It is said that most children in Africa die of treatable conditions of which diarrhea happens to be one of them. Diarrhea is the second leading cause of death and a leading cause of malnutrition in children according to WHO report. About 1.7 billion children come down with diarrhea every year globally while over 500,000 deaths are recorded annually.

Definition

Diarrhea is frequent loose or watery stools which deviate from the child’s normal pattern. It is passage of three or more loose stools in a day.

The frequent passage of formed stool is not diarrhea neither is the passage of pasty loose stool in breast fed infants. Diarrhea is the body’s own way of ridding itself of germs and according to WHO classification, there are 3 types of diarrheal diseases.

  • Acute bloody diarrhea: Acute bloody diarrhea is when the stool is stained with blood and is also called dysentery.
  • Acute watery diarrhea: Acute watery diarrhea is the passage of loose stool which usually lasts some hours or a few days.
  • Persistent diarrhea: This refers to any passage of loose stool for 14 days or more.

Pathophysiology

Diarrhea can be osmotic or secretory.

Osmotic Diarrhea: The absorption of water in the intestine is dependent on absorption of solutes, if excess solutes are retained in the intestine, water will also be retained leading to diarrhea.

When one ingests a poorly absorbed osmotically active substance, water passes through the gut unabsorbed also leading to diarrhea.

Secretory Diarrhea: A large amount of water is normally secreted in small intestines most of which is absorbed by the time it gets to the large intestine. In this case, the amount of water secreted is more than the amount absorbed usually caused by toxins in the bowel secreted by organisms such as Vibrio cholera.

Causes of Diarrhea

  • too much fruit or fruit juice
  • use of antibiotics or other medications
  • allergies or sensitivities to particular foods
  • dietary changes
  • bacterial infections
  • viral infections
  • parasites
  • malnutrition
  • improper food preparation
  • poor hygiene
  • inflammatory bowel disease. Read more


Symptoms of Diarrhea

  • Frequent loose stool
  • abdominal pain or cramping
  • nausea
  • fever and chills
  • dehydration

Symptoms of Moderate Dehydration

  • dry mouth
  • dry/sunken eyes
  • sunken cheeks
  • no tears when crying
  • irritability
  • dry skin
  • fatigue

Symptoms of Severe Dehydration

  • more than eight hours have passed without urination
  • the fontanel appears sunken
  • skin does not spring back when pinched
  • high fever
  • unconsciousness

Prevention

  • Use bottled water for drinking.
  • Avoid unpasteurized milk or milk products.
  • Wash fruits and vegetablesthoroughly and with salt.
  • Avoid giving child raw or undercooked meat.
  • Avoid getting food from street vendors.
  • Practice proper hygiene and wash your child’s hands often.
  • Rotavirus vaccine to prevent rotavirus infections in children (RotaTeq and Rotarix). Both are given in multiple doses to babies during their first months of life. Ask your pediatrician if these vaccines are recommended for your child.

Treatment at Home

In the case of mild diarrhea, you can manage it at home by taking note of the following;

  • Do not stop breastfeeding. It can help speed recovery and alleviate symptoms
  • Do not use over the counter drugs used to treat diarrhea in adults. Consult a doctor before you use any drug.
  • Make sure your child drinks plenty of fluids.
  • Do not feed them foods that seem to trigger diarrhea.
  • Wash your hands often, especially after each diaper change to avoid spreading bacteria in the home.
  • Watch out for dehydration in your child.Call your doctor immediately if you see any sign of dehydration. See below for signs of dehydration.
  • Change diaper after each bowel movement to prevent rash and irritation. Also use water instead of wipes. Wipes can worsen skin irritation.
  • Creams with zinc oxide can be applied to help soothe the skin and protect from any irritation.

Red Flags

Diarrhea in children can quickly lead to dehydration which is dangerous. If diarrhea exceeds 2 days, take your child to see a doctor or if any of these symptoms are present;

  • Tachycardia, hypotension, and lethargy (significant dehydration)
  • Vomiting
  • Petechiae and/or pallor
  • Fever
  • Bloody diarrhea
  • Severe diarrhea (more than eight stools in eight hours)
  • Abdominal pain or cramping/distention
  • Recurring diarrhea

Diagnoses

A detailed medical history and physical examination is important. Information about child’s diet, eating habits and medication would be helpful. History should include frequency and duration of stools, the presence of fever, vomiting, abdominal pain, or blood in the stool. Composition of the diet e.g, amounts of juice, foods high in sugars or sorbitol should be investigated as well as the current or recent use of antibiotics. The doctor should assess for risks for infection such as recent travel, recent contact with animals, or someone with similar symptoms.

The doctor should check for signs and symptoms of complications e.g weight loss and decreasing frequency of urination and fluid intake.

Physical examination

  • Vital signs should be assessed for signs of dehydration such as tachycardia, hypotension and fever.
  • Assess mucous membranes to see if they are moist or dry.
  • Examine extremities and assess skin turgor, capillary refill time, and the presence of petechiae, lesions, rashes etc.
  • Examine abdomen for distention, tenderness, bowel sounds.
  • Examine genitals for signs of rashes, anal fissures, and ulcers.

Laboratory investigation that could be requested includes:

  • Blood tests (to check for disease)
  • Stool culture (to check for bacteria and parasites)
  • Allergy tests
  • Enzyme immunoassay for rotavirus antigens
  • L:atex agglutination assay for rotavirus
  • Leucocyte count

Treatment

Intervention would depend on the causes of diarrhea. However, it should be noted that anti-diarrheal agents are not used in children.

Often time hydration is what is needed which could be given orally or intravenously.

Oral rehydration solution is recommended by WHO and is widely available everywhere. ORS should contain a complex carbohydrate or 2% glucose and sodium. It should be noted that sodas, juices, energy drinks and so on cannot meet these requirements. If one has no access to already prepared oral rehydration salt, it could be locally prepared at home using salt and sugar pending the time one finds the prepared salt.

In mild dehydration, 50mls/kg of ORS is administered over 4hours and in moderate diarrhea, 100mls/kg is administered over the same 4hour period. Asides this, 10mls/kg is given to the child after each loose stool. After 4 hours, the child is then reassessed for dehydration. If there are still signs of dehydration, the ORS should be re-administered as was done initially.

However, if the child is vomiting, small but frequent amounts should be given and gradually increased as the child begins to tolerate it.

Zinc supplements are given to reduce the duration of diarrhea episode and volume of stool. A nutritious diet should also be ensured to avoid malnutrition.