Diarrhea is a very common problem in children. It consists of frequent, loose, or liquid defecation that differs from the normal pattern of a child. Sometimes diarrhea contains blood or mucus. Identifying mild diarrhea can be difficult because, in healthy children, the number and consistency of bowel movements vary with age and diet. For example, breastfed babies who are not yet on solid foods often have frequent, watery stools that are considered normal. A sudden increase in number and fluency may indicate diarrhea in these children. However, having a liquid stool for more than 24 hours is not normal.
Children with diarrhea may lose their appetite, vomit, lose weight, or have a fever. If the diarrhea is severe or lasts a long time, dehydration can occur. Babies and young children can become dehydrated very quickly, sometimes in less than a day. Uncompromising dehydration can cause brain damage, seizures, and death.
Worldwide, diarrhea causes 1.5 million deaths a year, mostly in developing countries. In the United States, diarrhea accounts for about 9% of hospitalizations for children under 5 years of age.
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Causes of diarrhea in children
The most likely causes of diarrhea vary depending on whether it lasts less than 2 weeks (acute) or more than 2 weeks (chronic). Most cases of diarrhea are acute.
Frequent causes of diarrhea in children
Acute diarrhea usually is produced by:
- Infectious gastroenteritis
- Food poisoning
- Use of antibiotics
- Food allergies
Gastroenteritis is usually caused by a virus, but it can also be caused by bacteria or parasites.
Food poisoning usually refers to the presence of diarrhea and/or vomiting, caused by eating food contaminated by toxins produced by certain bacteria, such as staphylococci or clostridia.
Certain antibiotics can alter the types and numbers of bacteria in the gut. As a result, diarrhea can occur. Sometimes the use of antibiotics allows a particularly dangerous bacteria, Clostridioides difficile (previously called Clostridium difficile ) to multiply. This bacterium ( Clostridioides difficile ) releases toxins that can cause inflammation of the protective lining of the large intestine.
Chronic diarrhea in children usually caused by:
- Dietary factors, such as lactose intolerance or excessive consumption of certain foods
- Infections (especially those caused by parasites )
- Celiac Disease
- Inflammatory bowel disease
Less frequent causes of diarrhea in children
Acute diarrhea may also result in more serious disorders such as appendicitis, the intussusception intestinal, and hemolytic uraemic syndrome (a complication of certain types of bacterial infection). In addition to diarrhea, these serious disorders are often associated with other worrisome symptoms, such as severe abdominal pain or bloating, bloody stools, fever, and a sick appearance.
Chronic diarrhea may also result from disorders that interfere with the absorption of food ( malabsorption ), such as cystic fibrosis, or alteration of the immune system (due to a disorder such as AIDS or the use of certain medications).
Diarrhea can be secondary to constipation. When hardened stool collects in the rectum, the loose stool can seep around it and into your child’s underwear.
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Warning signs of diarrhea in children
Some symptoms are cause for concern. These include the following:
- Signs of dehydration, such as decreased urine volume, lethargy or listlessness, crying without tears, intense thirst, and dry mouth
- Appearance of disease
- High fever
- Blood in the stool
- Spontaneous pain in the abdomen and very severe pain when touched
- Bleeding from the skin (which looks like small dots or petechiae; or reddish-purple or purple spots)
When to go to the doctor
A child with any warning sign should be evaluated by a doctor immediately, as well as one who has had more than 3 or 4 episodes of diarrhea and does not drink or drinks very little.
If the child does not have warning signs and is drinking and urinating normally, the doctor should be called if diarrhea lasts 2 days or more, or if there are more than 6 to 8 episodes of diarrhea per day. If the diarrhea is mild, it is not necessary to visit the doctor. Children with diarrhea lasting 14 days or more should be seen by a doctor.
First, the doctor asks about symptoms and medical history. Next, perform a physical examination. What they find during the physical examination and history usually proposes a cause of the disorder and the tests that may necessitate being done.
The doctor asks about the appearance of the bowel movements, how often, how long they last, and if the child has other symptoms, such as fever, vomiting, or abdominal pain.
The doctor also asks about possible causes, such as diet, use of antibiotics, consumption of possibly contaminated food, recent contact with animals, and recent travel.
A physical exam should be done to look for symptoms of dehydration and disorders that can cause diarrhea. The abdomen is palpated for distention and pain. The doctor also estimates the kid’s growth.
If diarrhea lasts less than 2 weeks and there are no warning signs, the cause is probably gastroenteritis due to a virus and, as a rule, no tests are necessary. However, if the doctor suspects another cause, tests are done to check it.
Tests are typically done when the child has warning signs. If there are signs of dehydration, blood tests are done to measure electrolyte levels (sodium, potassium, calcium, and other minerals needed to maintain fluid balance in the body). If other warning signs are present, a complete blood count, urinalysis, stool examination and analysis, abdominal X-rays, or a combination of several tests may be performed.
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Treatment of diarrhea in children
Treatment focuses on the specific cause of diarrhea. For example, if the child has celiac disease, gluten is eliminated from his diet. Antibiotics that cause diarrhea are stopped if recommended by your doctor. Gastroenteritis due to a virus usually goes away without treatment.
Medicines to stop diarrhea, such as loperamide, are not recommended in infants and young children.
The main concern in children is dehydration, so treatment focuses on rehydration through the administration of fluids and electrolytes (see Dehydration in Children ). Most children with diarrhea can be successfully treated by giving fluids by mouth (orally). Fluids are given through a vein (IV) only if the child is not drinking or is severely dehydrated. Oral rehydration solutions are used that contain the correct balance of carbohydrates and sodium. In the United States, these solutions are widely available without a prescription in drug stores and most supermarkets. Sports drinks, carbonated drinks, juices, and similar beverages have too little sodium and excess carbohydrates and should not be used.
If the child is also vomiting, small, frequent amounts of fluid are given initially. Typically 1 teaspoon (5 mL) every 5 minutes. If the child endures this quantity, it slowly increases. If the child does not vomit, it is not necessary to limit the initial amount of fluid. With perseverance and encouragement, most maximum children can absorb enough fluids by mouth to avoid the need for IV fluids. However, severely dehydrated children may need intravenous fluids.
As soon as the child has received enough fluids and is not vomiting, he should be given an age-appropriate diet. Babies can resume breast milk or formula.
In children with chronic diarrhea, treatment depends on the cause, but the most important thing is the provision and maintenance of adequate nutrition and monitoring for possible vitamin or mineral deficiencies.
- Diarrhea is common in children.
- Gastroenteritis, habitually due to a virus, is the most prevalent cause.
- The child should be evaluated by a doctor if he has any warning signs (such as signs of dehydration, severe abdominal pain, fever, blood, or pus in the stool).
- Testing is rarely necessary when diarrhea lasts less than 2 weeks.
- Dehydration is likely if the diarrhea is severe or lasts a long time.
- In most children, oral fluids can effectively treat dehydration.
- Medicines to stop diarrhea, such as loperamide, are not recommended in infants and young children.