: Gastroenteritis: Diarrhea and Vomiting in Children
What causes diarrhea?
There are many possible causes of diarrhea in children but the most common are viruses. This is why most children with diarrhea get better on their own, without any specific medications or antibiotics.
Are there any other associated symptoms?
Sometimes the diarrhea may be the only symptom, but a child may have associated symptoms such as vomiting, as well as a low-grade fever (known as gastroenteritis. In most cases the illness lasts for three to six days. Often, there is a history of contact with a person who has had similar symptoms.
What is gastroenteritis?
Gastroenteritis is an infection of the gastrointestinal system; In other words, of the stomach and/or the intestines. Sometimes it is referred to as the stomach flu stomach flu or "gastro" (note this is unrelated to the flu caused by the influenza virus). The symptoms usually include: diarrhea and/or vomiting, One or the other, or both at the same time. In some cases, there can be associated fever, abdominal pain or cramps.
What causes gastroenteritis?
In most cases viruses such as the Rotavirus, which tends to infect younger children, cause it. Another virus commonly associated with outbreaks of gastroenteritis is the Norwalk virus. Some of the viruses cause symptoms of gastroenteritis only, while others can also cause cold symptoms. Less commonly, several different types of bacteria can also cause gastroenteritis. Importantly, food poisoning is a form of gastroenteritis that can occur if a person eats or drinks contaminated (spoiled) food water. This is why in order to prevent food poisoning; it is necessary to cook foods well and to make sure that they are properly refrigerated.
What problems can occur?
The main concern when dealing with diarrhea (and/or vomiting) is dehydration. Children, can easily become dehydrated if they lose more fluid than they take in. So taking care of them is like playing "catch-up"; with the goal being for them to drink enough to make up for the fluid lost in the diarrhea.
What is the treatment of diarrhea?
Fortunately, in most cases, the treatment is simply to give the child adequate amounts of fluid, depending on the severity of the symptoms. Recently, doctors have modified their approach to mild cases of diarrhea and usually do not change the child's diet at all. In moderate illness, specific liquids are used called "oral rehydration solutions". Never give only water to a child
who is vomiting or has diarrhea. This can be dangerous. The body needs a certain (right) amount of salt and sugar, which are not in adequate amounts in water nor in watered-down juice or soft drinks. Only "oral rehydration solutions" such as Pedialyte or Infalyte contain the right amount of sugar and salt. Generally milk can be continued as long as it does not make the diarrhea worse. Breastfeeding can usually continue as well. Also, if a child is hungry, let him/her eat.
A word about "Protracted Diarrhea of Childhood"
In the past most children with diarrhea would be fed a very bland diet, and this for prolonged
periods. This approach actually made matters worse. Modern medicine has now come to
recognize a condition called "Protracted Diarrhea of Childhood".
These children suffering from this condition had diarrhea that simply would not go away and
needed to be admitted to hospital for weeks or even months of intravenous therapy.
They started off with a simple or typical viral-induced diarrhea which would just seem
to get worse. It is now understand that this protracted diarrhea
was due to the fact that these children were being given low calorie
diets. Because the intestinal lining did not get enough nutrition
it became damaged and started to a leak or secrete liquid into
the intestine causing large amounts of diarrhea. This is why
current reccomnedations stipulate that aside from the use of appropriate oral rehydration
solutions, a resumption of a normal diet should start as soon
as possible. Consequently the so called BRAT(Banana, Rice, Apple sauce,Toast) diets which are both in calories and fat)should therefore not be used for prolonged
periods of time(more than a day or 2) if at all.
What if the child is vomiting too?
If a child has just vomited, parents should wait for half an hour and then begin giving fluids starting with one tablespoon. If the child keeps it down, five minutes later, one and a half tablespoons is given and so on, progressively increasing the amount each time. Should the child vomit again take a break for about 30 minutes and start the cycle over again. If the child cannot keep any fluids down, medical attention should be sought. Happily, most children will be able to keep down enough fluids and the vomiting as well as any other associated 'gastroenteritis" symptoms go away on their own. If a vomiting child also has a fever and cannot keep the fever medication down, suppository acetaminophen is a very practical solution.
How do we know a child is dehydrated?
The signs of dehydration include:
Less frequent urination (less than 6 wet diapers per day, in babies)
No tears when crying,
Dry or sticky mouth,
When should a doctor be consulted?
Take your child to a doctor immediately if:
There are signs of dehydration, or
Your child is younger than six months, or
There is blood in the stool, or
There is frequent vomiting preventing him/her from drinking, or
The diarrhea lasts for more than 1 week, or
Your child complains of abdominal pain, looks or behaves unwell and/or has high fever
Can it get more serious?
In severe cases of diarrhea (and/or vomiting) and dehydration, and they are relatively rare, the only treatment is the administration of intravenous fluids in a hospital setting. Because each child is different, treated based on the individual situation.
What about anti-diarrhea medications?
Anti-diarrhea medicines should not be used in children. They are not helpful and indeed may be harmful.
Are special tests needed?
In most children with diarrhea, stool tests or other tests are not necessary. However, if a physician suspects bacteria as the cause, then a stool culture (a test for bacteria) will be sent.
Are antibiotics helpful?
Most cases of diarrhea are caused by viruses, which are not treated by antibiotics. In certain cases of bacterial infection, antibiotics may be prescribed, depending on the individual situation, age of child and the specific type of bacteria causing the infection.
What is the Norwalk virus?
This virus first discovered in Norwalk, Ohio, has been at the root of several epidemics or outbreaks of
gastroenteritis across North America in hospital emergency rooms, schools and even on cruise ships.
There is a group of similar or related viruses that are referred to as Norwalk-like viruses or agents.
These viruses can infect people of any age and usually cause profuse watery diarrhea, vomiting and fatigue.
The infection lasts a few days and there is no specific treatment.
Most of the time, it spreads form one person to another through direct or indirect contact with infected feces or
vomit. The virus is highly infectious and tends to occur ion clusters, like in a schools and hospital wards.
More rarely, it can also be transmitted by drinking water, which contains the virus, or by eating food
contaminated by this virus. The infection develops within 1-2 days after contact with an infected person.
The prevention approach to Norwalk induced gastroenteritis is the same as with the other forms of
viral gastro-intestinal infections: hand washing, before and after contact with any infected individual,
and decontamination of areas such as toilets, sinks and other objects that have come into contact with
infected stool or vomit. The treatment is as outlined above for any gastroenteritis. Confirmation of Norwalk virus infection is possible, although technically difficult, through a specific stool test. A blood test can also confirm the infection. These tests are usually performed during epidemic situations (not routinely) so that authorities can determine the specific cause of the outbreak.
Other Childhood Illnesses
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designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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