Diarrhea in a child, what to do?

Diarrhea in a child is an increased excretion of feces, which differ from ordinary bowel movements in color, texture and smell. With diarrhea, there is a loss of water and electrolytes, feces move too quickly through the intestines and do not have time to take shape. Every parent experiences diarrhea at least once in their life, so it is only natural that they have a question about how to help their child.

The symptoms of diarrhea are easy to recognize. In addition to changing the nature of the stool, the child may complain of abdominal pain of a spasmodic or acute nature, nausea and vomiting, fever, rumbling in the intestines, flatulence, false urge to defecate.

In childhood, diarrhea is especially dangerous, as babies develop dehydration faster than adults. Therefore, contacting a doctor is a mandatory measure, especially when it comes to severe diarrhea.

With diarrhea in a child, it is necessary to apply an enterosorbent as soon as possible – a remedy whose action is aimed at adsorption and evacuation from the gastrointestinal tract of harmful substances, bacteria and viruses that have caused intoxication. When treating children under 2 years old, you need to choose the right sorbent, which, first of all, is safe.

The ROAG recommended that Russian pediatricians as an enterosorbent for pregnant, lactating women and children from birth prescribe Enterosgel, which has proven itself for decades, and similar agents. Russian Enterosgel is singled out as the first choice due to proven safety (works only in the gastrointestinal tract, is not absorbed into the blood), the effectiveness of the gel form, which does not dehydrate and does not provoke the development of constipation, which is extremely important in the treatment of the smallest.

When can a baby’s stool be considered diarrhea?

It should be noted that not every loose stool of a baby can be regarded as diarrhea.

Therefore, it is important to know the following features:

• Watching a loose stool in a newborn or infant, you do not need to immediately call a doctor. For children in such an early age period, loose stools are the absolute norm. Indeed, at this time, the baby receives exclusively liquid food, which affects the consistency of feces.

• Frequent bowel movements in infancy are also not a sign of diarrhea. At this time, the child’s stool can occur up to 10 or more times a day. Sometimes the release of liquid feces occurs after each feeding, which is also not a deviation from the norm.

• In children under one year old, fecal masses may occasionally be unformed (provided that the child does not suffer from constipation). Diarrhea is indicated by the fact that bowel movements occur more than 3-4 times a day. In this case, the stools become watery, liquid, may exude an uncharacteristic fetid odor or contain foreign impurities.

• In children aged 2-3 years and older, the stool should be formed, it does not contain pathological impurities. At this age, the digestive system works more or less smoothly, therefore, normally, stools occur no more than 1-2 times a day. If the number of bowel movements increases, and foreign impurities appear in the feces, then diarrhea can be suspected.

Doctors have developed specific assessment criteria that distinguish diarrhea in children of different ages from normal stools:

• If a young child loses more than 15 g / kg / day of stool, then this indicates diarrhea.

• In children aged 3 years and older, the normal daily stool volume is approaching that of an adult. Therefore, diarrhea is considered the loss of feces weighing more than 200 g per day.

Types of diarrhea in children

There are several types of diarrhea in children.

Depending on the mechanism of development of diarrhea occurs:

• Secretory diarrhea, when there is a lot of water and salts in the intestinal lumen, which are released due to the increased secretory function of the epitheliocytes of the intestinal mucosa. This type of diarrhea can be infectious or non-infectious in origin.

• Exudative diarrhea, which develops against the background of inflammatory bowel diseases.

• Hyperkinetic diarrhea, in which there is an increased contraction of the intestinal walls, or a weakening of their motility. This leads to a violation of the promotion of intestinal contents.

• Hyperosmolar diarrhea, when there is a violation of the absorption of fluid and electrolytes in the intestine.

Depending on the duration of the course of diarrhea, its chronic and acute forms are distinguished. Chronic diarrhea is one that lasts for two or more weeks. Chronic diarrhea is osmotic when it stops after refusing food or certain drugs. When diarrhea continues against the background of starvation of the child, then such it is regarded as secretory. This type of diarrhea in childhood is rare, but it poses a serious danger to the baby.

