Diarrhea in kids
- When they talk about diarrhea
- Why young children are prone to diarrhea
- Types of diarrhea
- Key causes of diarrhea in children
- How it manifests itself
- How to treat diarrhea in children correctly
- When an emergency medical consultation is necessary?
Diarrhea is one of the most common health problems in any children, and most often parents face it in the first years of a child's life. In medicine, the term "diarrhea" is used to refer to this condition. But this is not an independent pathology with a separate diagnosis, but the key symptom of many diseases. It is developing diarrhea in a child often becomes the most obvious and potentially dangerous manifestation of the disease, encouraging parents to consult a pediatrician or a doctor of another specialty. And the younger the age of the patient is, the more important the timely start of treatment and the proper selection of drugs are.
Diarrhea is called the pathologically frequent dilated stool, and two existing signs are important to diagnose. If a child has a steady defecation regime (once every 1-2 days, with excreting formed stool), diagnosing diarrhea is not much difficult. Appearing mushy and, especially, liquid secretions 3 and more times a day is a key sign of diarrhea, which requires clarification of the most probable cause and beginning of treatment.
If mild diarrhea develops in 1-year old infant, parents do not always recognize such a disorder in a timely manner. After all, for infants, excreting mushy stool up to 10 times a day is normal. How to reveal diarrhea in this case? Diagnostic criterion of diarrhea in infants is increasing number of defecations by 2 and more times.
In 1-year old children, intestinal disorders with a tendency to diarrhea occur more often than in older preschool children, schoolchildren and adults. This is due to several factors:
- Functional immaturity of enzyme systems in children of 1 to 2 years old. Although they develop all the necessary digestive enzymes, their quantity and activity do not always correspond to the meal volume and composition. In addition, there is a partial lactase deficiency in infants often, a deficiency of the enzyme lactase, which is responsible for breaking down lactose milk sugar. This pathology often develops after the infectious diarrhea experienced by the child, creating preconditions for an unstable stool with a tendency to diarrhea when drinking milk.
- Insufficiently matured systems regulating digestive tract, which predisposes to imbalance in the motor activity of various parts of the intestine. This is considered a variant of the age norm, and the pathology requiring no treatment.
- Insufficiently formed and poorly balanced composition of intestinal flora. The intestine of the newly born baby is sterile and from the very first hours of life it starts being gradually populated by various microorganisms. Normal bacterial microflora helps to break down some nutrients, produces B vitamins and contributes to correct operating entire gastrointestinal tract. But children often have conventionally pathogenic bacteria and fungi developing excessively in the lumen of the intestine, which is called dysbiosis. It is not accompanied by intestinal disorders only, but also increases the likelihood of developing infectious diarrhea in a child.
- Increased (in comparison with adults) area of the intestine suction surface. Therefore, the toxins entering with the food and toxins produced by the pathogenic bacteria are absorbed much faster and have a more pronounced negative effect on the digestive tract.
As children grow, they become less prone to intestinal disorders, and diarrhea in a child 5 years and older, usually associated mainly with poisoning and intestinal infections.
The clinical classification of diarrhea allows for several symptoms:
- Duration of intestinal disorders. There is acute (up to 2 weeks), prolonged (over 14 days and up to 2-3 months) and chronic (more than 3 months) diarrhea.
- Severity of diarrhea. It can be mild, moderate, severe, which is determined by the stool frequency and abundance, general condition of the affected child and the severity of additional symptoms.
- Causal factor. Diarrhea is contagious and non-infectious.
Various factors can lead to stool liquefaction and increased frequency. But this action can include 5 (five) key pathogenetic mechanisms: secretory, osmolar, exudative, hyperkinetic, hypokinetic. The latter two types are often combined, speaking of the motor mechanism of diarrhea development.
