Newsletters

Healthy Child Fall/Winter 2001

Your Child and Diarrhea

by FRANCIS SUNARYO, M.D.
DIRECTOR OF PEDIATRIC GASTROENTEROLOGY, CHILDREN'S HOSPITAL OF NEW JERSEY AT NEWARK BETH ISRAEL MEDICAL CENTER

Diarrhea is a common problem in children. Most diarrhea is short-lived and self-limiting (i.e. it resolves on its own without any special treatment.) However, diarrhea can cause dehydration, which means that the body lacks enough fluid to function properly, and it must be treated promptly to avoid serious health problems. Chronic or recurrent diarrhea can be a sign of a more serious type of intestinal problem.

What Causes Diarrhea?

Children can have acute (short-term) or chronic (long-term) forms of diarrhea. There are numerous causes including illness, infection, food sensitivity, over consumption of fruit juice and antibiotics. Viruses, bacteria or parasites consumed through contaminated food or water can cause diarrhea. There are many viruses that cause diarrhea. Children with viral diarrhea illnesses often have vomiting, fever and irritability as well. Acute childhood diarrhea in the colder months is commonly caused by Rotavirus.

Common culprits in bacterial infection include Salmonella, Campylobacter and E.coli. Parasites that cause diarrhea include Giardia lamblia and Cryptosporidium. Diarrhea may also be due to intolerance to foods or a component of food, such as lactose, sugar found in milk. In addition, artificial sweeteners, sorbitol and mannitol found in chewing gums and other sugar-free products can cause diarrhea. Other causes of diarrhea include reactions to medications, particularly antibiotics; functional bowel disorders such as toddler's diarrhea and irritable bowel syndrome; and intestinal diseases, like inflammatory bowel disease and celiac disease.

When Should a Physician Be Consulted?

Diarrhea can be dangerous in newborns and young infants because they can dehydrate quickly. Notify your pediatrician or take your child to a physician if any of the following symptoms appear:

• Stools containing blood or pus, or black stools
• Severe abdominal pain
• Temperature above 101.5 degrees Fahrenheit
• No improvement after 24 hours
• Signs of dehydration (see following)

What Are Signs of Dehydration?

Dry mouth and tongue

• No tears when crying
  
• No wet diapers for 4-6 hours or more
  
• Eyes appear sunken
  
• Lethargy, listlessness or irritability
  
• In young infants, the soft spot (fontanelle) on top of the head is sunken
  
• Skin lacks turgor (i.e. when pinched between fingers, skin fails to spring back to its original shape) If you think your child is dehydrated, call the pediatrician immediately. Severe dehydration may require hospitalization.

What Tests Might the Physician Do?

In many cases, the diarrhea stops on its own and, therefore, extensive search for the cause is not usually necessary. However, if there is blood in stools or if the diarrhea is prolonged and associated with poor weight gain and growth, signs of anemia and low serum protein, your physician
may do testing to determine the cause of the problem. The diagnostic tests may include stool tests to check for bacteria or parasites, blood tests to look for certain diseases and, in some cases, colonoscopy or biopsy of the small intestine may be necessary. To diagnose lactose intolerance, there is non-invasive testing that measures the level of hydrogen gas in the breath after ingestion of lactose drink.

What Is the Treatment?

In most cases, replacing lost fluid to prevent dehydration is the only treatment necessary. In mild diarrhea, the diet need not be changed and breast milk or formula can be continued. If your child has a watery stool every one or two hours, or more frequently, consult your pediatrician. He or she may advise you to withhold all foods and to put your child on commercially prepared electrolytes solution. If the infant is breast fed, you can continue the breast feeding while giving the electrolytes solution. Avoid giving liquids that are high in sugar (full strength juice, soft drinks), or high in salt (packaged broth). It is usually unnecessary to withhold food for longer than 24 hours, as your child will need some normal nutrition to regain the lost strength. Do not give boiled milk to any child with diarrhea. Boiling the milk allows the water to evaporate, leaving the milk very high in salt content.

Prevention:

The following guidelines will help to reduce the chances that your child will get diarrhea:

1.Hand washing after using the toilet or changing a diaper and before handling food.

2.Avoid drinking raw (unpasteurized) milk or eating foods that may be contaminated.

3.Avoid unnecessary use of medications, especially antibiotics.

4.If possible, breastfeed your child through early infancy.

5.Avoid excessive consumption of sweetened beverages or juice.

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