Navigate childhood diarrhea with Meri Sehat's expert advice for your child's well-being.

Diarrhea In Children

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Ismail Munir

Overview

Diarrhea is defined as the passage of loose, watery, or frequent bowel movements. More than three loose or liquid stools per day is typically termed diarrhea<a href="#accordion">[1[2]</a>. 
&nbsp;

Diarrhea in children is a significant global health concern, being the second leading cause of death in children under five years old. Annually, approximately 525,000 children in this age group succumb to the disease, although it is preventable and treatable<a href="#accordion">[2]</a>. The majority of cases are linked to contaminated food or water sources. Therefore, improving access to safe drinking water, proper sanitation, and hygiene can help prevent a significant portion of diarrheal cases.

Childhood diarrhea is closely linked to malnutrition, as each episode deprives a child of the nutrients required for proper growth and development. Malnourished children are more susceptible to diarrheal infections, exacerbating the problem. Moreover, diarrheal disease has a profound impact on public health, with nearly 1.7 billion cases of childhood diarrhea reported globally every year<a href="#accordion">[2]</a>. 
&nbsp;

Diarrhea is the leading cause of infant and child deaths, accounting for 60% of mortality in children under 5 years old in Pakistan. With an estimated 6.4 million cases of pediatric diarrhea annually, the country has the highest ratio in all of Asia for infant mortality due to diarrhea. The situation is exacerbated by inadequate access to clean water, poor sanitation, and a lack of proper breastfeeding practices<a href="#accordion">[3]</a>.

Only 20% of the population has access to clean water, and contaminated water sources contribute to the spread of diarrheal pathogens. Additionally, insufficient breastfeeding rates among infants further increase the risk of diarrheal episodes. 
&nbsp;

The COVID-19 pandemic has added additional strain to the healthcare system and resources, potentially making it more challenging to address the rising cases of diarrhea in children. Therefore, implementing educational programs, promoting proper <a href="https://merisehat.pk/article/post-coitus-practices-to-adopt-for-good-health-and-hygiene">hygiene </a>practices, and addressing water sanitation issues are critical steps to curbing the incidence of childhood diarrhea in Pakistan<a href="#accordion">[3]</a>. 
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The disease presents in three clinical types<a href="#accordion">[2]</a>: 
&nbsp;

<ul>
	<li>Acute Watery Diarrhea, which includes cholera and lasts for a few hours or days.</li>
	<li>Acute Bloody Diarrhea, also known as dysentery.</li>
	<li>Persistent Or Chronic Diarrhea, which lasts for 14 days or longer.</li>
</ul>

&nbsp;

Signs and Symptoms

The signs and symptoms of childhood diarrhea often vary with the cause. Common signs and symptoms include<a href="#accordion">[1]</a>: 
&nbsp;

<ul>
	<li>Watery or bloody stools</li>
	<li>Floating stools (indicating increased fat content)</li>
	<li>Urgency with bowel movement</li>
	<li>Abdominal pain and/or bloating</li>
	<li>Rectal pain</li>
	<li>Nausea and/or vomiting</li>
	<li>Weight loss</li>
	<li>Fever</li>
</ul>

Diarrhea in children can lead to varying degrees of dehydration, which are classified on a scale of three levels: 
&nbsp;

<h5>Severe Dehydration</h5>

At least two of the following signs are present:

<ul>
	<li>Lethargy or unconsciousness</li>
	<li>Sunken eyes</li>
	<li>Inability to drink or drinking poorly</li>
	<li>Skin pinch goes back very slowly (&ge;2 seconds) 
	&nbsp;</li>
</ul>

<h5>Some Dehydration</h5>

Two or more of the following signs are observed:

<ul>
	<li>Restlessness or irritability</li>
	<li>Sunken eyes</li>
	<li>Drinks eagerly and is thirsty 
	&nbsp;</li>
</ul>

<h5>No Dehydration</h5>

<ul>
	<li>Not enough signs are present to classify as some or severe dehydration. 
	&nbsp;</li>
</ul>

Monitoring these signs is crucial to identify the level of dehydration in children with diarrhea and to seek appropriate medical attention and rehydration therapy when needed. Severe dehydration requires immediate medical intervention to prevent serious complications 
&nbsp;

Causes

The causes of diarrhea depend on whether it&#39;s acute or chronic. 
&nbsp;

<h5>Acute Diarrhea</h5>

<ul>
	<li>Infectious Gastroenteritis: Usually caused by viral infections, but can also be triggered by bacterial or parasitic pathogens. E. coli and Rotavirus are the two most common infectious causes of severe diarrhea in low-income countries.</li>
	<li>Food Poisoning: Occurs due to the ingestion of food contaminated with toxins produced by certain bacteria, such as staphylococci or clostridia.</li>
	<li>Use Of Antibiotics: Some antibiotics can alter the gut&#39;s natural bacterial balance, leading to diarrhea. In severe cases, the use of antibiotics may enable the overgrowth of Clostridium difficile, causing <a href="https://merisehat.pk/disease/ulcerative-colitis">colitis</a>. 
	&nbsp;</li>
</ul>