|Mechanism of intestinal disorders||Causes||Type of diarrhea|
|Secretory type, associated with hypersecretion of electrolytes and water in the lumen of the intestine.||Performing enterocytes (cells of the intestinal mucosa) gets disordered under influencing bacterial and other toxins, viruses, excess bile acids and some biologically active substances.||Stool is abundant, watery, painless (watery diarrhea).|
|Osmolar type, associated with accumulation in the lumen of the intestine of substances featuring increased osmolarity, which "attract" a large amount of water and electrolytes.||Food digestion and absorption gets disordered usually against the background of a lack of enzymes or their reduced activity. More rare cause of this kind of diarrhea is taking substances featuring osmolarity (eg, lactulose).||Stool is plentiful featuring numerous insufficiently digested food residues (diarrhea by the type of polyphecal). The severity of intestinal disorders depends on the amount and composition of food consumed, and fasting can completely eliminate diarrhea.|
|Exudative type, when increased water outlet into the intestine lumen is caused by appearing multiple erosive-ulcerative mucosa defects or increasing lymph pressure.||Inflamed or destructed intestinal wall due to some infectious agents.||The stool is liquid, featuring medium abundance, blood, mucus and painful defecation.|
|Hyperkinetic type, characterized by increased intestinal motor activity and accelerated evacuating contents.||Disordered neurogenic regulation, increased amount of biologically active substances featuring stimulating effect.||Stool is frequent, liquid, but small featuring unproductive urges and cramping pains|
|Hypokinetic type is the rarest in children. Characterized by delayed advancing food mash in the intestines with water hypersecretion added.||Persistent disordered nervous regulation of the intestine on the background of severe systemic diseases (scleroderma, amyloidosis) or complicated diabetes mellitus.||Stool is moderately diluted, viscous, stagnant, poor|
All possible variants of diarrhea in children of different ages can be divided into infectious and non-infectious.
|Infectious diarrhea||Non-infectious diarrhea|
|Conditionally pathogenic bacterial flora (streptococci, staphylococcus, E. coli and others). The excessive growth of their colonies is associated mainly with imbalanced intestinal microflora (dysbacteriosis), including after taking antibiotics.||Enzymatic deficiency, resulting in incomplete digesting nutrients and stored products featuring increased osmolarity. In childhood, the following problemas are of greatest value:
1. Lactase insufficiency;
2. Celiac disease;
3. Dusordered fat digestion accompanied by forming steatorrhea (fatty feces), which is associated with a reduced amount of lipase (enzyme breaking down fats) and disordered bile secretion.
This also includes the effects of overeating, accompanied by a relative deficiency of normally secreted enzymes. This also includes effects of overeating, accompanied by a relative deficiency of normally secreted enzymes.
|Disease-causing bacteria (cholera vibrio, salmonella, escherichia, pathogenic forms of staphylococci, clostridia, iersinia, campylobacteria). Infants are infected from ill carrier mother or another adults, with inaccuracies in nursing. In elder children, the cause of infection is ignorable personal hygiene, food poisoning, epidemic outbreaks of intestinal infections in children's groups. There are also special forms of bacteria (tubercle bacillus). Fortunately, intestinal tuberculosis is rarely diagnosed now.||Disordered adaptation mechanisms featuring sudden change in the habitual diet, rapid turning to another climatic zone.|
|Viruses: enterovirus, rotavirus and other infections.||Irritable bowel syndrome means chronic disordered intestinal activity of a functional nature. Its symptoms are prone to recurrence and are not associated with any organic (structural defects) or infectious causes, and deterioration is often associated with stressful situations and neuro-emotional ovepressure.|
|Wormy invasions featuring developing various parasitic worms in the intestine (pinworms, ascarids, chains, etc.).|
|The protozoa (amoebae, lamblia).||Invaded wall of the colon of non-infectious origin: Crohn's disease, ulcerative colitis, ischemic colitis (against the background of disordered blood supplying intestine). Existing specific tumors produce biologically active substances featuring stimulating effect (VIPoma, gastrinoma). Relate to the rare causes of persistent diarrhea in children. Systemic diseases (amyloidosis, scleroderma).|
There are mainly infectious forms of a diarrhea in children of the senior preschool and school age, as well as in adults. Primarily non-infectious or dysbiosis-based diarrhea strikes newborn and 1-2 years old babies.
Diarrhea can have a different degree of dilution: from mushy to watery. Usually the more vigorous discharge is, the more abundant it is. In general, the nature of the discharge depends on the prevailing mechanism of developing diarrhea.
Diarrhea features an increased fluid loss, which is fraught with dehydration of varying degrees.
This is the most potentially dangerous manifestation of the disease for the child, which can cause serious, life-threatening brain and other organ disorders.
And, the younger the child is, the faster signs of dehydration increase. Therefore, if the child is one month old, then developing diarrhea is an occasion for prompt doctor`s consultation.
With diarrhea, there are usually accompanying symptoms, which often help the doctor determine the level of damage and possible cause of the intestinal disorder:
- Stomachache. Intense cramping like intestinal colic, pulling-noisy, bursting happen in this case. In most cases, they get worse before the next defecation. In babies, the pain syndrome is revealed by indirect signs: increased motor anxiety and tearfulness, legs clamping to the stomach, crying when applied to the breast (which is explained by increased intestinal activity in response to food intake). But there is also diarrhea in a child without pain - for example, this is possible with irritable bowel syndrome or functional infant diarrhea.
