DIARRHEA IN CHILDREN

BE CAUTIOUS OF DEHYDRATION 

In our previous blog, we saw that diarrhea is an underlying cause of fever. Today, we shall look at diarrhea and its effects on children and how you can manage it at home to prevent dehydration. Dehydration is a complication of diarrhea leading to loss of essential minerals and water from the body and can have dire consequences. With this in mind, let us dive in and see how we can bridge the health gap.

Diarrhea in children is the second leading cause of death.

Look at this scenario. While working at the Emergency Department, occasionally, a mother hurriedly walks in carrying an almost lifeless baby in her arms. Quickly, she places the baby in the hands of the nearby nurse shouting that her baby is dying! The baby has had diarrhea for the past three days. It is from here that the health care providers will frantically work to revive the child. If the mother is lucky, the team will fix an intravenous line and put the baby on the lifesaving fluids. The rest is history!

Diarrhea in children is the second leading cause of death worldwide. It affects over two billion children and causes over 525,000 deaths annually. To be more practical, 1 in 9 deaths of children globally is as a result of diarrhea. World Health Organization (WHO) defines diarrhea as the passage of three or more loose stools in 24 hours. However, in children, it is the change in stool consistency and frequency of bowel movement. Bacterial, viral, or parasitic infections are the most common causes of diarrhea in children. As well, malnutrition is another major cause of diarrhea in children. Malnutrition and diarrhea in children have a symbiotic relationship. Prolonged diarrhea leads to malnutrition when essential nutrients are lost whist malnourished children suffer more episodes of diarrhea. Viral infections such as Rotavirus and measles are often associated with diarrhea in children and have debilitating consequences. Food poising is a less likely cause of diarrhea in children. Poor food hygiene and improper food storage can lead to contamination by harmful microbes.

Common types of diarrhea

Diarrhea presents in three forms; acute watery diarrhea, acute bloody diarrhea, and chronic or persistent diarrhea that lasts for more than 14 days. In children, acute watery diarrhea often results from viral infections like Rotavirus. Acute bloody diarrhea is commonly related to bacterial infection or inflammatory bowel disease. Chronic or persistent diarrhea occurs when a child has diarrhea for 2 to 4 weeks due to infection of the digestive tract, food allergies or intolerance, and inflammatory bowel diseases.

Several factors increase the risk of diarrhea in children. Children feeding practices can lead to an increased risk of diarrhea. Starting to give solid foods (before six months) to a child is likely to cause diarrhea. Before a child is six months old, the immune system is still immature and the digestive system under-developed. Even when the child is above six months, diarrhea can still occur during the transition period from a breast milk-based diet to other forms of foods. However, this type of diarrhea is short-lived and self-limiting.

Diarrhea can spread from caregiver to the child, contaminated surfaces, or feeding equipment. In particular, diarrhea can occur in children who have not been well pot-trained with possible oral-fecal contamination.

Alongside diarrhea, poor appetite, nausea, vomiting, abdominal pain, and cramps may also be present.

Home management of diarrhea

Home management of diarrhea aims to replace fluids and minerals lost. Oral Rehydration Salts (ORS) are scientifically tested and proved effective in replacing water and minerals, reducing the amount of stool passed and the frequency of diarrhea. ORS is available across the counter in most chemists and shops at affordable prices. To purchase a sachet of ORS does not require a prescription. Alongside ORS, one can add zinc sulfate in the management of diarrhea. Zinc sulfate is in tablet form of 20mg and should be given to the baby once a day for 10 to 14 days. Zinc is effective in the control of diarrhea even in the next three months. Again, to buy Zinc Sulfate does not require a prescription and is available at the chemist.

Dietary management of diarrhea at home

If a child is on exclusive breastfeeding, continue to breastfeed the child and give ORS in between breast milk to increase fluid intake.  It is good practice to feed a baby ORS using a cup and a spoon. Initially, start by giving the baby one teaspoonful (about 5ml) every five minutes. Increase the fluid intake when the baby can drink and retain it. 

For a child who is on complementary feeding, continue breastfeeding, give little bits of food that they can accept. Continue giving ORS in between and maintain a record of the amount of fluid fed. For a child on solid foods, give ORS freely and small bits of food throughout the day. Choose a whole and balanced diet that is nutrient-dense like cereals, whole grain, beans, mashed bananas, fresh fruits, and vegetables. Limit or avoid giving foods or liquids high in sugar like juices, carbonated drinks, or other sweetened drinks that are likely to increase the frequency of diarrhea.

Prevention against diarrhea in children

Diarrhea in children is preventable and consequences avoidable. These measures can serve as a guide;

1. Exclusively breastfed for the first six months of age. Exclusive breastfeeding means that the child feed with breast milk only and no other additions. It is good to add here that breastfeeding is safe and wholesome.
2. Introduce other foods to the baby only after six months. A mother should continue breastfeeding and introduce the feeds to the baby gradually. Give a balanced diet that includes all the five components of a healthy diet; carbohydrates, protein, fats, vegetables, and fruits to meets the needs of a growing infant.
3. Washing hands with water and soap is one of the most effective practices to break the chain of infection. Washed hands before preparing and feeding the baby, after cleaning the baby, and after every diaper change.
4. Disinfect the child’s play toys, food preparation surfaces, and any space that can increase the risk of contamination with germs.
5. Rotavirus and measles vaccination is critical preventive measures against diarrhea. Therefore, it is necessary to follow children’s immunization schedules. In particular, the Rotavirus vaccine minimizes episodes, duration, and severity of diarrhea in children. A strong relationship between measles infection and subsequent diarrhea infections that is very debilitating has occurred.

Seek medical attention

Despite all measures implemented to control diarrhea at home, the child may still fail to improve. Monitor how well the child responds to home therapy and seek medical attention when there are no signs of improvement. Listed are symptoms that can alert you that the child needs advanced medical care;

1. The baby is six months or below and has diarrhea
2. When a child has abdominal pain and cramps
3. The child is unable to drink
4. The child has prolonged diarrhea for more than 14 days
5. The child has bloody diarrhea or black stool
6. The child is vomiting
7. The child is irritable and restless
8. The child has sunken eyes
9. The child has decreased urination
10. A sunken fontanelle
11. The child becomes lethargic, unconscious, or has seizures

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