<h5>Chronic Diarrhea</h5>

<ul>
	<li>Dietary Factors: Includes lactose intolerance and overconsumption of certain foods that can lead to chronic diarrhea.</li>
	<li>Infections: Chronic diarrhea may be caused by parasitic infections.</li>
	<li>Celiac Disease: An autoimmune disorder triggered by gluten consumption, leading to chronic diarrhea.</li>
	<li>Inflammatory Bowel Disease: Chronic conditions such as Crohn&#39;s disease and ulcerative colitis can cause persistent diarrhea. 
	&nbsp;</li>
</ul>

<h5>Less Common Causes Of Acute Diarrhea</h5>

<ul>
	<li>Appendicitis: Inflammation of the appendix can lead to acute diarrhea, along with severe abdominal pain and other worrisome symptoms.</li>
	<li>Intussusception: A medical emergency where one segment of the intestine slides into the next, causing blockage and diarrhea.</li>
	<li>Hemolytic-Uremic Syndrome: A complication of certain bacterial infections that can cause acute diarrhea, along with other severe symptoms. 
	&nbsp;</li>
</ul>

<h5>Less Common Causes Of Chronic Diarrhea</h5>

<ul>
	<li>Malabsorption Disorders: Disorders like cystic fibrosis interfere with food absorption, leading to chronic diarrhea.</li>
	<li>Weakened Immune System: Chronic diarrhea may result from a weakened immune system due to disorders like AIDS or the use of specific drugs. 
	&nbsp;</li>
</ul>

<h5>Diarrhea Resulting From Constipation</h5>

Diarrhea can sometimes occur when softened stool leaks around hardened stool in the rectum.

Understanding the various causes of diarrhea in children is vital for accurate diagnosis and appropriate treatment. If children experience persistent or severe diarrhea, seeking medical advice is crucial to manage the condition effectively. 
&nbsp;

While doctors cannot screen for diarrhea in children, they do conduct a combination of medical history, physical examination, and, if necessary, laboratory tests to detect the cause. 
&nbsp;

Diagnosis

<h5>Acute Diarrhea</h5>

Diagnosing acute diarrhea, usually caused by acute gastroenteritis, typically does not require extensive tests. In some cases, doctors may order blood tests to assess dehydration levels in the child. Stool samples (stool cultures) may be collected to identify the specific cause of diarrhea, especially if there is blood in the stools. Stool cultures can take a few days to yield results and may help identify bacterial or parasitic pathogens, including Giardia. However, in many cases of acute infectious diarrhea, the precise cause may remain unidentified despite stool testing. 
&nbsp;

<h5>Chronic Diarrhea</h5>

Diagnosing chronic diarrhea requires comprehensive confirmatory tests to pinpoint the exact cause. Several different tests may be performed, including:

<ul>
	<li>Blood Tests: These tests can check for anemia, inflammation, dehydration, and nutrition status. They may also screen for possible conditions like Celiac disease. 
	&nbsp;</li>
	<li>Stool Studies: These tests aim to identify possible bacterial, viral, or parasitic causes of chronic diarrhea. 
	&nbsp;</li>
	<li>X-Ray Studies: Although not routinely performed, X-rays may be useful in specific cases to evaluate the liver and gastrointestinal tract if other causes are suspected. 
	&nbsp;</li>
	<li>Upper Endoscopy And/Or Colonoscopy With Biopsy: These procedures can help assess for inflammation and are invaluable in diagnosing conditions like Celiac disease and inflammatory bowel disease. Colonoscopy can also diagnose diarrhea following antibiotic use and rare conditions such as lymphocytic colitis. 
	&nbsp;</li>
	<li>Lactose Breath Hydrogen Test: This test is used to diagnose lactose intolerance, which can cause chronic diarrhea. 
	&nbsp;</li>
</ul>

Note: Determining the exact cause of chronic diarrhea is crucial to choosing the most appropriate treatment for the child. Your physician will guide you through the diagnostic process and assist in developing a tailored treatment plan based on the identified cause of your child&#39;s diarrhea. 
&nbsp;

Treatment

Doctors treat diarrhea in children through a combination of measures aimed at rehydration, dietary management, and addressing specific causes. The key treatment measures include: 
&nbsp;

