Clinic Consult: Pediatrics (Childhood Diarrhea) Ajay Kalra, Vipin M Vashishtha
INDEX
×
Chapter Notes

Save Clear


Diarrhea in ChildrenCHAPTER 1

 
INTRODUCTION
Diarrhea is a leading cause of morbidity and mortality in developing countries. Each year in developing countries, roughly 4 billion episodes of acute diarrhea take place. In India, a child suffers, on an average, of 10–15 episodes of diarrhea in the first 5 years of life. Of these, 3–6 episodes (average 4.2) may occur in the very first year of life, especially in the urban slums and rural areas. It is responsible for nearly 2 million deaths of children below 5 years age every year in the developing world.
The surface area of intestinal mucosa of a child from where the diarrheal fluids are secreted is fairly large. Therefore, a child may lose almost as much water and electrolytes from the body during the episode of diarrhea as an adult. Loss of 1 liter of fluid from the body of a child weighing 7 kg may be more dangerous compared with a similar depletion from an adult of 70 kg weight. Out of all cases of diarrhea, nearly 2–3% would have a significant disturbance in the electrolyte balance and acid base status of the body and this may prove fatal, if fluids and electrolytes are not replaced immediately.
Diarrhea has been shown to have significant impact on nutrition. Even a brief episode of diarrhea leads to the loss of 1–2% of body 2weight per day. Infants and young children in developing countries are sick for nearly 30 days per year because of diarrhea. Therefore, such creeping deficit may accumulate to become a major nutritional hazard. If diarrhea becomes unusually prolonged, or is recurrent, the child further becomes severely malnourished. Moreover, the appetite is impaired, and food is often withheld from the child by the mother due to the belief that starvation may provide rest to the bowel and thus promote early recovery.
Further, atrophy of the intestinal epithelium in cases of malnutrition causes malabsorption and accentuates malnutrition. A vicious cycle of diarrhea-malnutrition-diarrhea sets in, contributing to a large majority of early childhood deaths either directly or indirectly.
 
DEFINITION
When a person has watery motions, it is called diarrhea. Diarrhea does not always mean many motions. Even one watery motion can be diarrhea. This is also regardless of its cause, its color, or any illness associated with it. Diarrhea can be very dangerous, especially in very small or weak children. This is because diarrhea leads to dehydration, which may cause death. That is why one must start treating a child for diarrhea as soon as the child passes even one watery motion. Young infants usually pass about 5 g of stool per kg of body weight per day, while diarrhea results in stool output greater than 10 g/kg/day.
 
WHAT IS NOT DIARRHEA?
  • Frequent semiformed or watery greenish yellow stools in the initial days of life (transitional stools). Due to some weight 3loss, they are often thought of as diarrhea. It is self-limiting and requires no treatment
  • Formed or pasty stools frequently passed in exclusively breastfed babies
  • Passing a stool immediately after feed by infants 3–6 months of age: It is due to exaggerated gastrocolic pattern, quite normal at this stage and requires no treatment
 
CLASSIFICATION OF DIARRHEA
Acute diarrhea: It is passage of several watery and loose stools in a day which generally terminate within 7 days (only rarely 14–28 days).
Persistent diarrhea: World Health Organization (WHO) defines this as a diarrheal illness, which begins acutely and lasts for 14 days or more. More than 60% episodes occur in infants less than 6 months and 90% before 1 year of age.
Chronic diarrhea: It is diarrhea of more insidious onset with stools, which are less watery in nature and semisolid. Their frequency may be four to five times per day. It is seen more in children above 3 years of age.
Dysentery: It is presence of visible blood in stool. It is usually accompanied by pus and abdominal cramps and fever. Shigella is the most common cause requiring treatment with antibiotics.
Acute infective diarrhea may be both “noninflammatory” or “inflammatory”. Noninflammatory diarrhea is due to enterotoxin produced by bacteria, destruction of villus (surface cells) by viruses, or adherence by parasites. Diarrhea may be inflammatory due to bacteria that invade intestine directly or produce cytotoxins.
4