Baby Yomi is a one-year old toddler who was brought to hospital by his mum because his stools had been very watery for some days. His mum said in a day he stooled many times and she was really worried because her really active son was then looking very weak and tired. Also, baby Yomi had lost a lot of weight because he felt lighter and his clothes were not as tight fitting as before.
When questioned about what she had given him, the mum noted that she had given him antibiotics prescribed by a chemist but the stooling frequency hasn’t subsided. She also gave him water to drink as she believed he must be thirsty.
The mum said, “Yomi used be such a live wire around the house, now he’s always sleeping. He even refuses his favourite meals. All he wants to do is breastfeed. He really is a shadow of himself. Doctor, what is wrong with him?”
For a lot of parents, this scenario is all too familiar. Diarrhoeal diseases are one of the most common problems that children face growing up especially in their infancy. According to the World Health Organisation, there are nearly 1.7 billion cases of childhood diarrhoeal diseases every year. So common that sometimes, it is trivialised.
Diarrhoeal disease ranks as the 2nd leading cause of death among children under the age of five after the neonatal period. Every year, it is estimated that diarrhoea is responsible for about 18 per cent of the 10.6 million yearly deaths in children younger than five years. As a result of this, due attention should be given to this highly dangerous disease.
How do we define diarrhoea? It is the passage of three or more loose stools per day. The frequency and the consistency of infants’ stools may vary based on the nature of their diet – whether they are being breastfed, formula fed or on solid foods. In deciding if an infant is truly experiencing diarrhoea, it is important for parents to note that if there is a change in the consistency of the stool from pasty or semi solid to watery or if there is more frequent passage of stools than is normally experienced. If your child is experiencing either or both symptoms, then he/she is having diarrhoea.
There are many causes of diarrhoeal diseases in children such as food allergies, intestinal surgeries, vitamin deficiencies, misuse of antibiotics, intestinal enzyme deficiencies. However, the most common cause of diarrhoeal diseases is due to infections.
There are a plethora of organisms that could cause diarrhoea such as viruses, bacteria or parasites. These organisms are usually introduced into the body through ingesting contaminated foods and liquids. Infective diarrhoea is a common stay in environments where there are poor levels of hygiene and cleanliness and lack of access to clean and safe water for drinking, cooking or cleaning. Unfortunately, majority of the population do not have access to safe water and have to source for water from questionable sources which usually are already contaminated. This puts infants at risk of contracting diarrhoea.
Another source of infection comes from unhygienic food preparation and handling arising from a lack of personal hygiene such as not washing of hands with soap and water before handling foods or utensils to be used for feeding the infant.
In a child experiencing diarrhoea, there is a disruption of the normal physiologic function of the intestines which is to absorb nutrients, water and important ions but rather there is a reversal leading to secretion and net loss of both water and ions. When these losses are not adequately replaced, it results in dehydration.
Children with mild dehydration tend to be their normal selves, exhibiting little or no apparent signs of an underlying problem except that they may appear to be thirstier. This early sign of dehydration usually goes unnoticed by most parents and caregivers. As the water loss increases, children start showing clearer signs of dehydration. They may appear irritable or restless, and their eyes have a sunken look. They have fewer wet diapers because they urinate less. This may sometimes be difficult to notice if they are stooling a lot but when they urinate it has a deep yellow colour.
Severe dehydration is a medical emergency. Severely dehydrated children are usually extremely weak and unresponsive, in some cases, they may become unconscious. They are unable to drink any fluids and if they do, it is usually very poor. Their eyes are mouths and very dry. Children at this stage of dehydration are always in a very critical condition.
It must be noted that children with diarrhoea can deteriorate very rapidly so that a once playful child can become critically ill if its warning signs are not identified early and addressed properly.
So apart from the signs of dehydration, what are the other major warning signs that should prompt caregivers to seek medical attention in a child experiencing diarrhoea? First of all, if the child is below the age of three months, medical attention must be sought. Also, if there is a fever greater than 38.0oC or the child is vomiting and complaining of abdominal discomfort. If at any point, caregivers notice blood in the stool; then a visit to your child’s doctor is highly warranted.
In the homestead, there are many significant steps that can be taken to prevent diarrhoea such as exclusive breastfeeding for the first six months of life; handwashing with soap before handling or preparing foods; using only clean and safe water that has been treating to remove harmful organisms; practising good personal hygiene and ensuring that home assistants and day care attendants are educated on the importance of adhering to good sanitation; ensuring that children younger than 6 months are vaccinated against rotavirus.
Coping with a child with diarrhoea can be a very exasperating experience. Apart from the frequent diaper changes and toilet trips, the constant stooling usually leaves them with soreness around their anus making them very uncomfortable and cranky. As the diarrhoea continues, children lose the zeal to eat or drink, adding to the challenge of trying to nurse them back to good health. So it is always important to identify early diarrhoea and begin proper care before it spirals out of hand.
Early rehydration is the most important step in caring for children with diarrhoea and this is primarily achieved using oral rehydration salt solutions (ORS). Plain water is not appropriate to treat diarrhoea in children as it lacks all the ions being lost constantly in the stool and may worsen their condition further. Premixed ORS is a very low cost and highly effective therapy that replaces the water and ions lost in stool and is absorbed by the intestines. They are easily gotten from the local pharmacies and it highly preferred to homemade solutions.
Encouraging your toddler to drink the ORS usually isn’t a stroll in the park as most caregivers would observe. However, with patience, determination and a lot of cajoling, it can be done, one sip at time. Within a few hours, the evidence of good rehydration becomes apparent as your baby springs back to himself. He starts having more wet diapers from urinating more, his eyes and mouth become moist once more and he starts getting more active and independent.
There are some cases in which ORS may not be ideal to replace lost fluids of dehydration, such as in severe dehydration. Children in such situations require hospitalisation to achieve rehydration through intravenous fluids.
Starting zinc supplements alongside the ORS, if it is not already present in it, further reduces the duration of the diarrhoea.
During this rehydration step, mothers are encouraged to continue breastfeeding and providing nutrient rich foods. Breast feeding not only helps in providing further rehydration and transferring protective antibodies to the child but it also provides the comforting and reassuring presence of the mother to the already distressed child.
Routine use of antibiotics is highly discouraged. This is because not all diarrhoeal diseases are caused by bacteria which the antibiotics cover, but more importantly antibiotic use can actually worsen and prolong the duration of the disease. Antibiotic use in treating diarrhoea is limited to very few situations and these situations must be elucidated by a qualified health care professional.
Above all else, please contact your health care provider if you’re unsure or confused of what to do, if your child’s stooling persists despite commencing the appropriate therapy or if there are signs of dehydration or other red flags as outlined above.
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