DIARRHOEA IN CHILDREN- ENGLISH
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DIARRHOEA
IN CHILDREN-
•
Diarrhoea, is defined as the condition of having at
least three loose, liquid, or watery stools each day. it is the
consistency of the stools rather than the number that is most important.
Frequent passing of formed stools is not diarrhoea. When frequency of loose
stools increases it leads to dehydration leading to complications of diarrhea.
CLINICAL TYPES OF DIARRHOEA-
•
It
is most practical to base treatment of diarrhoea on the clinical type of the
illness, which can easily be determined when a child is first examined. Four
clinical types of diarrhoea can be recognized-
•
Acute watery
diarrhoea
(including cholera), which lasts several hours or days: the main danger is
dehydration; weight loss also occurs if feeding is not continued.
•
Acute bloody
diarrhoea,
which is also called dysentery: the main dangers are damage of the intestinal
mucosa, sepsis and malnutrition.
•
Persistent diarrhoea, which lasts 14 days
or longer: the main danger is malnutrition and serious non-intestinal
infection.
•
Diarrhoea with severe
malnutrition (marasmus
or kwashiorkor): the main dangers are severe systemic infection, dehydration,
heart failure and vitamin and mineral deficiency.
CAUSES
OF DIARRHOEA-
•
Dirrhoea is caused by many factors such as –
•
Infection.- Infectious
diarrhoea is most commonly caused by viruses passed from person to person, or
by eating or drinking food or water contaminated with viruses such as
rotavirus, astroviurs and norovirus. Bacterial infections such as salmonella,
Campylobacter, Escherichia coli and Shigella, fungus such as candida
albecans or a parasite – such as Cryptosporidium, Entamoeba histolytica,
and Giardia lamblia
•
Dietary factors.- Drinking alcohol
can cause diarrhea in some people.
Fatty foods can
worsen diarrhea, so it may be a good idea to avoid
fatty foods such as meats with a high fat content.
Fiber-rich foods, Excess fruits
or vegetables. ...
Excess use of Dairy products ,Coffee and tea.
And Sweeteners.
•
Food intolerance- Food intolerance such as
lactose intolerance(allergy to milk), gluten intolerance (allergy to wheat),
caffeine intolerance (allergy to coffee), Amine intolerance ( fermented food allergy) etc. leads
to food intolerance diarrhoea.
•
Medical/surgical
conditions-
Medical conditions resulting in diarrhea includes inflammatory bowel disease
(ulcerative colitis or Crohn’s disease), coeliac
disease or irritable bowel syndrome (IBS).
Surgical conditions includes any surgery on
small or large intestine.
•
Medicines- Some medicines can cause
diarrhoea as a side effect. Antibiotics are a common example. They
can disrupt the balance of bacteria in your gut, which can lead to
diarrhoea. Other examples of medicines that can cause diarrhoea include some
antacids and diabetes tablets.
SIGN
AND SYMPTOMS OF DIARRHOEA-
•
Loose
stools
•
Painful
abdominal cramps;
•
Nausea;
•
Fever;
•
Bloating;
•
Generalised
weakness.
Other symptoms related to dehydration such as-
•
Increased
thirst;
•
Lack
of energy;
•
Decreased
urine than normal;
•
Dizziness
or light-headedness; and
•
Loss
of skin turgor.
DIAGNOSTIC
INVESTIGATIONS-
Diagnosic investigations includes-
•
Physical
examination
•
Serum
electrolytes
•
Stool
examination
MANAGEMENT
OF DIARRHOEA-
•
The
main focus in diarrhea management is to prevent or treat dehydration. Oral
Rehydration Therapy is the best line of action. Zinc sulphate tablets are also
given to the child. Antibiotics may be needed for bacterial diarrhea. WHO
recommended ORS or home made ORS may be used for Oral Rehydration Therapy. In
severe dehydration hospitalization may be needed with IV fluid therapy
•
Most
fluids that a child normally takes can be used. Fluids that normally contain
salt, may be used to prevent dehydration such as: • ORS solution • salted
drinks (e.g. salted rice water or a salted yoghurt drink) • vegetable or
chicken soup with salt. A home-made solution containing 3g/l of table salt (one
level teaspoonful) and 18g/l of common sugar (six level teaspoonful) is also
effective.
•
Unsuitable fluids - A few fluids are potentially dangerous
and should be avoided during diarrhoea. Especially important are drinks
sweetened with sugar, which can cause osmotic diarrhoea and hypernatraemia.
Some examples are: • commercial
carbonated beverages
• commercial fruit juices
• sweetened tea.
•
The
general rule is: give as much fluid as the child or adult wants until diarrhoea
stops. As a guide, after each loose stool, give:
•
children
under 2 years of age: 50-100 ml (a quarter to half a large cup) of fluid;
•
children
aged 2 up to 10 years: 100-200 ml (a half to one large cup);
•
older
children and adults: as much fluid as they want.
•
Zinc
can be given as a syrup or as dispersible tablets, whichever formulation is
available and affordable. By giving zinc as soon as diarrhoea starts, the
duration and severity of the episode as well as the risk of dehydration will be
reduced. By continuing zinc supplementation(20mg/day) for 10 to 14 days, the
zinc lost during diarrhoea is fully replaced and the risk of the child having
new episodes of diarrhoea in the following 2 to 3 months is reduced.
PREVENTION
OF DIARRHOEA-
•
Key
measures to prevent diarrhoea include:
•
Access
to safe drinking-water- mostly diarrhea spreads through feco-oral route so safe
drinking water and use fresh food can prevent diarrhea.
•
use
of improved sanitation- Clean environment is a key measure to prevent all types
of infection including diarrhea.
•
Hand
washing with soap- Hand washing is best and easy procedure to prevent
infections. We must wash hands before eating or even touching our mouth.
•
Exclusive
breastfeeding for the first six months of life- Breastfeeding provides immunity
against many infections and it also reduces exposure to unhygienic milk formula
and hazards of bottle feeding.
•
Good
personal hygiene- Not only environmental
hygiene, but personal hygiene also prevents spreads of infection including
diarrhea.
•
Good
food hygiene- Well cooked food should be given to reduce chances of spread of
infections. Fruits should be eaten after properly washing cutting or peeling.
•
health
education about how infections spread- parents should be explained about causes
and preventive measures of diarrhea and used of ORS. Awareness is the best
policy to prevent spread of infections.
rotavirus vaccination- Rotavirus vaccination (5 drops orally) which is given at the age of 6weeks, 10 weeks and 14 weeks.
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