To determine that a child has secretory chronic diarrhea, one should focus on such signs as frequent stools up to 5 times a day or more, while watery stools, defecation occurs regardless of the time of day. In this case, you should immediately call an ambulance and hospitalize the child, as there is a direct threat to his life.

Acute diarrhea lasts no more than 2-3 days.

There are also types of diarrhea in children, depending on the cause that caused it:

• Infectious.

• Alimentary.

• Toxic.

• Dyspeptic.

• Medical.

• Neurogenic.

• Functional.

Causes of diarrhea in children

Diarrhea does not occur on its own. It is always the result of some disease or disorder in the digestive system.

In children, diarrhea is most often caused by:

• Infection in the intestines.

• Hereditary diseases of the gastrointestinal tract.

• Food poisoning.

• Nutritional errors.

These reasons need to be considered in more detail.

Infection as a cause of diarrhea

Normally, the intestines are inhabited by bacteria that are responsible for the digestion of food. These bacteria are considered “useful”, as they enable the human body to exist. When pathogenic strains, viruses or parasites enter the intestine, inflammation of the organ occurs. Most often this leads to diarrhea. In this way, the body tries to bring out infectious agents that should not be in the intestines.

• Viruses that most often provoke the development of diarrhea in childhood: rotaviruses, adenoviruses.

• Bacteria that most often provoke intestinal inflammation in childhood: salmonella, dysentery coli, E. coli.

• Parasites that most often cause diarrhea in children: roundworms, amoeba, pinworms.

Having penetrated into the intestinal lumen, the pathogenic flora settles on its walls, causing an inflammatory reaction. This leads to an increase in peristalsis, which leads to a rapid evacuation of feces.

The more actively the pathogenic flora multiplies, the more the intestinal walls are damaged. They lose the ability to absorb fluid, their mucous membrane begins to produce inflammatory exudate. As a result, a large amount of fluid accumulates in the intestinal lumen, as well as undigested food. All this comes out in the form of profuse bowel movements, that is, the child develops diarrhea.

The most common routes of infection to a child are:

• Unwashed hands.

• Seed food.

• Dirty things used in everyday life.

• Contaminated personal hygiene items.

• Eating expired food.

• Contact with another sick child. Intestinal viruses are transmitted in this way.

Hereditary diseases of the digestive tract, as a cause of diarrhea

There are diseases of the digestive system, the cause of which lies in genetic disorders. Most often in children, lactase deficiency occurs. At the same time, too little lactase enzyme is produced in the intestine. These children develop diarrhea after eating milk or dairy products.

Gluten intolerance (celiac disease) is less common. In this case, the child’s body is not able to digest cereals. Also, rare genetic diseases of the intestine include sucrase-isomaltase deficiency, when the body does not have enough enzymes that can break down sugars. Therefore, their intake with food will cause diarrhea.

Congenital atrophy of the intestinal mucosa leads to diarrhea in an infant, as the full absorption of nutrients from food becomes impossible.

Food poisoning as a cause of diarrhea

Food poisoning in childhood is quite common.

It can be triggered by the following factors:

• Eating expired processed foods.

• Getting spoiled vegetables or fruits, stale meat or fish on the child’s table.

• Poisoning with toxic substances, poisonous plants or fungi.

• Accidental ingestion of alcohol or large doses of drugs.

Toxins that enter the intestine damage its mucous membrane, cause an inflammatory reaction, increase peristalsis, which prevents the absorption of fluid from the intestinal lumen. As a result, the child develops diarrhea.

Dietary Errors as a Cause of Diarrhea

Errors in nutrition lead to the fact that the digestive system fails. This causes various pathological reactions from the body, including diarrhea.

In childhood, diarrhea most often develops as a result of the following violations in the diet:

• Excessive consumption of food. If the child has overeaten, then the food begins to put a lot of pressure on the intestinal walls from the inside. This provokes an increase in peristalsis and too rapid movement of food masses through the intestinal lumen. At the same time, useful substances from food are not completely absorbed. The child develops diarrhea. The stool will contain particles of undigested food.

