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Diarrhoea: A Common Childhood Problem

Dr Anupam Sibal and Dr Shravan Mehra

 
As pediatricians, we know that childhood illnesses can be a tremendous source of stress for parents. Often, a lot of this stress is related to the parents’ lack of understanding about their child’s illness, and the worry that their child’s health is no longer within their control..

In this article we will cover diarrhea, a common problem that will help parents understand their child’s condition, so that parents can then become better informed and effective partners with their doctor, in managing and safeguarding their child’s health.

Diarrhoeal disease is very common in infants and young children. These are caused by more than 100 different bacteria, protozoa or viruses.The majority of diarrhoeas are viral in origin. Diarrhoeas of less than 14 days duration are called acute and are presumed to be infective in origin.

When it exceeds 14 days it is called chronic / persistent. Dysentery is a more serious form of diarrhea, where the stools are tinged with blood and mucus. The diarrhea can be quite severe, characterized by colicky pains and frequent purging in a child with dysentery.

Causes of acute diarrhoea
  • Infection of the gut is the common cause. Many bacteria, viruses, and other ‘germs’ can cause diarrhoea. Sometimes the germs come from infected food (food poisoning). Infected water is a source. Sometimes it is just ‘one of those germs going about’. Viruses are easily spread from one person to another by close contact, or when an infected person prepares food for others.
  • Non-infectious causes of acute diarrhoea are uncommon in children. For example, colitis (inflammation of the gut), food intolerance, and various rare disorders of the gut.
Symptoms
There may be a prodrome of low-grade fever, body pain, headache and even upper respiratory tract symptoms. The diarrhoea is usually watery and there is no blood or pus in the stool. Vomiting often accompanies the diarrhoea and gastroenteritis can be manifest by vomiting alone. Abdominal cramps may occur. Usually the diarrhoea is self-limiting (2 - 7 days) and none of the true diarrhoea viruses cause chronic diarrhoea. However re-infections with the same virus like rotavirus can occur in childhood.

The most worrying aspect of diarrhoea is dehydration, which means that too much liquid has been drained out of the child’s body. So as soon as diarrhoea starts, it is essential to give the child extra drinks to replace the liquid being lost. In spite of the frequent loose stools, the baby does not look very ill. The paediatrician must be consulted immediately if the baby - is less than 6 months of age, has blood in the stool (dysentery), has frequent vomiting, significant abdominal pain or fullness of abdomen, or urinates less frequently and is extremely thirsty and has dry lips and mouth with poor intake of liquids, has high fever, weight loss or is malnourished.
 
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