Diarrhea in Children


Diarrhea is defined as loose or watery stools, in increased amounts, and usually more frequent than usual (but not always). Increased fluid in the intestines may be due to two reasons: (1) The intestines are "sick" and can’t work normally to absorb the fluids that you drink, and (2) some types of diarrhea can cause so much irritation inside the intestines that they actually "secrete"  or lose more fluid than you drink, robbing your body of vital fluids.

Fortunately, the second type ("secretory" diarrhea) is less common, the classic cause being a bacteria called Cholera, mostly found in India and Africa. However, other bacteria and some viruses can cause secretory diarrhea to a lesser extent. This is why the main goal of treatment is to keep fluids going in almost continually.

Avoid Antibiotics!

In the U.S., the major cause of diarrhea is virus infections, such as rotavirus and other enteric viruses. As with other virus infections, it is useless and even dangerous to use antibiotics to try to treat this illness. Antibiotics kill the useful bacteria that normally live in the intestines to help digest your food. Just killing your normal bacteria can cause diarrhea, which is why diarrhea is a common side effect of taking antibiotics.

Replacing the normal bacteria in the intestine can be done using "probiotic therapy". Medications such as Lactinex and Floranex are available in most drug stores over-the-counter. These are safe and effective in reducing the duration of diarrhea symptoms for any type of diarrhea, even if it was not caused by using antibiotics.

Other treatments often used for diarrhea in adults are Kaopectate and Peptobismol. These are not safe to use in children because both contain salicylate (aspirin) which can be very dangerous in children.

Diarrhea is the result of damage to the intestines.

In diarrhea, a virus infection in the intestines causes damage to the inside lining (called the mucosa). It takes time for this damage to heal so that the intestines can function normally again, and absorb the fluids and foods that you drink and eat. The actual virus infection goes away in a few days, but then we are left with the problem of healing the damage left behind.

Treatment of Diarrhea

The major goal in treatment of diarrhea is to rest the intestines so that they can heal, and to provide fluids and electolytes (the chemicals normally found in the body) to prevent dehydration. Using electrolyte solution (like Pedialyte) is a good way to do this. In older children other clear liquids are generally adequate. Don't use apple juice, since it is very high in fructose and low in glucose, so it produces its own type of diarrhea (osmotic diarrhea). Once the diarrhea starts to improve, it is important to begin adding some mild foods to provide nutrition for healing. In infants, this might mean using a diarrhea formula (like Isomil-DF) or a pre-digested formula (like Nutramigen or Alimentum).

Sometimes you get a set-back, and diarrhea gets worse after starting foods. Just drop back to using clear liquids for 12-24 hours, and start advancing again when the diarrhea starts to improve. This can sometimes be tricky, and might take weeks before getting back to normal. One study showed that biopsy of the mucosa does not get back to normal until 1 month after a virus intestinal infection.

Signs of dehydration include dry mouth, no tears, weakness, decreased urine output, and weight loss. If diarrhea continues more than a few days, or if you think your child is dehydrated, you need to call your doctor. Often a child will feel too weak or ill to drink much, and you have to try to get at least an ounce or more of fluids in every hour. If a baby refuses to drink from a bottle you might have to give 5 or 6 tsp (about an ounce) of Pedialyte® on a spoon. This is not too hard to do for a few hours, then the baby will start to feel better and start drinking on her own.

Breastfed babies get less diarrhea, but it still can happen. Continue breastfeeding, and add some Pedialyte in between feedings if the baby will take it. Breastmilk has antibodies to help fight the infection.

Probiotic therapy reduces diarrhea by 1-2 days!

If diarrhea does not improve in a few days, it is well worth getting some probiotic therapy. Take some Lactinex or Floranex or Biotic Buddies twice a day for 3 days. It can be mixed in any food or liquid. Probiotic therapy replaces your normal bacteria in the intestines, to force out abnormal bacteria and yeast, and help you digest your food. Recently there is evidence that probiotics may help the immune system by stimulating production of more IgA antibodies.

Bacterial intestinal infections (as opposed to virus) can cause diarrhea which lasts much longer. Some of these might need to be treated with antibiotics. Doctors usually will check a stool culture if the diarrhea lasts over a week, or sooner if associated with bloody or mucousy diarrhea and high fevers. A stool culture usually takes about 2 days.

Summer Diarrhea

There are several viruses and a few bacteria that can contaminate swimming pools, and are a common cause of summer diarrhea. Viruses from a child's rectum enter the water, and spread to other children. A child can give off viruses up to 2 weeks after having diarrhea, so the CDC recommends not swimming in public pools for 2 weeks after having a diarrhea illness. Other people may not be as considerate as you are, so be sure to shower well after swimming. Never swallow pool water! When taking small children to the pool, wash their bottoms well before you go, never change diapers at poolside, use a bathroom instead.

Even a well-chlorinated pool can be contaminated, since Giardia and Cryptosporidium are resistant to chlorine. Check the link below:

Healthy Swimming Web Page

 

 

© Rick Voakes 1999, Health-bytes LOGO  by Rie Cramer