Diarrhea needs to be tackled quickly in the young

Maria Endah Hulupi, Contributor, Jakarta

Wiwied was overwhelmed by fear when her babysitter told her on her return from work that her eight-month-old son had passed watery stools at least seven times during the day.

"I was panicking, upset and really worried. I rushed him to a nearby hospital. My instinct told me it was diarrhea and the doctor confirmed it. I just did not know where he got it from," she said.

Rani also panicked after her one-year-old boy defecated at least 15 times in one day. Advice from her neighbors to feed the baby with different concoctions added to her confusion.

"The whole situation was distressing. The baby was suffering and his buttocks became sore. It took place in the morning but I had to wait until the pediatric clinic opened at 4 p.m.," said the mother of two.

Like many parents, Wiwied and Rani feared they could not tell the difference between a simple upset stomach and a potentially life-threatening case of diarrhea.

A pediatrician at Siloam Gleneagles hospital in Karawaci, Tangerang, Andreas Liando, explained that diarrhea in children is diagnosed when there was an increased frequency of passing stools, more than three times a day, and the stools are watery in consistency.

It can be dangerous when dehydration occurs and causes serious complications. However, passing stools around 10 times each day is normal for newborns.

"Newborn babies can pass stools 10 times each day but this cannot be classified as diarrhea because they sleep soundly, are breast fed or bottle-fed normally, gain weight and grow normally. They are perfectly healthy," he explained.

He added that children's diarrhea was often accompanied by other symptoms like fever, vomiting, bloating and abdominal pain.

Breast-fed children, he said, were less likely to contract diarrhea since they developed better resistance against infections than bottle-fed children.

The disease can be caused by several factors, like lactose intolerance (the inability to digest lactose, the sugar found in milk) and intestinal disorders.

But the most common causes are infections caused by viruses (the most common cause of acute diarrhea is the rotavirus), bacteria (salmonella, E. coli) and parasites like Entamoeba histolytica.

The diarrhea-causing infections can be obtained because of poor personal and environmental hygiene as well as through contaminated food or drinks -- including ones sold at unhygienic eating spots -- or due to the failure to sterilize the children's bottle and eating equipment.

Examples of poor personal hygiene include failing to properly wash hands after diaper changing, which allows the viruses and bacteria in the stools to infect a healthy child.

For these reasons, diarrhea prevalence is higher in impoverished areas or countries whose communities and citizens have little awareness of the importance of personal and environmental hygiene. It is also rampant in refugee camps or areas devastated by war or natural disaster where access to clean water and proper toilets is scarce.

Andreas explained that children aged 12 months were especially prone to contracting diarrhea since at this age they start exploring their surroundings by touching and by putting objects into their mouth. This is the reason it is especially important to keep the child's hands, toys and surroundings clean.

Viral diarrhea, he said, exhibited certain characteristics, namely watery stools with flecks of mucus and/or blood, while diarrhea caused by bacterial infections was often not very watery and less frequent. But to establish the exact cause of diarrhea and to determine the treatment, a laboratory test must be carried out.

In general, diarrhea can be effectively dealt with by timely treatment, for the onset of dehydration can be dangerous.

Andreas said that to replace fluid and electrolyte loss, immediate treatment should be done with rehydration fluid because water alone is not enough. Doctors would prescribe special rehydration fluid for children to restore their electrolyte balance.

While diarrhea caused by lactose intolerance will stop when the baby is given lactose-free milk, doctors may prescribe medication, such as antibiotics, for children with bacterial infections. Those with viral infections will receive symptomatic treatment to ease the symptoms until the virus run its course, usually in about seven days.

During a bout of diarrhea, parents should continue giving the child food, in a softened or pureed form, and liquids as part of maintaining electrolyte balance.

"Soft food is given to help the absorption of nutrition in the intestine. Very sweet drinks should be avoided because they can worsen the diarrhea," he said.

Rehydration efforts become impossible when vomiting also occurs, and parents should then immediately take the child to a doctor. Failure to do so may led to severe life-threatening dehydration, with the likelihood of shock, unconsciousness and complications affecting kidney and heart functioning.

"In serious diarrhea, dehydration can occur in a matter of hours," Andreas warned.

Some cases of diarrhea, especially occurring following surgery to remove a tumor or mass in the intestine or involving malnourished children, need special medical attention.

"Malnutrition itself can lead to diarrhea and when a malnourished child gets diarrhea-causing infections, it can be serious," Andreas said.

Preventive measures against diarrhea include sterilizing feeding equipment, bottles, pacifiers, toys, maintaining personal hygiene -- especially by properly washing the child's and your hands before feeding or eating -- and by keeping the immediate environment clean.

Parents, adult family members and care givers should also be educated about prevention of the disease, and what to do when it occurs to avoid dehydration.

It is also advisable to use clean cotton balls soaked in warm water to gently clean the baby's buttocks, and use cloth napkins instead of diapers to prevent skin irritation during the bout.

Indications of dehydration in children

* Reduced urine production

* Fever

* No tears when crying

* Dry mouth

* Lethargy

Dehydration, without quickly replacing the fluid and electrolyte losses, can be fatal and when early signs of dehydration show, consult a doctor immediately.