Diarrhea in Children

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What is diarrhea ?

Diarrhea is usually defined, as the passage of three or more liquid stools per day. A loose stool is one, that takes the shapes of container. It is important to note that an infant who is exclusively breast-fed normally passes several soft, semiliquid stools per day. In such babies any abnormality in stools presenting as either increase in number or fluidity is considered as diarrhea.

The main cause of death in acute diarrhea is due to dehydration, which results from the loss of fluid and electrolytes in stools. Dehydration occurs faster in infants

and young children, in hot climate and in the presence of fever. Diarrhea is an important cause of malnutrition. It is seen in children with multiple episodes of diarrhea. Atrophy of the intestinal villi in cases of
malnutrition leads to malabsorption, which in turn accentuates diarrhea and aggravates malnutrition. Thus a vicious cycle of diarrhea and malnutrition sets in.

Treatment of diarrhea is mainly supportive and is directed at preventing or treating dehydration. Diarrheal morbidity can be significantly reduced by following the correct recommended practices of treatment as laid down by the World Health Organization (WHO) and by widespread use of Oral Rehydration Therapy (ORT). This article deals with the common causes of diarrhea in a child and management based on WHO guidelines.

Types of diarrhea:

The WHO has classified diarrhea into three types.

1. Acute watery diarrhea: This is when diarrhea starts acutely, is not associated with blood or mucus and lasts for less than 14 days. It may be associated with fever and vomiting. The main causative agents are Rotavirus, enterotoxigenic, E.Coli, Shigella and Vibrio cholerae.

2. Acute bloody diarrhea/dysentery: This is diarrhea with visible blood in stools. It occurs due to infection with Shigella, enteroinvasive E.Coli Salmonella or Camphylobacter jejuni. E. histolytica is rare cause dysentery in young children. Dysentery is generally associated with more complications, lasts longer and has a higher risk of death.

3. Persistent diarrhea: Diarrhea that persists for more than 2 weeks after an apparent episode of infectious gastroenteritis is termed as persistent diarrhea. Risk factors for persistent diarrhea are low birth weight, absence of breast-feeding concurrent medical illness, malnutrition blood or mucus in stools and prior antibiotic use.

Causes of diarrhea:

Most cases of diarrhea in children occur due to infectious agents that are transmitted faeco-orally. Diarrhea may follow bacterial viral or protozoal infections of the intestine or infectious extrinsic to the gastrointestinal tract.

Causes of diarrhea in a child

  • Viruses _ Rotavirus*, enteric adenovirus, Astrovirus etc.

  • Bacteria _ E.Coli*, Shigella*, Salmonella*, Vibrio cholerae*, Campylobacter jejuni, Yersinia.

  • Parasites _ E.histolytica*, Giardia lamblia*, Cryptosporidium, S.stercoralis etc

  • Infections*(parenteral) _ pneumonia, otitis media, urinary tract infections etc.

  • Dietary causes _ overfeeding, underfeeding, food allergy, food poisoning etc

  • Miscellaneous causes _ antibiotic associated*, malabsorption, anatomic defects of the GIT, endocrinopathies like thyrotoxicosis and laxative abuse.

*Common causes

Congenital lactase deficiency is a very rare cause of diarrhea in children. Secondary lactase deficiency may occur following an episode of acute gastroenteritis.

Predisposing factors for diarrhea are: poor sanitation, contamination of food and drinking water, use of bottle-feeding, failure to wash hands after defecation and failure to breast feed exclusively for the first 4-6 months of life. Newborns, young infants and malnourished children are at risk for diarrhea because of their immature immunological system, especially if they are not breast-fed.

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I have 22 days old son and he is having diarrhea from last 12 days. we consulted doc. he gave zinc drops & last time multi vit drops. but my baby still suffers problem of diarrhea. its like, he is given feeding at aprox 2 hrs interval, he sucks properly & sucks for 15-20 min but after completing food he does toilet, every time.
so please give some advise..

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