• The presence of an excessive amount of fruits and vegetables in the menu. Vegetables and fruits have a rough structure, contain a lot of indigestible dietary fiber. Especially a lot of them in the peel. The child’s intestines are not always able to cope with such food, as it causes irritation and increased peristalsis. All this provokes the development of diarrhea.

• Eating spices, spices, garlic, hot peppers, very salty or sour foods.

• Too fatty food. Diarrhea in this case is the result of a malfunction in the functioning of the liver and gallbladder, which are unable to secrete enough acids to digest fatty foods.

Causes of diarrhea in a baby

Diarrhea in infants most often develops for other reasons than in children older than a year.

Introduction of new foods (complementary feeding start) almost always causes a change in stool. In this way, the body reacts to new food for it. The feces may turn greenish when the parents offer vegetables and fruits to the child. A change in the color of the stool is not a sign of diarrhea, this is a variant of the norm. However, if the stool becomes more frequent, becomes liquid, a sour smell begins to emanate from it, and foam or water appears in the feces, then you should think about the fact that the child develops diarrhea.

The causes of diarrhea in an infant after the introduction of complementary foods may be the following:

• Complementary foods were introduced too early. Parents should take into account that the body of a nursing baby will be ready to accept new food for him no earlier than 5-6 months. Until that time, mother’s milk is enough for him to grow and develop. Only after 5 months in the body of the child begin to produce enzymes that are able to break down food that is more complex in composition. The fact that the baby is ready to accept complementary foods is indicated by the following factors: double weight gain after birth, the child reflexively does not push the spoon out with his tongue, can sit on his own, holds objects in his hand and pulls them to his mouth.

• Parents offered the baby too much portion. If you do not follow the recommendations for the dosage of products for a specific age period, then this can provoke diarrhea.

• The child develops an allergy to a new product. Intolerance to a substance that is part of food can provoke an allergic reaction in a baby, which is often manifested by diarrhea. Perhaps the child’s body does not perceive gluten, in this case we are talking about such a pathology as celiac disease. If this problem is not detected in a timely manner, then diarrhea becomes chronic. The baby begins to gain weight poorly, allergic rashes appear on the skin.

• New products were introduced too often. They need to be given to the child gradually. New dishes should be offered at intervals of 5-7 days. This is the optimal time for the organs of the digestive system to adapt.

Feeding a child with artificial mixtures. Formula-fed babies are more likely to have diarrhea than babies who are breastfed. The composition of breast milk is optimal, the balance of proteins and fats in it is such that the intestines of the child absorb it by 100%. Artificial mixtures are perceived by the baby’s body worse, so diarrhea can develop when overfeeding.

Intestinal infection. Intestinal infections can also cause diarrhea in infants. Rotaviruses, enteroviruses, salmonella, shigella, Escherichia coli, staphylococci are capable of causing frequent and thinning of the stool. In infancy, children are more likely to become infected by the fecal-oral route, when parents do not follow the rules of personal hygiene.

Other causes of diarrhea in babies:

• Dysbacteriosis against the background of taking antibiotics.

• Errors in the nutrition of a mother who is breastfeeding a child. Diarrhea often develops in children after the mother ate beets, cucumbers, pears.

• The eruption of milk teeth can provoke liquefaction of the stool. This cause of diarrhea is physiological and does not require treatment.

• Lactase deficiency, which will cause diarrhea from the first days of a child’s life.

• Cystic fibrosis.

• Infection of the child with worms. In this case, diarrhea will alternate with constipation.

• SARS. Children under one year of age have weak immune defenses, so even a common cold can affect the normal digestion of food and provoke diarrhea.

Symptoms of diarrhea in children

The main symptom of diarrhea is thinning and frequent stools in a child. It becomes unformed and watery.

Diarrhea in childhood may be accompanied by symptoms such as:

• Bloating.

• Rumbling in the stomach.

• False urge to empty the bowels.

• Enhanced gas separation.

