors to ask for your child’s symptoms and medical history, do a physical examination, and prescribe lab tests for blood and urine apart from those for stool.
Acute diarrhea usually doesn’t require elaborate tests; blood tests to determine the extent of hydration generally suffice. If blood appears in your child’s stool, stool samples need to be collected to perform a stool culture which takes 2-5 days to yield results. Giardia is identified via stool studies.
Chronic diarrhea requires confirmatory tests to be performed. To establish the exact cause of the chronic illness, some of these tests are done:
● Blood tests to detect anemia & inflammation, check dehydration & nutritional status, and screen for the possibility of celiac disease.
● Stool studies to detect possible bacterial, viral or parasitic etiologies
● Radiological imaging & x-ray studies to assess and screen the liver and gastrointestinal tract for structural disabilities or risk factors.
● Lactose breath hydrogen test to diagnose lactose intolerance.
● Upper endoscopy and/or colonoscopy (sigmoidoscopy) with biopsy to check for intestinal inflammation, useful in diagnosing IBDs like Crohn’s disease and ulcerative colitis, along with celiac disease.
The treatment obviously depends on the extent of the diarrhea, its signs & symptoms, and your child’s general health.
Ensure Adequate Hydration
As dehydration is the most major complication of diarrhea, it is mandatory to make your kid drink lots of fluids to replenish the lost body fluids. Here’s how:
1. Specialised oral rehydration solutions (ORS) available at pharmacies and grocery stores can treat most cases of mild diarrhea at home, and are the best way to rehydrate a child who isn’t vomiting.
2. Drinks called glucose-electrolyte solutions, also available as popsicles, that provide the right balance of water, sugar, and salts.
3. Avoid giving your kid other drinks like juices, colas, sodas, and sports drinks as a substitute for ORS. They can worsen the situation. Drinking too much juice or carbohydrate sweetened liquids such as sports drinks can cause chronic non-specific diarrhea instead.
4. Do not give too much plain water to your baby. This can be dangerous for the brain of children of any age.
5. Continue breastfeeding your baby, as a breastfed baby is said to experience lesser episodes of diarrhea.
6. Children with severe forms of diarrhea, along with vomiting and dehydration, may require intravenous fluids given under medical supervision.
A balanced regular diet plays an important role in preventing and treating infantile diarrhea. Breastfed babies are to be nursed normally and regularly during episodes of acute gastroenteritis. Formula fed babies should continue their regular diet, and, in young children, regular diet needs to be re-introduced as soon as viable.
Milk and dairy products can be avoided initially and replaced with solid foods like rice & toast, and fruits and vegetables such as bananas, apple juice, and others.
The physician may prescribe antibiotics for kids with specific bacterial or parasitic infections, even though the medications may not alter the length or severity of the diarrhea. Probiotics can help immensely in re-establishing the equilibrium between good and bad bacteria in the intestines, thus decreasing the severity of the diarrhea.
Although they are important in children with chronic diarrhea, antidiarrheals or drugs slowing down bowel movements aren’t recommended in babies with acute diarrhea.
All family members should practise careful handwashing, especially after changing diapers.
Preventing Infantile Diarrhea.
The tried-and-tested ways to prevent diarrhea in babies are summarized as follows:
1. A rotavirus vaccine can help prevent diarrhea resulting from rotaviral infections.
2. When traveling to developing countries, ensure that your child drinks clean, safe, packaged water only.
3. Proper handwashing can help prevent diarrhea resulting from bacterial infections.
4. Pasteurizing milk before consumption.
5. Avoid eating raw or undercooked meat or fish, unwashed fruits and vegetables, especially from street vendors and food trucks.
Pediatric or infantile diarrhea, occurring as an acute condition, is very common among babies all over the world. Introduction of certain bacteria into the body through food is also believed to be an important pioneer step in the process of the baby’s blood group development. Infectious diarrhea is also believed to strengthen the immune system of the baby and better prepare it for fighting off more severe bacterial infections in the future.
However, contact your doctor without any delay if you find your child to be extremely sick, if your child has had diarrhea for more than a week, is younger than 6 months of age, is vomiting bloody green or yellow fluid, seems dehydrated, has not urinated in 6-12 hours, or has passed blood in stool.
Dr. Rajalben Prajapati, Associate Professor, Department of Paediatrics at Smt NHL Municipal Medical College, Ahmedabad.
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