- Intensified intestinal peristalsis (pulsing intestinal wall), which is often heard at a distance and even visible through the anterior abdominal wall.
- Appearing pathological impurities in the stool. Most often the baby experiences diarrhea featuring mucus, blood (fresh or already partially altered by digestive enzymes), undigested food residues.
- Increased gasification (flatulence), which provides liquid stool with foaminess, increases discharge pressure, leads to bloating and frequent gas discharge with leakage of fluid from the anus.
- Vomiting. It can happen simultaneously combined with intestinal disorders or precede them. Combined vomiting and diarrhea in a child significantly increases dehydration and makes its condition worse.
- Changing stool color, most often yellow color features intestinal contents. Green diarrhea in a child may indicate a bacterial infection, but this symptom can not yet be attributed to key and unambiguous diagnostic features.
- Increased temperature, which can be a manifestation of intoxication and inflammation. But often diarrhea happens in a child without existing high temperature, even if the intestinal disorder is of an infectious nature.
Treatment of diarrhea in a child of any age is recommended to be carried out under the supervision of a doctor, avoiding unauthorized prescription of antibiotics and drugs from the "adult" first-aid kit.
How to help child remove developing diarrhea?
- The primary target is reducing dehydration severity as much as possible. To do this, give the child drink pure or non-carbonated mineral water, low salt solutions. Milk and sour-milk products, concentrated juices of home and factory production, broths should be avoided. If the baby refuses water, giveit diluted fruit drinks or unsweetened compotes if the doctor approved. In order not to provoke vomiting, drinking is often provided in small fractions and portions.
- In the early days of acute diarrhea, apply therapeutic starvation. Exception is babies - they continue to suck breastmilk, preferably on-demand feeding. If the child had already been introduced a lure before, it is temporarily canceled. Further, the diet is gradually expanded, the duration is determined individually according to the doctor`s recommendation. The doctor should determine whether it is possible for a child suffering from diarrhea to have certain meal.
- With the resumption of nutrition, take enzyme preparations (for example, Micrasim), even if diarrhea is not originally associated with enzyme deficiency. After all, there are microdamages of the intestinal mucosa during any diarrhea, the functional activity of the digestive glands decreases. Taking enzyme preparations compensates for the developed enzymatic deficiency and will make digestion and absorption of nutrients in the intestines more complete, that will let avoid compounds featuring high osmolarity stored and thus reduce fluid loss.
- Vomiting, temperature and diarrhea existing in the child is in most cases a sign of poisoning, food poisoning or intestinal viral infections. When the symptoms appear, start giving the baby enterosorbents (for example, Filtrum®). This drug performs only in the intestinal lumen, precipitating on its highly porous surface bacterial and toxins produced in the body, pathogenic microorganisms, extra biologically active substances. This treatment helps reduce intoxication and severity of diarrhea.
Important: Before using, read the instructions or consult your doctor.
Any medications can be prescribed only by the doctor, taking into account baby`s general condition, the nature of its symptoms, the causes of diarrhea. Unauthorized use of drugs is fraught with developing side effects, emerging various reactions due to incompatibility of drugs or improper selection of dosage, worsening sufferer`s condition.
In some cases, diarrhea in a child requires an early doctor`s consultation. This is due to developing severe complications:
- Diarrhea in a child of the first 3 months of life, especially accompanied by rejection of the breast milk and / or bottle of milk, which can cause critical dehydration of the child's body and severe intoxication, internal organ and brain disorders.
- Diarrhea featuring blood in a child of any age.
- Diarrhea accompanied by seizures.
- Developing excessive drowsiness, inhibition and even unconsciousness in the child suffering from diarrhea.
- Abundant multiple watery diarrhea in the form of a rice broth, that can be cholera infection.
- Rapidly appearing and steadily increasing signs of dehydration: lethargy, objectively determined muscle weakness, dryness and flabbiness of the skin, fibrillation of fontanelles and eyeballs. During acute diarrhea happening in 1 year old baby, dehydration develops within 1 day and is not always corrected by drinking abundantly.
- High and non-decreasing temperature and diarrhea combined in the child, which means a marked intoxication, usually of infectious origin.
Diarrhea in a child is a frequent and not always harmlessly proceeding pathology. But timely and correctly selected treatment allows you to eliminate all the symptoms quickly and completely, prevent developing severe complications, restore the normal functioning of the digestive tract.