Diarrhoea in Children

Diarrhoea is a condition of excessive fluid and electrolyte loss from the body due to frequent stools. It commonly affects both kids and adults of all age groups. Its toll on the human body may range from mild to severe. With adequate fluids and appropriate medications, most cases can be managed effectively.

What Is Diarrhoea?

Diarrhoea is defined as passing frequent (mostly watery) stools more than three times a day. It may be classified, in terms of duration, as acute and chronic. Acute diarrhoea starts abruptly and lasts for a few days up to four weeks, while the condition is termed chronic diarrhoea if it persists beyond a month. It is termed persistent if an acute diarrhoea episode persists beyond 2 weeks. It may also be categorized on the basis of the causative factor. Infectious diarrhoea is much more common than other causes of systemic diseases and medication-associated diarrhoea.

The main worry in diarrheal diseases is dehydration, or simply the loss of fluids from the body. Newborn babies and young children are the most vulnerable to diarrhoea, as their immunity is low, and digestive tracts are underdeveloped. Dehydration may or may not be associated with loss of electrolytes or body salts. These electrolytes are essential for normal functioning of the body, including cardiac, renal, and muscular-skeletal systems.

Causes of Diarrhoea in Children

Following are the most common causes studied:

1. Gastro-Intestinal Infections

Infections of the gastric and intestinal mucosa are the most common cause of diarrhoea in children and adults. Microbes enter the gastrointestinal tract (GIT) through unhygienic food or water, uncooked or partially cooked food. These organisms may include viruses, bacteria, and parasites.

2. Rotavirus

It is the most common diarrheal disease-causing agent in newborns and children, and is the leading cause of infant deaths worldwide. It is now preventable by means of a rotaviral vaccine.

3. Adenovirus

Besides causing respiratory illnesses in newborns and young children, adenoviruses can cause diarrheal diseases in them, too. It may spread through close contact, coughing, and sneezing. The infection may be severe enough to cause dehydration.

4. Salmonella typhi

Typhoid or enteric fever is a bacterial form of gastroenteritis. It may spread through contaminated water or food. In its most severe form, it may cause ulcers in the digestive system, which might require surgical management.

5. Escherichia coli

A Gram-negative bacteria usually associated with urinary infections, E. coli may cause diarrheal diseases in children due to contaminated water and foods. This is the organism also associated with traveller’s diarrhoea.

6. Parasitic Infections

Infestations by hookworms, roundworms and tinea infections are caused mostly by eating raw meat, beef, or swine meat.

7. Food Allergies and Intolerance

Some babies are intolerant of certain foods like milk proteins, eggs, potatoes, and groundnuts. When such foods are ingested, the gastric mucosa is inflamed, which responds by means of an immune reaction to curb the inflammation. This immune reaction is associated with symptoms like nausea, gastritis and vomiting. Galactose intolerance is one such example, wherein the necessary enzymes to metabolize the sugar galactose present in milk are deficient. Hence, such babies are intolerant to milk, including breast milk.

8. Medication

Certain medications, including anti-cancer drugs, anti-inflammatory drugs, and various antibiotics cause diarrhoea by inciting an inflammatory reaction in the gastric and intestinal mucosal linings.

9. Diseases of the GIT

A host of gastric disorders, including autoimmune disorders, cancers, and structural diseases may cause diarrhoea as a manifestation.

10. Bowel Disorders

Inflammatory bowel diseases including ulcerative colitis and Crohn’s disease, irritable bowel syndrome, celiac and tropical sprues, are among the most common disorders causing diarrhoea.

11. Hormone Disorders

Hormonal disorders, like diabetes and hyperthyroidism, lead to an autonomic instability, causing diarrhoea.

12. Cancer

Diarrhoea can be a symptom of gastric or intestinal infection.

Symptoms of Diarrhoea in Kids

The severity of diarrhoea may be divided into mild, moderate, and severe categories based on the symptoms.

Mild to moderate diarrhoea may have the following symptoms:

• Frequent loose stools with watery consistency
• Pain in abdomen; cramping or severe pain

• Fever; infectious diarrhoea is associated with elevated temperatures
• Nausea and vomiting

Severe diarrhoea & dehydration may have the following additional symptoms:

• Dehydration
• Blood in stools
• Pus in stools, which is usually seen in parasitic infections
• Pain while defecating
• Persistent vomiting

Diagnosing and Treating Diarrhoea in Children

Diagnosing and treating diarrhoea medically would require the following steps to be taken:

Diagnosis

1. Detailed Clinical History

An elaborate history of symptoms, eating habits, and medications can be useful for diagnosing the cause of diarrhoeal diseases.

2. Physical Examination

Your clinician will examine the child for signs of dehydration, like abdominal pain and tenderness.

3. Laboratory Investigations

• Blood tests: to detect bacterial diseases, hepatitis, and PCR for viral pathogens
• Stool microscopy: to detect parasites in the stools
• Allergy tests: to diagnose intolerance or allergies to certain foods or substances
• Ultrasound examination

Treatment

1. Hydration

Primary management of diarrhoea is restoring the lost fluid and electrolytes from the body.

