Diarrhoea is the passage of three or more loose (watery) stools in a day (or more frequent passage than is normal for the individual). Loose but non-watery stools in babies who are exclusively breastfed may be normal. Frequent passing of formed stools is not diarrhoea. Diarrhoea in children is the second leading cause of death in children under 5 years old. It is most common in developing countries, where young children have diarrhoea on average three times a year. According to WHO, diarrhoea causes deaths in 525 000 children every year.
Diarrhoea is commonly caused by viruses, bacteria and parasites. These infections are often acquired from food or water that has been contaminated by stool, or directly from another person who is infected. Diarrhoea can be acute (lasting less than 14 days) or chronic (lasting more than 14 days). It can also be associated with vomiting, fever, abdominal pain. Diarrhoea can last for a few days and if not well managed can lead to dehydration and death.
These factors increase the risk of a child contacting diarrhoea;
Non-breastfed children: Breastfeeding increases the immunity of children against diarrhoea.
Unsafe drinking water and food: Contaminated food habour pathogens that cause diarrhoea.
Poor hygiene practices:; Open defecation is a leading cause of infectious diarrhoea leading to death.
Malnutrition: About 45% of all child deaths are linked to malnutrition.
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Prevention of Diarrhoea in Children
These are some ways to prevent diarrhoea in children;
Exclusive breastfeeding: Mothers should give babies only breast milk for the first 6 months of life. Breast milk contains sufficient water, nutrients and antibodies that will help the child to fight off infections.
Safe water and food: Meals should be properly cooked in clean environment. Therefore, doctors advise that children should feed with cups and spoons instead of feeding bottles to reduce the chances of infections.
Adequate sanitation: It is important to keep the environment and the floors clean especially when a child starts to crawl around. Similarly, proper and regular washing of toys that the child puts into the mouth is important.
Hygiene: Doctors advise regular hand washing with soap and water. This will reduce the incidence of diarrhoea in children by approximately 42–48%.
Adequate nutrition: Children should feed on meals rich in protein and vegetables. These help to boost their ability to fight infections.
Vaccines: Vaccination against rota virus (which accounts for 40% of the cases of diarrhoea in children) should be given routinely.
Proper disposal of waste and waste products.
Vitamin A supplements: Children should get vitamin A supplements to improve the body’s ability to fight off infections and reduce the severity of diarrhoea.
Signs of dehydration
Dehydration results when the body loses more fluid than it takes in. This commonly occurs in diarrhoea. It can be classified into;
Mild/no dehydration (not enough signs to classify as some or severe dehydration)
Some/moderate dehydration (two or more of the following signs):
- restlessness, irritability
- sunken eyes
- drinks eagerly, thirsty
Severe dehydration (at least two of the following signs):
- sunken eyes
- unable to drink or drink poorly
- skin pinch goes back very slowly ( ≥2 seconds )
These are some treatments doctors recommend for diarrhoea in children;
Oral rehydration salts (ORS): This consists of one-litre water with one teaspoon salt and two tablespoons sugar. ORS may lower the mortality rate of diarrhoea in children by as much as 93%. It should begin at the first sign of diarrhoea in order to prevent dehydration. Children under two can be given a quarter- to a half-cup (60-120 mls) of fluid following each loose bowel movement. Older children can have a half- to a full cup (120-240mls). If the person vomits, the caretaker should wait for 5–10 minutes and then resume giving ORS.
Home-made solutions: This includes salted rice water, salted yoghurt drinks, vegetable and chicken soups with salt. Others are; unsalted soup, green coconut water, weak tea (unsweetened), and unsweetened fresh fruit juices. You can add half a teaspoon to full teaspoon of salt per litre.
Zinc supplements: You can give zinc tablets to children. These help in the development and proper functioning of the human immune system
Antibiotics: You do not need antibiotics in the management of diarrhoea except there is a passage of bloody stool or fever.
Loperamide: Loperamide is not advisable in children younger than 12 years because they easily dehydrate children. Thus, fluid replacement via ORS is more advisable.
Try to avoid sweetened fluids like soft drinks, energy drinks, sugar water and undiluted fruit juices. These all contain sugar that draws water into the intestine and can make diarrhoea worse.
Give your child solid foods, such as bread, cereal, rice, lean meat, yoghurt, fruit and vegetables. These can help restore essential nutrients needed to fight infection. In addition, offer your child yoghurts that contain live or active cultures.
Regular changing of nappies with plenty of nappy cream helps to keep your child’s buttocks dry. This is important because dirty nappies can irritate your baby’s bottom.
If your child’s diarrhoea lasts longer than 48 hours, or you’re otherwise concerned about their health, you should consult your doctor.
Evidence suggests that diarrheal disease has significant impacts on mental development and health. Children who had experienced severe diarrhoea had significantly lower scores on a series of tests of intelligence. Therefore, prevention and prompt care of diarrhoea are very important.