Diarrhea deadly but not difficult to deal with

By Donya Betancourt

SANUR, Bali (JP): Statistics now show diarrhea is still one of the top 10 causes of death in children under five years of age in developing countries. Diarrhea is also a leading cause of protein energy malnutrition in infants and young children. But if you know and understand how to manage it, diarrhea is not difficult to deal with.

When your child's bowel has toxins or foreign substances, the body tries to get rid of them, cleaning itself by flushing them out in this is so-called "diarrhea". So diarrhea is one way to get rid of toxins. It is a healthy mechanism and in most cases of simple diarrhea we only support the child with adequate fluids.

Question: How can we identify "diarrhea"?

Answer: The frequency of watery stool more than three times a day or a bloody stool one time is considered "diarrhea". Acute diarrhea is less than two weeks in duration and usually, it lasts one or two days and it is not serious. If diarrhea persists more than two weeks, it is chronic diarrhea and needs medical evaluation. Remember, breastfed babies usually have frequent loose stools and can have up to eight stools a day, which is a normal condition.

What are the causes of diarrhea?

Acute diarrhea can occur as a result of the ingestion of a virus, bacteria, and parasites in food and drink. The other common causes are allergies to food or milk and some medicines which are used widely with ill children e.g. ampicillin.

Chronic diarrhea may be due to bowel motility disorders, inflammation, or malabsorption.

In children one to two years old, their bowels are easily sensitive to infection. So, at these ages, you have to be very careful with hygiene in foods, bottles and the cleaning process before feeding your child.

What should we be concerned with when the child has diarrhea?

Diarrhea effects nutrition. Studies show nutrition will take three to five days to recover after a day of diarrhea even in healthy children. The other main concern is if the child loses abnormally large amounts of water over a short period of time by loose stools, fever, or vomiting. This is called "dehydration".

The doctor will access the severity of diarrhea by the dehydration. These are symptoms and signs for hydration status;

* Mild dehydration: The child will have few stools without much water, is still active, has no dryness of skin and mouth, has no sunken eye, the fontanel (a soft spot on the head) will look a little flat and the child will wet at least six diapers per day.

* Moderate dehydration: The child will have a dry mouth and produce little or no tears, will be less active than usual or may be cranky and irritable. He will wet less than six diapers per day, will be vomiting, and the fontanel will look flat but not sunken. In an older child he may feel thirsty. If any of these signs look positive you should see your child's doctor.

* Severe dehydration: The child will be inactive (very fussy, upset or very sleepy), may have a very dry mouth, dry and wrinkled looking skin and no tears in his eyes, no urine for several hours (dry diaper for more than three hours in an infant and no urine for more than six hours in a child), the infant's fontanel will be sunken. The child may be in shock and suffering from cyanosis (turning blue).

How can we prevent dehydration?

It depends on the symptoms. If he has only diarrhea, no vomiting, fever, or signs of dehydration, you can continue the normal diet but cut down on sweetened drinks and juices, which can make diarrhea worse. If your child has diarrhea and vomiting, your child's doctor may stop his normal diet temporarily and suggest substituting an electrolyte solution. Do not stop your child's normal diet without your doctor's recommendation. If you think your child has any signs of dehydration, call your pediatrician immediately.

What kind of an electrolyte fluid should we use with children?

There are a few brands of electrolyte fluid such as Pedialyte, Renolyte, and ORS (oral rehydration solution from the World Health Organization (WHO)). If you can't find an electrolyte fluid you can make it by mixing half a teaspoon of salt with two tablespoons of sugar and 750 ml of water.

How can we treat diarrhea?

There are 4 treatment phases for acute diarrhea:

* Phase 1: Predehydration phase for the child who has diarrhea once or twice without signs of dehydration. The treatment is food and fluid. Most cases will recover without other specific treatment. Continue normal food or soft foods, such as rice, broth and cooked potatoes. Stay away from meat, nuts, beans and dairy foods.

If a breast-feeding baby, mother should continue breast- feeding and use caution with the foods and substances that the mother eats e.g. high fiber and spicy foods. If a bottle-feeding baby, mother may dilute the concentration to half and step up to normal if the diarrhea is better. If your baby still has more diarrhea, watch out for signs of dehydration.

* Phase 2: Rehydration phase: The treatment here consists of correcting dehydration and maintaining hydration. For mild dehydration, it is corrected by drinking 50 ml/kg of electrolyte fluid in the first four hours, then maintaining hydration by drinking 100 ml/kg/day of fluid along with breast milk, food and water. I recommend you to consult your pediatrician if your child has moderate or severe dehydration.

* Phase 3: Post-rehydration or maintenance phase: In this phase your child will not have dehydration. His symptoms are better and his desire for food will return even if he still has diarrhea so you can give him food, such as ripe bananas, rice, apple sauce and toast without butter and start with small amounts of food. Do not feed high-fiber foods like bran cereal or whole- grain bread, raw fruits, vegetables or fried food. Remember the number of stools may increase after eating food, it is not an indication to stop feeding him but if the increasing stools cause dehydration you should stop that food.

* Phase 4: Recovery phase: This phase is to be followed until your child's nutrition or his weight gets back to the same as before the diarrhea and, unfortunately, because the stool is normal it is usually neglected. The child should get more protein and more fatty foods such as eggs, beans, or sesame seeds and you should increase the amount of food as well as the frequency of meals.

The following are conditions when your child should see a doctor immediately: Diarrhea in a newborn. Your child has bloody, severe or persistent abdominal pain with diarrhea. Diarrhea more than 48 hours. Diarrhea with vomiting more than 24 hours. Your child has any signs of dehydration.

There are many over-the-counter medications available but most are not to be used with children under two years of age. Remember prevention is always the best, cleaning hands before eating and after using the toilet can prevent diarrhea.

The writer is a pediatrician based in Sanur, Bali. Please feel free to write or ask questions of the writer through her e- mail address, drdonya@hotmail.com.