Diarrhoea in Children

Epidemiology 

Affecting around 1.7 billion children worldwide, diarrhoea is the second leading cause of death in those under 5 years, globally. It’s impact to the health status of the world has made ‘the prevention of deaths caused by diarrhoea’ a priority in the eyes of the WHO. According to the Demographic and Health Survey report of 2016, within a period of 2 weeks preceding the survey, three percent of children in Sri Lanka had been reported to have diarrhoea.

Aetiology 

Diarrhoea is defined as the passage of loose or liquid stools three or more times within 24 hours. Infective diarrhoea can be caused by viruses, bacteria or even parasites. The most common causative organisms of childhood diarrhoea are viruses, out of which Rotavirus is notoriously common. Other non-infective causes are lactose intolerance, antibiotic-associated diarrhoea, inflammatory bowel disease and the list goes on. A higher incidence of diarrhoea is seen in six to eleven month babies, with the introduction of semi-solid and solid food. The most commonest non infective cause in children is toddler’s diarrhoea for which the exact cause is unknown, however suspected to be related to diet and is commonly seen in toddlers and preschoolers.

What is so dangerous about diarrhoea in children? 

It is advisable to seek medical care if the diarrhoea is profuse if associated with intractable vomiting, if the child has severe abdominal pain if the stool contains blood or pus, if it is black or tarry if the child refuses to eat or drink and most importantly if the child develops signs of dehydration.

The killer in most cases of diarrhoea in children is dehydration rather than the disease per se. With the loss of fluids and electrolytes needed for the body due to increased passage of stools and vomiting, there will be fluid and electrolyte imbalances in the body causing the inability to carry out the normal functions of the body. So it is important that the caregiver should recognise the features of dehydration in the child. Drying of lips and mouth, passing less urine than normal, increased thirst, sunken eyes, cold hands and feet, the child seems restless and irritable, changes in breathing may indicate that the child has dehydration. It may be severe if the child becomes pale, drinks poorly, the mouth looks parched, has no tears, if the child becomes lethargic and unconscious. If these develop seek medical care immediately.

What can be done at home to care for the child and to avoid dehydration?

With the increased loss of nutrients and reduced absorption of food, your child needs his/her nutrients more than ever. If the child is not refusing meals, there is no harm in giving a normal diet. You can give carbohydrates such as rice, potatoes, bread, meat, fruits and vegetables. In breastfeeding children, continue breast-feeding. It is not necessary to avoid milk products (unless lactose intolerant or allergic to milk). The food can be provided in smaller portions to reduce the risk of vomiting. Also as mentioned earlier, be on the lookout for any sign dehydration! 

If the child is refusing to eat, continuously vomiting and passing stools the risk of dehydration is higher. However, hydration with water alone is not sufficient. Due to the diarrhoea, absorption of water and electrolytes is changed than when normal. Effective concentrations of electrolytes and glucose are needed for absorption to take place effectively. These concentrations are correctly present in Oral Rehydration Solutions (ORS, commonly known as Jeewani). So to replenish the electrolytes and the fluids lost, Oral Rehydration Solution is given in hospitals and can be given at home as well. 

How to give Jeewani?

It is important to follow the instructions given on the packet when preparing this. Avoid adding sugar or anything else. Once prepared use the preparation only for 24 hours, afterwards discard and make a new one. Can continue other fluids as well. King coconut water is a natural alternative to ORS and can be given as well. Unless medically indicated, antibiotics and antidiarrhoeals are not recommended. It might prolong the disease duration.

How to prevent?

As the saying goes, prevention is better than cure. Thus maintaining personal hygiene, washing hands of the children before and after eating, washing hands before preparation of meals, giving the child clean drinking water and safely prepared food, not giving water to a baby during the exclusively breastfed period (usually first 06 months) and having proper sanitation play important role in the road to preventing diarrhoea.

By

Rtr. Sandamini Liyanage

Dir. of Finance

RACFOM