Description

Even though diarrhea is very common in children, parents should evaluate the situation and know when to consult a physician, Dr. Hands says.

Transcript

How to Treat Diarrhea and Vomiting in Children My next topic is diarrhea and vomiting, a very, very common cause for a visit to pediatric office even probably more common for cold to a doctor’s office. Diarrhea and vomiting obviously has many causes. It causes that we think of the most are those caused by bacteria or viruses, many of which are food borne and also parasitic infections. Parasitic infections usually don’t cause acute diarrhea. They usually cause a chronic diarrhea pattern. It has to be considered among other organic causes of chronic diarrhea. The diarrhea we’re talking about is the acute onset gastroenteritis that we all of us have had, all of us have suffered from and will suffer many times more from. It is specially devastating to children because of their smaller body mass, they have decreased fluid volume, and therefore, their propensity to get dehydrated a lot quicker than an adult. Now, one thing I want to stress is viral gastroenteritis is not a 24-hour illness, not even in adults. The only exception is the Norwalk virus which is very common and lasts for maybe three days tops. The Norwalk virus is a common virus, and people think all diarrhea should be treated that way and get very upset when their child has diarrhea to five, six, seven, eight days. But, the rule of thumb basically, is diarrhea is not a short illness that tends to last for a reasonable length of time. Now, there’s immediate evaluation phenomenal with diarrhea. Let me give some of the reasons that a parent should immediately call the doctor and expect immediate evaluation. One is any child under six months with significant diarrhea probably should be seen by the physician and followed by the physician. Obviously, dehydration, if it’s obvious and cause for immediate evaluation. Frequent vomiting would be a cause since you cannot get any fluids in and you cannot correct the problem. The loss of appetite for fluids so the child doesn’t take any fluids in or if your child is extremely thirsty, there is a message that the child is getting dehydrated. Weight loss, bloody diarrhea requires immediate access to the physician. Abdominal pain with diarrhea merits concern. It certainly is seen more with things like salmonella, and that and it should probably be evaluated. Fever with diarrhea over 102, again, not common with the viral diarrheas in the older children so when you get a temperature with it, it causes more concern. Diarrhea that’s one stool per hour for over 12 hours is a reason for immediate evaluation. Letharging, irritability, or if it’s connected with the ingestion of drugs or toxic substances, there is an entity called -- that occurs with the child, and it can be a very severe intestinal problem that is produced by a child taking long courses of antibiotics. Now, there are fluids that are not recommended in the treatment of diarrhea. Fluids are the main treatment but these fluids aren’t: tea, juices -- they’re high sugared content. Lack of electrolytes lead to low sodium and they also lead to further diarrhea because of the high carbohydrate intake. Same is true with colas and soft drinks. Chicken broth is not a good idea for diarrhea. Boiled skim milk is a problem because it’s highly concentrated and you substitute high sodium for sodium loss and you can get what’s called hypernatremic dehydration which is extremely severe because there are fluids chips from the brain and thy can be complications in rehydrating the person. The other thing would be sports drinks and Kool-Aid. Kool-Aid is nothing but sugar water and will replenish none of the above. Pedialyte if of course, and it’s related substances which are World Health Organization recognized electrolyte solutions, which have a small amount of sugar and have in them electrolytes are the treatment of choice. So, how do you care with a child for diarrhea? You give liquids as soon as the diarrhea starts. A good rule of thumb for the homemaker is one half cup, that’s four ounces of rehydrating solution for every stool that child has, if the child is younger than two. One half cup to one cup for every child over two rehydrates the fluid loss from the stool. The modern thinking is not starvation. After your rehydrating or replaced or maintenancing the child with the fluids, you give food. You do not restrict food because many of the enzymes in the intestinal tract are inducible, and when you give food, they replenish the enzymes that are required for absorption correctly in the gut. If you delay food, you prolong the diarrhea and prolong the recovery. No medicines are indicative for pediatric diarrhea. That includes anti-diarrheal agents. They do not make the diarrhea lasting, thy make the stools less but the same -- but more fluid is actually a loss in the gut then you see come out with the infrequent stools so that’s really third spacing of fluids in the intestine, and you're not accomplishing anything. The other thing with medicine is that they can prolong cramping, and there are some scientific data with disease bacterial causes of gastroenteritis that you may make the disease worse because you prolong the contact time of the infecting agent with the intestine, and there’s great spreading of the disease. Then, the case of the colitic diarrhea, it may precipitate the hemolytic uremic syndrome. The main thing with this disease is you take steps to prevent with hand washing, food handling and the like.