Diarrhoea in Children

Diarrhoea in children is one of the most common health issues worldwide, affecting millions of young ones each year. Diarrhoea is a significant concern, as children are more susceptible to fluid loss (dehydration) due to their smaller body size. Diarrhoea in children can stem from various factors, including viral infections, food sensitivities, and certain medications. Understanding the causes of diarrhoea in children and knowing how to treat it effectively is among the most crucial steps for ensuring the well-being of our little ones.

In this article, we'll explore the common triggers of diarrhoea in children and discuss practical ways to manage this condition at home. We'll look at the symptoms to watch out for, how doctors diagnose the problem, and how to treat diarrhoea in children.

Symptoms of Diarrhoea in Children

Diarrhoea in children manifests as: 

• Passing loose, watery stools more than thrice a day for at least four weeks
• Abdominal pain, cramping, and bloating 
• Nausea or vomiting
• Bloating and gas
• Changes in appetite
• In some cases, children might have bloody stools or lose control of their bowel movements.
• Fever and chills 

Dehydration is a serious concern with diarrhoea. Signs include:

• Excessive Thirst
• Decreased urination
• Lack of energy
• Dry mouth
• No tears when crying
• Sunken eyes or cheeks
• Decreased skin turgor

Causes of Diarrhoea in Children

Diarrhoea in children has various causes, ranging from infections to food-related issues. These may include: 

• Viral infections, such as rotavirus and norovirus, are common culprits. Bacterial infections, including E. coli, Salmonella, and Shigella, also play a significant role. 
• Parasitic infections, like Cryptosporidium and Giardia, can cause persistent diarrhoea.
• Food allergies and intolerances contribute to diarrheal episodes. Milk, soy, and other food allergies often affect young children. Lactose intolerance, fructose intolerance, and sucrose intolerance can lead to chronic diarrhoea.
• Contaminated food and water sources are major risk factors, especially in areas with poor sanitation. Person-to-person spread, aggravated by poor hygiene, is another common transmission route.
• Certain medical conditions (celiac disease & inflammatory bowel disease) can cause chronic diarrhoea in children. Functional gastrointestinal disorders, like toddler diarrhoea and irritable bowel syndrome, are also potential causes.

Diagnosis of Diarrhoea in Children

Doctors diagnose diarrhoea in children through various methods, including:

• Medical History: Doctors assess the child's medical history, dietary habits, and the duration and frequency of diarrhoea.
• Physical Examination: It may involve a comprehensive checking of the child's vital signs, hydration status, abdominal tenderness, and other potential complications.
•  Blood Tests: Doctors may conduct blood pictures to check for signs of infection, swelling (inflammation), or dehydration, such as electrolyte imbalances.
• Stool Analysis: Doctors collect stool samples for the presence of pathogens like bacteria (e.g., Salmonella, E. coli), viruses (e.g., rotavirus), or parasites (e.g., Giardia). The stool may also be evaluated for blood, mucus, or unusual consistency.

For chronic diarrhoea, more extensive testing is usually required. This may include:

• Blood tests to assess anaemia, inflammation, dehydration, and nutrition status
• X-ray studies in certain circumstances
• Endoscopy or colonoscopy with biopsy to check for inflammation
• Lactose breath hydrogen test to diagnose lactose intolerance
• Doctors may also recommend keeping a food diary and may perform tests to rule out food allergies or intolerances. Sometimes, they might suggest a trial elimination diet to identify potential triggers.

Treatment for Diarrhoea in Children

The main goal of treatment of diarrhoea in children is to prevent dehydration. Here’s a common guideline:

• Parents should offer plenty of fluids to replace those lost through diarrhoea. 
• For mild diarrhoea cases, children can continue their regular diet, including breast milk or formula for infants. Older children should consume more starchy foods like rice, cereal, and crackers.
• Oral rehydration solutions (ORS) are recommended for moderate to severe cases. These solutions replace lost electrolytes and fluids. 
• Avoid fruit juices, sugary drinks, and sports drinks, as these can worsen diarrhoea.
• In severe cases or when oral feeding is impossible, intravenous fluids may be necessary. 
• Doctors may prescribe antibiotics when bacterial infections are confirmed. 
• Parents should monitor their children for signs of dehydration and seek medical help if symptoms worsen or persist for more than 48 hours.

