DIARRHOEA IN CHILDREN: CAUSES & PREVENTION - Volume 2
March 1, 2017
Diarrhoea refers to the passage of loose or watery stools or an increased frequency of stools for a child and occurs at some point in the life of nearly every child. Diarrhoea can lead to dehydration, which alters the child’s natural balance of water, and to electrolyte (sodium, potassium, Chloride) imbalance. It can be serious if not treated promptly.
In Nigeria, dehydration from diarrhoea is a major cause of death among young children. Diarrhoea is one of the top three causes of childhood mortality in Sub-Saharan Africa (SSA); approximately, 40% of childhood deaths from diarrhoea worldwide occurred in SSA in 2000. Thus, there has been a considerable research interest in understanding the etiology and preventive measure of the childhood diarrhoea. Vulnerability of children to this disease, which posed a major threat to children in Africa, is strongly associated to parental care and household environmental factors among others. For instance, household environmental factors, particularly water and toilet facilities, have been found to be significantly related to the incidence of childhood diarrhoea.
CAUSES OF DIARRHOEA
The most common cause of acute diarrhoea is a viral infection. Other causes include bacterial infections, side effects of antibiotics, and infections not related to the gastrointestinal (GI) system. In addition, there are many less common causes of diarrhoea.
Viral, bacterial, and parasitic infections are all contagious, and parents/caretakers can assist in preventing spread of the infection. Children are considered contagious for as long as they have diarrhoea. However, depending on the microorganism, some children can spread diarrhoea even before they develop symptoms, and a minority will continue to spread diarrhoea pathogens for weeks, months, or years after their symptoms resolve. Microorganisms causing diarrhoea are spread from hand to mouth; hand washing and separating food-handling and faeces disposal (e.g., not changing diapers in the kitchen) are very important to preventing infection in family and other contacts.
Viral infection — Viral infection is the leading cause of diarrhoea. Symptoms of viral infection can include fever (temperature higher than 38ºC or 100.4ºF), watery diarrhoea, vomiting, abdominal cramps, lack of appetite, headache, and muscle aches.
Children with diarrhoea from viral infections are best treated with supportive measures (oral rehydration solution; age-appropriate diet, limiting foods high in fat and simple sugars; and rest). Vomiting is the predominant feature of gastroenteritis caused by Norovirus and medicines to prevent vomiting may be prescribed to assist the child with oral rehydration.
Bacterial infection — Bacterial infection is sometimes hard to distinguish from viral infection. Bacterial infections are more common in locations where there is unsafe drinking water and poor handling of sewage. Persistent high fever (higher than 40ºC or 104ºF) and diarrhoea that is bloody or contains mucus are more common with bacterial diarrhoea. Most children with bacterial infection do not require antibiotics and will improve with time and supportive measures, however, treatment may be necessary in certain situations.
Parasitic infection — Parasitic infections are more common in locations where there is unsafe drinking water and poor handling of sewage. Infection with a parasite is uncommon in developed countries but may be seen in children who have recently ingested contaminated water or who have travelled to or lived in developing countries. Diarrhoea from parasitic infections may last for weeks to months.
Antibiotic-associated diarrhea — A number of antibiotics can cause diarrhoea in both children and adults. The diarrhoea is usually mild and typically does not cause dehydration or weight loss. In most cases, antibiotics should not be stopped and the child's diet does not need to be changed. The diarrhoea usually resolves one to two days after antibiotics are finished. Always Contact a healthcare provider if a child on antibiotics has diarrhoea that is severe, contains blood, or does not resolve after the antibiotic is stopped.
Although it's almost impossible to prevent kids from ever getting infections that cause diarrhoea, here are some things to help lessen the likelihood:
Make sure kids wash h their hands well and often, especially after using the toilet and before eating. Hand washing is the most effective way to prevent diarrhoea infections that are passed from person to person. Dirty hands carry infectious germs into the body when kids bite their nails, suck their thumbs, eat with their fingers, or put any part of their hands into their mouths.
Keep bathroom surfaces clean to help prevent the spread of infectious germs.
Wash fruits and vegetables thoroughly before eating, since food and water also can carry infectious germs.
Wash kitchen counters and cooking utensils thoroughly after they've been in contact with raw meat, especially poultry.
Refrigerate meats as soon as possible after bringing them home from the supermarket, and cook them until they're no longer pink. After meals, refrigerate all leftovers as soon as possible.
Never drink from streams, springs, or lakes unless local health authorities have certified that the water is safe for drinking.
When to Take Your Child the Doctor
Take your child to the doctor if your child has diarrhoea and is younger than 6 months old or has:
a severe or prolonged episode of diarrhoea
fever of 102°F or higher
repeated vomiting, or refusal to drink fluids
severe abdominal pain
diarrhoea that contains blood or mucus
Take your child to the doctor immediately if your child seems to be dehydrated. Signs of dehydration include:
dry or sticky mouth
few or no tears when crying
eyes that look sunken into the head
soft spot (fontanelle) on top of the head that looks sunken
lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount of dark yellow urine)
lack of urine for 12 hours in an older child (or only a very small amount of dark yellow urine)
dry, cool skin
lethargy or irritability
fatigue or dizziness in an older child
As mentioned earlier, Rotavirus is the most common cause of infective diarrhoea in children. There are two oral vaccines that can help prevent rotavirus infection in children (RotaTeq and Rotarix). Both are given in multiple doses to babies during their first months of life.
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Patient education: Acute diarrhea in Children (Beyond the Basics)
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Prevalence and treatment of childhood Diarrhea among Nigerian Ethnic Groups
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