<ul>
	<li>Rehydration: Rehydration is the primary focus of treatment for diarrhea. Oral rehydration salts (ORS) solution, which contains a mix of clean water, salt, and sugar, is commonly used to replace lost fluids and electrolytes. ORS is effective in mild to moderate dehydration and can be administered at home. For severe dehydration or shock, intravenous fluids may be necessary and are given in a hospital setting. 
	&nbsp;</li>
	<li>Zinc Supplements: Zinc supplements are beneficial in reducing the duration of diarrhea episodes by 25% and stool volume by 30%. They are often recommended as part of the treatment for diarrhea. 
	&nbsp;</li>
	<li>Nutrient-Rich Foods: Providing nutrient-rich foods, including breast milk, during a diarrhea episode is essential to break the vicious circle of malnutrition and diarrhea. For infants, exclusive breastfeeding for the first six months of life is encouraged. 
	&nbsp;</li>
	<li>Diet: After rehydration, children are encouraged to resume their regular diet as soon as possible. Breastfed infants should continue nursing normally, while formula-fed infants can continue their regular formula. Older children may start with a bland diet consisting of bananas, apple sauce, rice, and toast before reintroducing their regular diet. 
	&nbsp;</li>
	<li>Medications: In specific cases of bacterial or parasitic illnesses, antibiotics may be prescribed. However, antibiotics are not always necessary, as most cases of diarrhea are viral. Probiotics may be used to help restore the balance of good bacteria in the intestines. 
	&nbsp;</li>
	<li>Supportive Care: Careful handwashing by all family members, especially after diaper changes, helps prevent the spread of infection. 
	&nbsp;</li>
	<li>Specific Causes: If the underlying cause of diarrhea is known, doctors will address it directly. For instance, gluten is removed from the diet in cases of celiac disease, and antibiotics causing diarrhea may be discontinued if advised by a doctor. 
	&nbsp;</li>
	<li>Avoid Antidiarrheal Drugs In Young Children: Drugs like loperamide to stop diarrhea are not recommended for infants and young children. 
	&nbsp;</li>
</ul>

In cases of severe dehydration, intravenous fluids may be necessary. As children recover from diarrhea and dehydration, they should gradually resume a normal diet, and careful monitoring for possible vitamin or mineral deficiencies is essential, especially in chronic diarrhea cases. Overall, the treatment approach for diarrhea in children is tailored to each individual&#39;s needs, focusing on hydration, nutrition, and specific causative factors. 
&nbsp;

Complications of diarrhea in children may include: 
&nbsp;

<ul>
	<li>Dehydration: The most common and potentially serious complication, especially if not promptly treated.</li>
	<li>Electrolyte Imbalance: Diarrhea can lead to imbalances in essential electrolytes like sodium, potassium, and chloride.</li>
	<li>Malnutrition: Prolonged or severe diarrhea can result in nutrient deficiencies and malnutrition, particularly in young children.</li>
	<li>Weight Loss: Significant and prolonged diarrhea can lead to substantial weight loss in children.</li>
	<li>Weakness And Fatigue: Dehydration and nutrient loss can cause weakness and fatigue in affected children.</li>
	<li>Seizures: Severe electrolyte imbalances, particularly low sodium levels, may lead to seizures.</li>
	<li>Kidney Problems: Dehydration and electrolyte imbalances can put stress on the kidneys.</li>
	<li>Infection Spread: Diarrhea caused by infectious agents can be highly contagious, leading to spread among family members or in daycare/school settings.</li>
	<li>Bacterial Invasions: Some bacterial infections can lead to more severe complications, such as hemolytic uremic syndrome (HUS).</li>
	<li>Intussusception: In rare cases, severe diarrhea may be associated with intussusception, a medical emergency where a portion of the intestine slides into another part, causing an obstruction.</li>
	<li>Impaired Immune Function: Chronic or persistent diarrhea can weaken the immune system, making children more susceptible to other infections. 
	&nbsp;</li>
</ul>

Prompt recognition and appropriate management of diarrhea can help prevent or minimize these potential complications. If children experience severe or persistent diarrhea, seek medical attention promptly to prevent further health risks. 
&nbsp;

Common risk factors associated with diarrhea in children include: 
&nbsp;