When to See a Doctor

Parents should contact their child's doctor if: 

• Diarrhoea persists for more than 48 hours or worsens 
• The child shows signs of dehydration (decreased urination, dry mouth, or sunken eyes)
• If the child has a high fever, especially for infants under three months with a temperature of 38°C or above 
• If the child refuses to eat or drink or shows signs of abdominal swelling
• Other concerning symptoms include severe stomach pain, bloody stools, and frequent vomiting. 
• For children with weakened immune systems, prompt medical care is crucial. 
• Parents should be alert to symptoms like stiff neck, unusual rash, or extreme drowsiness. 

Home Remedies for Diarrhoea in Children

• Parents can manage mild diarrhoea in children at home by focusing on hydration and proper nutrition. Offering plenty of fluids is crucial to prevent dehydration. Water, broth, and low-sugar sports drinks are suitable options. 
• For infants, continue breastfeeding or formula feeding as usual.
• Oral rehydration solutions (ORS)are effective for replacing lost electrolytes. It's important not to dilute ORS or mix it with formula.
• Dietary adjustments can help. Offer starchy foods such as rice, cereal, and crackers. 
• For children over one year old, yoghurt and flavoured gelatin cubes may be given. 
• Avoid fruit juices and sugary drinks, as these can worsen diarrhoea.
• Parents should not give medicines to stop diarrhoea unless specifically prescribed by a doctor, as these can be dangerous if not used properly. 

Prevention

Preventing diarrhoea in children involves several key strategies, such as: 

• Proper handwashing with soap & warm water for about 20 seconds is crucial. Parents should teach children to wash their hands before and after meals, after using the bathroom, and when sharing objects. When soap and water are unavailable, children can use alcohol-based hand sanitisers.
• Vaccination plays a vital role in prevention. The rotavirus vaccine can protect children from a common cause of severe diarrhoea and vomiting. 
• Food safety is essential. Parents should cook food thoroughly, especially meat, to kill harmful bacteria. 
• When travelling, families should be cautious about water and food sources. They should drink bottled water, avoid ice made from tap water, and be wary of raw fruits and vegetables unless personally washed and peeled.

Conclusion

Understanding the causes and effective management of diarrhoea in children is crucial for parents and caregivers. Parents can play the most important role in managing and preventing diarrhoea in their little ones by focusing on proper hydration, nutrition, and hygiene practices. It's essential to remember that while many cases can be handled at home, some situations call for prompt medical attention.

Keeping children healthy involves a combination of preventive measures and timely action when illness strikes. From maintaining good hand hygiene to ensuring food safety and staying up-to-date with vaccinations, there are many steps you can take as a parent to reduce the risk of diarrhoea in your child. When diarrhoea does occur, knowing how to respond effectively can make a big difference in a child's comfort and recovery. By staying informed and attentive, parents can help ensure their children's well-being and confidently navigate this common health challenge.

FAQ's

1. Can diarrhoea in children be prevented?

Parents can take several steps to prevent diarrhoea in children. These may include proper handwashing, vaccination against rotavirus, and being cautious about food and water sources. Avoiding tap water, unpasteurised milk, and raw fruits and vegetables is also crucial. Breastfeeding infants for the first six months protects against many infections.

2. When should I be concerned about my child's diarrhoea?

Parents should contact a doctor if their child shows signs of dehydration, such as decreased urination, dry mouth, or sunken eyes. Other concerning symptoms include high fever, bloody stools, frequent vomiting, and severe abdominal pain. For infants under six months, any diarrhoea warrants medical attention. Persistent diarrhoea lasting more than 2-3 days or accompanied by weight loss also requires professional evaluation.

3. Will fibre or certain foods stop my child's diarrhoea?

Certain fibre-rich foods may help slow diarrhoea in children. Apples (without skin), bananas, barley, oats, and sweet potatoes (without skin) can be beneficial. Curd and coconut water can help replenish lost fluids and minerals. However, avoiding milk, fatty foods, and sugary drinks is important during diarrhoeal episodes.

Dr. Shalini

CARE Medical Team