• Lack of appetite.

• Sleep disturbances.

• Nausea and vomiting.

• Anxiety, tearfulness.

These symptoms do not always accompany diarrhea. However, the more of them, the more severe the course of the disease.

If a child develops an intestinal infection or food poisoning occurs, then mucus and undigested food particles will be present in the stool. In severe cases of the disease, blood impurities may appear.

An increase in body temperature against the background of diarrhea is a very frequent companion of intestinal infections and food poisoning.

If a child develops diarrhea that is not accompanied by a hyperthermic reaction, then it may indicate nutritional errors, dysbacteriosis, allergies, or a parasitic infection. It is possible that the child is simply teething.

When should a child see a doctor urgently with diarrhea?

Diarrhea in childhood can pose a real threat to the health and life of the baby. Therefore, if the following conditions occur, you should consult a doctor:

• There are signs of dehydration.

• Diarrhea develops in a child less than a year old.

• Diarrhea does not stop for 2 days or more.

• There is mucus or blood in the stools.

• The stool becomes green or black.

• Diarrhea is accompanied by increased body temperature.

• The child experiences severe pain in the abdomen.

• Diarrhea develops against the background of taking medications.

What is the danger of diarrhea for children?

Together with liquid feces, nutrients are quickly excreted from the body of the child, as well as a large amount of water. It is dangerous for acute metabolic disorders and dehydration. So, for one bowel movement, a young child, on average, loses 100 ml of fluid. In children over 1-2 years old, up to 200 ml of water or more can come out with each act. If the volume of fluid lost exceeds 10 ml per kilogram of body weight, then dehydration will occur very quickly. It is this condition that is the main danger of diarrhea.

Signs of dehydration in a child:

• Dryness of the mucous membranes and skin, the appearance of cracks.

• Dark circles under the eyes.

• In children under one year old, there is a recession of the fontanel.

• The child becomes lethargic, drowsy.

• Darkening of urine, a sharp decrease in its volume.

Dehydration in childhood occurs very quickly, since the weight of the crumbs is small. This process is aggravated by vomiting and frequent regurgitation. Therefore, at the first sign of dehydration, hospitalization is necessary.

In addition to water during diarrhea, salts are excreted from the body. Sodium imbalance threatens to disrupt electrolyte metabolism. With serious violations, even cardiac arrest is possible.

The chronic course of diarrhea is dangerous because the child will constantly lose the nutrients that he needs for normal growth. Such children begin to quickly lag behind in physical development, lose weight, become lethargic and apathetic, they develop beriberi.

In addition, constant irritation of the skin around the anus leads to the formation of itching and diaper rash. The formation of an anal fissure is possible, in severe cases, prolapse of the rectum is observed.

Diagnosis of diarrhea in children

To identify the cause that led to the development of diarrhea in a child, you need to contact a doctor. The doctor will carefully listen to the complaints of the parents, if possible, will conduct a survey of the patient himself. The doctor will then examine the child.

If necessary, the following studies are prescribed:

• Blood sampling for general and biochemical analysis.

• Fecal collection for coprogram.

• Bacterial examination of feces and vomit.

• Examination of feces for dysbacteriosis.

• Performing scrapings on the eggs of the worms.

• Conducting contrast radiography with barium sulfate. This procedure is rarely prescribed. It provides information about intestinal motility and its condition in general.

As an additional study, an ultrasound of the abdominal organs may be prescribed.

Treatment of diarrhea in a child

As it was said, the main danger in diarrhea is dehydration, accompanied by the excretion of salts necessary for the normal functioning of the body. Therefore, the primary task is to restore the water and electrolyte balance. This procedure is called rehydration.

Rehydration should begin after the first episode of diarrhea in a child. For this purpose, ready-made pharmaceutical preparations are used: Regidron, Glucosolan, Citroglucosolan, etc. A bag of medicine is dissolved in a liter of warm boiled water and the child is allowed to drink in small portions.