<ul>
	<li>Age: Infants and young children, especially those under the age of five, are more susceptible to diarrhea due to their developing immune systems and limited hygiene practices.</li>
	<li>Poor Hygiene: Lack of proper handwashing, especially after using the toilet and before eating, can increase the risk of contracting diarrhea-causing pathogens.</li>
	<li>Contaminated Water And Food: Consuming water or food contaminated with bacteria, viruses, or parasites is a significant risk factor for diarrhea.</li>
	<li>Malnutrition: Malnourished children are more vulnerable to infections, including those causing diarrhea.</li>
	<li>Lack Of Breastfeeding: Infants who are not breastfed have a higher risk of diarrhea compared to breastfed infants.</li>
	<li>Overcrowding: Living in crowded conditions or using communal facilities can promote the spread of infections leading to diarrhea.</li>
	<li>Lack Of Access To Sanitation: Poor sanitation facilities increase the risk of exposure to fecal matter and contamination.</li>
	<li>Low Socioeconomic Status: Children from lower socioeconomic backgrounds may have limited access to clean water, nutritious food, and healthcare, increasing their susceptibility to diarrhea.</li>
	<li>Travel: Traveling to regions with poor sanitation or different pathogens can increase the risk of traveler&#39;s diarrhea in children.</li>
	<li>Immune Compromised: Children with weakened immune systems, such as those with HIV or certain medical conditions, may be more prone to severe or persistent diarrhea.</li>
	<li>Antibiotic Use: Antibiotics can disrupt the balance of gut bacteria and lead to diarrhea, especially in young children. 
	&nbsp;</li>
</ul>

Understanding and addressing these risk factors can help in preventing and managing diarrhea in children effectively. 
&nbsp;

Key measures to prevent diarrhea in children include<a href="#accordion">[2]</a>: 
&nbsp;

<ul>
	<li>Access To Safe Drinking Water: Ensure that children have access to clean and safe drinking water to prevent waterborne infections that can cause diarrhea. 
	&nbsp;</li>
	<li>Use Of Improved Sanitation: Proper sanitation facilities help reduce the risk of fecal-oral transmission of pathogens responsible for diarrhea. 
	&nbsp;</li>
	<li>Hand Washing With Soap: Encourage regular handwashing with soap, especially before eating and after using the toilet, to prevent the spread of germs. 
	&nbsp;</li>
	<li>Exclusive Breastfeeding For The First Six Months Of Life: Breastfeeding provides essential nutrients and antibodies that protect infants from infections, including diarrhea. 
	&nbsp;</li>
	<li>Good Personal And Food Hygiene: Practice good hygiene in food preparation and storage to prevent contamination and foodborne infections. 
	&nbsp;</li>
	<li>Health Education About How Infections Spread: Educate parents, caregivers, and children about the transmission of infections to promote preventive practices. 
	&nbsp;</li>
	<li>Rotavirus Vaccination: Ensure that children receive the rotavirus vaccine, which protects against the most common cause of diarrhea and vomiting in infants and young children. 
	&nbsp;</li>
</ul>

<h5>Additional Preventive Measures</h5>

<ul>
	<li>Avoid giving children raw or unpasteurized milk and contaminated foods.</li>
	<li>Limit the consumption of juice and sweetened drinks, which may contribute to diarrhea.</li>
	<li>Avoid unnecessary use of antibiotics, as they can disrupt the balance of gut bacteria and lead to diarrhea.</li>
	<li>Practice respiratory hygiene&nbsp; (Cough and Sneeze Etiquette) to prevent the spread of respiratory infections that may trigger gastrointestinal issues. 
	&nbsp;</li>
</ul>

By implementing these preventive measures, caregivers and communities can significantly reduce the incidence of diarrhea in children and promote overall child health. 
&nbsp;

Key Points

<ul>
	<li>Diarrhea in children is defined as the passage of three or more loose or liquid stools per day.</li>
	<li>It is the second leading cause of death in children under five years old worldwide, causing around 525,000 deaths annually.</li>
	<li>Diarrhea is usually a symptom of an infection in the intestinal tract caused by viruses, bacteria, or parasites.</li>
	<li>Acute diarrhea lasts for a short duration (less than two weeks), while chronic diarrhea persists for more extended periods.</li>
	<li>Common causes of acute diarrhea include infectious gastroenteritis, food poisoning, antibiotic use, and food allergies.</li>
	<li>Chronic diarrhea may result from dietary factors, infections, celiac disease, and inflammatory bowel disease.</li>
	<li>Diarrhea can lead to dehydration, especially in young children, requiring rehydration with oral rehydration salts (ORS) or intravenous fluids.</li>
	<li>Proper handwashing, access to safe drinking water, and improved sanitation are vital in preventing diarrhea.</li>
	<li>Exclusive breastfeeding for the first six months of life helps protect infants from diarrhea and other infections.</li>
	<li>Rotavirus vaccination is recommended to prevent the most common cause of diarrhea in infants and young children.</li>
	<li>Early diagnosis and treatment, along with supportive care and nutrition, are essential for managing diarrhea and preventing complications. 
	&nbsp;</li>
</ul>

[1] Diarrhea in Children Overview. American College of Gastroenterology.

[2] Diarrheal Disease. World Health Organization.

[3] Rahmat ZS, Zubair A, Abdi I, Humayun N, Arshad F, Essar MY. The rise of diarrheal illnesses in the children of Pakistan amidst COVID-19: A narrative review. Health Sci Rep. 2023;6(1):e1043. Published 2023 Jan 3. doi:10.1002/hsr2.1043