Diarrhea deadly but not difficult to deal with<\/p>\n
By Donya Betancourt<\/p>\n
SANUR, Bali (JP): Statistics now show diarrhea is still one of
\nthe top 10 causes of death in children under five years of age in
\ndeveloping countries. Diarrhea is also a leading cause of protein
\nenergy malnutrition in infants and young children. But if you
\nknow and understand how to manage it, diarrhea is not difficult
\nto deal with.<\/p>\n
When your child's bowel has toxins or foreign substances, the
\nbody tries to get rid of them, cleaning itself by flushing them
\nout in this is so-called \"diarrhea\". So diarrhea is one way to
\nget rid of toxins. It is a healthy mechanism and in most cases of
\nsimple diarrhea we only support the child with adequate fluids.<\/p>\n
Question: How can we identify \"diarrhea\"?<\/p>\n
Answer: The frequency of watery stool more than three times a
\nday or a bloody stool one time is considered \"diarrhea\". Acute
\ndiarrhea is less than two weeks in duration and usually, it lasts
\none or two days and it is not serious. If diarrhea persists more
\nthan two weeks, it is chronic diarrhea and needs medical
\nevaluation. Remember, breastfed babies usually have frequent
\nloose stools and can have up to eight stools a day, which is a
\nnormal condition.<\/p>\n
What are the causes of diarrhea?<\/p>\n
Acute diarrhea can occur as a result of the ingestion of a
\nvirus, bacteria, and parasites in food and drink. The other
\ncommon causes are allergies to food or milk and some medicines
\nwhich are used widely with ill children e.g. ampicillin.<\/p>\n
Chronic diarrhea may be due to bowel motility disorders,
\ninflammation, or malabsorption.<\/p>\n
In children one to two years old, their bowels are easily
\nsensitive to infection. So, at these ages, you have to be very
\ncareful with hygiene in foods, bottles and the cleaning process
\nbefore feeding your child.<\/p>\n
What should we be concerned with when the child has diarrhea?<\/p>\n
Diarrhea effects nutrition. Studies show nutrition will take
\nthree to five days to recover after a day of diarrhea even in
\nhealthy children. The other main concern is if the child loses
\nabnormally large amounts of water over a short period of time by
\nloose stools, fever, or vomiting. This is called \"dehydration\".<\/p>\n
The doctor will access the severity of diarrhea by the
\ndehydration. These are symptoms and signs for hydration status;<\/p>\n
* Mild dehydration: The child will have few stools without
\nmuch water, is still active, has no dryness of skin and mouth,
\nhas no sunken eye, the fontanel (a soft spot on the head) will
\nlook a little flat and the child will wet at least six diapers
\nper day.<\/p>\n
* Moderate dehydration: The child will have a dry mouth and
\nproduce little or no tears, will be less active than usual or may
\nbe cranky and irritable. He will wet less than six diapers per
\nday, will be vomiting, and the fontanel will look flat but not
\nsunken. In an older child he may feel thirsty. If any of these
\nsigns look positive you should see your child's doctor.<\/p>\n
* Severe dehydration: The child will be inactive (very fussy,
\nupset or very sleepy), may have a very dry mouth, dry and
\nwrinkled looking skin and no tears in his eyes, no urine for
\nseveral hours (dry diaper for more than three hours in an infant
\nand no urine for more than six hours in a child), the infant's
\nfontanel will be sunken. The child may be in shock and suffering
\nfrom cyanosis (turning blue).<\/p>\n
How can we prevent dehydration?<\/p>\n
It depends on the symptoms. If he has only diarrhea, no
\nvomiting, fever, or signs of dehydration, you can continue the
\nnormal diet but cut down on sweetened drinks and juices, which
\ncan make diarrhea worse. If your child has diarrhea and vomiting,
\nyour child's doctor may stop his normal diet temporarily and
\nsuggest substituting an electrolyte solution. Do not stop your
\nchild's normal diet without your doctor's recommendation. If you
\nthink your child has any signs of dehydration, call your
\npediatrician immediately.<\/p>\n
What kind of an electrolyte fluid should we use with children?<\/p>\n
There are a few brands of electrolyte fluid such as Pedialyte,
\nRenolyte, and ORS (oral rehydration solution from the World
\nHealth Organization (WHO)). If you can't find an electrolyte
\nfluid you can make it by mixing half a teaspoon of salt with two
\ntablespoons of sugar and 750 ml of water.<\/p>\n
How can we treat diarrhea?<\/p>\n
There are 4 treatment phases for acute diarrhea:<\/p>\n
* Phase 1: Predehydration phase for the child who has diarrhea
\nonce or twice without signs of dehydration. The treatment is food
\nand fluid. Most cases will recover without other specific
\ntreatment. Continue normal food or soft foods, such as rice,
\nbroth and cooked potatoes. Stay away from meat, nuts, beans and
\ndairy foods.<\/p>\n
If a breast-feeding baby, mother should continue breast-
\nfeeding and use caution with the foods and substances that the
\nmother eats e.g. high fiber and spicy foods. If a bottle-feeding
\nbaby, mother may dilute the concentration to half and step up to
\nnormal if the diarrhea is better. If your baby still has more
\ndiarrhea, watch out for signs of dehydration.<\/p>\n
* Phase 2: Rehydration phase: The treatment here consists of
\ncorrecting dehydration and maintaining hydration. For mild
\ndehydration, it is corrected by drinking 50 ml\/kg of electrolyte
\nfluid in the first four hours, then maintaining hydration by
\ndrinking 100 ml\/kg\/day of fluid along with breast milk, food and
\nwater. I recommend you to consult your pediatrician if your child
\nhas moderate or severe dehydration.<\/p>\n
* Phase 3: Post-rehydration or maintenance phase: In this
\nphase your child will not have dehydration. His symptoms are
\nbetter and his desire for food will return even if he still has
\ndiarrhea so you can give him food, such as ripe bananas, rice,
\napple sauce and toast without butter and start with small amounts
\nof food. Do not feed high-fiber foods like bran cereal or whole-
\ngrain bread, raw fruits, vegetables or fried food. Remember the
\nnumber of stools may increase after eating food, it is not an
\nindication to stop feeding him but if the increasing stools cause
\ndehydration you should stop that food.<\/p>\n
* Phase 4: Recovery phase: This phase is to be followed until
\nyour child's nutrition or his weight gets back to the same as
\nbefore the diarrhea and, unfortunately, because the stool is
\nnormal it is usually neglected. The child should get more protein
\nand more fatty foods such as eggs, beans, or sesame seeds and you
\nshould increase the amount of food as well as the frequency of
\nmeals.<\/p>\n
The following are conditions when your child should see a
\ndoctor immediately: Diarrhea in a newborn. Your child has bloody,
\nsevere or persistent abdominal pain with diarrhea. Diarrhea more
\nthan 48 hours. Diarrhea with vomiting more than 24 hours. Your
\nchild has any signs of dehydration.<\/p>\n
There are many over-the-counter medications available but most
\nare not to be used with children under two years of age. Remember
\nprevention is always the best, cleaning hands before eating and
\nafter using the toilet can prevent diarrhea.<\/p>\n
The writer is a pediatrician based in Sanur, Bali. Please
\nfeel free to write or ask questions of the writer through her e-
\nmail address, drdonya@hotmail.com.<\/p>",
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