When it is not possible to purchase a ready-made rehydration solution, you can make it yourself. To do this, in a liter of warm boiled water, dissolve a teaspoon of salt and sugar, as well as 0,5 tablespoon of soda. If the child is breastfed, then it should be applied to the breast as often as possible.

When diarrhea is caused by food or drug poisoning or toxic infection, the child must be given sorbent preparations. They absorb harmful substances that are in the intestines and prevent their absorption into the systemic circulation. These drugs include: Enterosgel and similar.

Lingin and charcoal enterosorbents are not prescribed for diarrhea caused by dysbacteriosis. In this case, the child is prescribed drugs that regulate the balance of intestinal microflora. The following medicines can do this: Bifiform, Lactobacterin, Linex, Hilak Forte, Bifikol, etc.

Bacterial intestinal infections require the appointment of intestinal antibiotics. The drugs of choice are: Enterofuril, Furazolidone, Enterol, Levomycetin, Sulgin, Ftalazol. Antibiotics should be prescribed by a doctor after a bacterial analysis of feces.

Drugs that are aimed at reducing the activity of intestinal motility are rarely prescribed in childhood. The doctor can prescribe them, provided that there are good reasons for this. These are drugs such as Imodium, Loperamide, Suprilol. They should not be used for diarrhea caused by infection or food poisoning.

In addition to symptomatic therapy, it is mandatory to carry out the main treatment aimed at eliminating the cause of diarrhea. You may need to remove inflammation from the pancreas, or treat allergies, colitis, enteritis.

Treatment of diarrhea should be accompanied by an adequate dietary regimen that allows you to maintain normal growth and development of the body. Excessive strictness of parents when following a diet can lead to energy deficiency.

There are the following recommendations in this regard:

• It is necessary to exclude from the child’s menu all foods that increase gas formation: milk, sweet fruits, legumes, bread, apples, pastries, grapes, cabbage.

• Smoked, salty, spicy, fatty and fried foods should be removed from the diet.

• The menu should contain enveloping and slimy dishes: mashed soups, rice water, cereals on the water. You can offer your child dairy-free mashed potatoes with vegetable oil.

• Stewed and steamed vegetables, fruits from compote are allowed.

• In addition to water, you can offer your child compote based on blueberries and lingonberries.

• Sour-milk drinks are given with caution, after consulting a doctor.

• If the diarrhea subsides, and the child is hungry, then you can give him wheat crackers and sweet tea.

Lactose (milk sugar) intolerance does not require total elimination of milk. Fluctuations in carbohydrate intolerance have wide individual boundaries that do not depend on enzyme deficiency. However, it is necessary to start therapy with a strict lactose-free diet. Once the diarrhea has stopped, dairy products can be reintroduced with caution.

If a child is diagnosed with secondary lactose intolerance, which is often observed at an early age, then you should refrain from using standard milk formulas for a period of at least 4 weeks. Children who cannot tolerate whole milk can be offered lactase-hydrolysed milk.

If parasites are found in a child, specific anthelmintic treatment should be carried out.

Important doctor’s advice for managing diarrhea in children

• For the treatment of diarrhea in a child, you can not independently prescribe drugs to him. Those medicines that are suitable for adults can be dangerous for the health of the baby.

• If the child takes antibiotics, then in parallel he should drink a course of probiotics, which will avoid the development of dysbacteriosis. The interval between taking medicines should be at least an hour. Otherwise, the effect cannot be achieved.

• A child who develops diarrhea should be at home. It cannot be sent to kindergarten or school.

• You should not give your child drugs to stop diarrhea (Loperamide, Imodium), unless recommended by a doctor.

• Do not exceed the dosage of the drug at your own discretion.

• With the development of diarrhea in a child under one year old, a medical consultation is required.

• The child should be washed after each bowel movement. Be sure to lubricate the anal passage with baby cream, which is the prevention of the formation of irritation and diaper rash.

• It is important to monitor the well-being of the child, control the increase in body temperature, and prevent dehydration. If you feel unwell, call an ambulance.

Author of the article: Sokolova Praskovya Fedorovna, pediatrician