Diarrhea in Children: Meaning and treatment best approaches

Diarrhoea is the passage of loose or watery stool at least three times within a 24-hour period. Dehydration and malnutrition are the two main issues that arise from diarrhoea in children.

Goals of Diarrhoea treatment in children

The main goals of therapy for treating diarrhoea in children are: 

  1. Prevent dehydration if it has not occured.
  2. Correct dehydration if it has occured. 
  3. Reduce the severity and duration of diarrhoea.
  4. Reduce the chances of the child developing diarrhoea for the next two to three months.
  5. Prevent malnutrition.
  6. Correct malnutrition if it has occured.

Components of Diarrhoea Treatment in Children

  There are five main components of diarrhoea treatment. They are:

  • Oral Rehydration Salts (ORS): 

This helps to achieve the first and second goal above.

  • Zinc Supplement:

Zinc supplementation helps to achieve the third and the fourth goal of the diarrhoea treatment in children.

  • Continued feeding of the child (Can help to achieve the fifth goal of therapy).
  • Antibiotics: For those with bloody diarrhoea (dysentery) or cholera, Antibiotics that’s suitable can be prescribed.
  • Addressing macro and micro nutrient deficiencies for persistent diarrhoea helps to achieve the sixth goal of therapy). 

Oral Rehydration Therapy (ORT)

The immediate treatment of diarrhoea is to replace lost fluids and electrolytes using oral rehydration Solution. This is called oral rehydration therapy and it’s highly effective in the treatment of diarrhoea in children. The child should be given as much fluids as he/she can tolerate till the diarrhoea stops. If the child has severe dehydration and cannot drink or is unconscious, referral to the hospital is necessary as intravenous hydration will be required.

N.B: Vomiting often occurs during the first or two hour of treatment especially when the child drinks the solution too quickly. If vomiting occurs, wait for 5-10 minutes and start giving ORS again, but more slowly.

 During rehydration with ORS, over-hydration may occur. This is shown by a puffy or swollen eyelid of the child. If over-hydration occurs, the caregiver should stop giving the ORS solution, but continue to give breastmilk or plain water and food. A diuretic should not be given. When the puffiness of the eyelid is gone, ORS can be resumed. 

Zinc Supplementation

WHO and UNICEF recommend that a child with diarrhoea should be given 10-20 mg of zinc daily for 10-14 days (even if the diarrhoea stops before then). 

  • >6 months:  20mg zinc, 
  • <6 months:   10mg zinc

Continued Feeding of the child.

Diarrhoea causes malnutrition and malnutrition further worsens diarrhoea. Therefore, all children with diarrhoea should be fed as usual.

N.B: Sweet tea, sweetened fruit drinks or soft drinks should not be given to children with diarrhoea.

Anti-motility drugs do not help to achieve any of the goals of therapy; therefore, it is not recommended for treating diarrhoea in children less than 5 years.

Antibiotics Use in Diarrhoea treatment in Children

Blood in diarrhoea indicates infection by bacteria such as Shigella, E. coli and Salmonella that cause destruction of the intestinal walls. Not all cases of diarrhoea is caused by bacteria. Viruses such as Rotavirus can also cause diarrhoea. Therefore, antibiotics should not be used routinely or as first line medicines for children with diarrhoea. Routine use can lead to spread of antibiotic resistance and this can worsen the child’s condition.

Probiotics

These are healthy and good microorganisms called normal flora in the intestine that synthesize vitamins such as biotin and folic acid and facilitate absorption of dietary minerals such as Magnesium, Calcium and Iron. In addition to loss of fluids and electrolytes, persistent diarrhoea can lead to disruption of this intestinal flora. Hence, probiotics which are live microorganisms that confer a benefit to health can also be given to children with diarrhoea, as they can help prevent malnutrition and reduce severity of diarrhoea.

Preventive Measures

Diarrhoea in children can be prevented by:

  • good hygiene
  • clean water supply
  • sanitation and
  • breastfeeding (exclusive if practicable)