2. Treating the Cause

Cause-specific therapy for infections and bowel disorders can cure diarrhoea permanently.

3. Probiotics

These help restore the natural intestinal flora of essential micro-organisms.

4. Antispasmodics

They help relieve the pain and spasms.

5. Antibiotics

They treat the infection by killing the organism responsible.

Alternative Therapies

Besides the standard therapies, the following options may help in the treatment of chronic diarrhoea.

1. Acupuncture

Stimulating certain vital pressure points either in the hands or feet may help reduce diarrhoea by means of providing involuntary stability.

2. Meditation & Yoga

This method helps improve immunity levels, decreases stress, clears the digestive system, and avoids over the counter medications.

Best Diet for Diarrhoea

Selecting foods can be a challenge when your baby is affected by diarrhoea, as the digestive system is extremely sensitive, and unable to digest foods easily. The guide below entails the things you can and cannot feed your little one in such an instance:

Foods to Eat

For babies younger than six months, you should continue breastfeeding as usual, besides the medications, if any, for diarrhoea. Your doctor might ask you to give additional breastfeeds if there are signs of dehydration. Lactose-intolerant babies may require special feeds in replacement of breast milk.

Babies older than six months can be fed the following foods:

• Banana mash with milk
• Boiled potato mash

• Bland porridge of rice
• Soft, tender vegetable roots, like beets and carrots
• Wheat cereals or oatmeal preparations
• Curd or flavoured yoghurt

Babies on formula feeds should be continued with their diets. It is essential to ensure adequate nutrition through diet during an episode of diarrhoea, for speedy recovery and prevention of weakness due to dehydration.

Foods to Avoid

The intestinal mucosa is altered in diarrhoea. Hencem digestion becomes difficult. It is advisable to avoid certain foods that may be difficult to digest and hence harmful during diarrhoea in toddlers and young children:

• Excessive dairy products like cow milk, butter, and cheese
• Packed foods, fried chips, or excessive sweets and chocolates

• Too much fruit juices, as they contain synthetic preservatives
• Fried and greasy foods, spicy or tangy sauces
• Seafood and non-vegetarian foods, as they are difficult to digest

Home Remedies for Diarrhoea in Kids

Mild to moderate diarrhoea without dehydration can be efficiently managed at home with the following:

1. Adequate Rehydration

ORS or Oral Rehydration Solution is a balanced mix of essential electrolytes, salts, and sugars that should be administered with a doctor’s advice to replenish the loss of electrolytes.

2. Continuing of Breastfeeding

Various studies and guidelines support the continuation of breastfeeding for babies less than six months with diarrhoea.

3. Small and Regular Meals

Babies, irrespective of their age, should be fed adequately and regularly during a diarrhoea episode. The loss of fluids and electrolytes causes weakness and deficiencies of vital nutrients. Ensure feeding every three to four hours.

4. Maintain Diaper Hygiene

Keep the child’s diaper region clean and dry. You may use anti-fungal or anti-bacterial creams and powders to avoid microbes.

Some common and natural homemade remedies for diarrhoea relief include the following:

• Herbs help in improving bowel habits, for example, tea made with chamomile.
• Turmeric is an ancient antiseptic. A teaspoon of turmeric taken with warm water (only if tolerated) can be helpful.
• Bitter gourd juice with an extra pinch of salt is helpful.
• Lemon drops and pinch of black pepper added to ginger juice is said to relieve cramps in diarrhoea.
• Gooseberry helps reduce the water content of stools.
• Mashed apple slices can help improve diarrhoea.
• Tannins present in black tea reduce intestinal inflammation.
• Blackberries and black seed oil are said to reduce diarrhoea.
• Coconut water replenishes potassium loss.
• Curd or yoghurt has probiotic properties, which enhance the normal intestinal flora.
• Banana is a high-fibre fruit, which helps maintain normal bowel habits and prevents diarrhoea.

How Can Diarrhoea in Children Be Prevented?

The following steps can help prevent diarrhoea in children:

• Exclusively breastfeed your baby until the age of six months, as it provides antibodies to the child.
• Boil water before use for drinking to destroy pathogens.

• Avoid outside food for your child as much possible, as you don’t know the level of hygiene in the kitchen where it is cooked.
• Ensure the child washes his hands before eating, to remove any lingering pathogens.
• Restrict the consumption of excess sweets, spices, and fried foods, as it could upset the stomach.
• Avoid excess use of medication, as it is known to disturb the digestive system.
• Recognize signs in your baby, such as excessive crying, not accepting feeds, frequent change of diapers, the colour of stools, etc. and take corrective action immediately.

When to Take Your Child to the Doctor

Following are the red flag signs, due to which you should immediately consult your baby’s doctor:

• Dry skin, sunken eyeballs, reduced urine volume
• Frequent soiling of diapers (4-6 stools a day is considered normal for newborns), watery stools, dark yellow or green stools
• Cold, clammy skin
• Drowsy or not playful like usual

Untreated diarrhoea is a major cause of malnutrition, especially in developing nations. Malnutrition is, in turn, the most common cause of infant deaths all around the world. As a parent, one must always watch out for the signs, and take remedial action immediately.

Also Read: Dehydration in Babies