Chapter 22: Acute Diarrhea in Children

1. Definition

Acute diarrhea is a condition characterized by passing loose or watery stools more than 3 times in 24 hours, lasting no more than 14 days (usually less than 7 days), with watery or loose stools without blood.

2. Classification

Acute diarrhea is classified based on symptoms and causes:

2.1. Non-Dysenteric Acute Diarrhea:

• Symptoms: Loose or watery stools, no blood, often accompanied by vomiting and fever.

• Causes: Caused by various pathogens, most common being Rotavirus, ETEC, Shigella, Campylobacter Jejuni, Cryptosporidia, Vibrio cholerae 01, Salmonella, and E Coli (EPEC).

2.2. Dysentery Syndrome:

• Symptoms: Bloody stools, potentially accompanied by abdominal pain, fever, loss of appetite, weight loss, and mucosal damage.

• Causes: Primarily caused by Shigella, some cases by Campylobacter Jejuni, invasive E.coli (ETEC), Salmonella, and E.Histolytica.

2.3. Persistent Diarrhea:

• Symptoms: Acute onset but abnormally prolonged (at least 14 days), can be acute diarrhea or dysentery syndrome, causing significant weight loss.

• Causes: No specific single microbe causes persistent diarrhea, but E.Coli adherence (EAEC), Shigella, and Cryptosporidia may play a more significant role than other agents.

3. Importance

Acute diarrhea is a major public health concern, especially among children:

• Leading Cause of Morbidity and Mortality: It is a leading cause of death in children under 2 years, peaking between 6-24 months. Dehydration and electrolyte imbalance are the main causes of mortality.

• Causes Malnutrition: Acute diarrhea reduces nutrient absorption, leading to malnutrition.

• Economic Burden: Acute diarrhea incurs costs on families and society due to treatment expenses and lost productivity.

4. Epidemiology

4.1. Transmission:

• Primary Mode: Fecal-oral route.

• Transmission Methods: Through contaminated food or water, direct contact with infected feces.

4.2. Practices Increasing Risk:

• Not breastfeeding exclusively for the first 4-6 months.

• Weaning early before 1 year of age.

• Bottle feeding and leaving cooked food at room temperature.

• Using water contaminated with intestinal bacteria.

• Not washing hands after using the toilet, after cleaning feces, or before preparing food.

• Not disposing of children’s feces hygienically.

4.3. Risk Factors:

• Malnutrition: Malnourished children are more susceptible to persistent and severe diarrhea, with a higher risk of death.

• Measles: Children with measles or recently recovered from measles within 4 weeks are more prone to diarrhea due to a weakened immune system.

• Immunosuppression or Immunodeficiency.

4.4. Seasonality: Acute diarrhea does not have a seasonal pattern.

5. Assessing and Classifying Dehydration:

• Mild Dehydration: Child is alert, eyes normal, thirst normal, skin turgor returns quickly.

• Moderate Dehydration: Child is restless, irritable, eyes sunken, drinks eagerly, skin turgor returns slowly.

• Severe Dehydration: Child is lethargic, comatose, eyes very sunken, unable to drink, skin turgor returns very slowly.

6. Treatment Principles:

6.1. Rehydration and Electrolyte Replacement:

• Oral Rehydration Solution (ORS): Replenish fluids and electrolytes for children with diarrhea, dosage depending on the level of dehydration.

• Intravenous Fluids: Administered to children with severe dehydration or inability to drink.

6.2. Medication:

• Antibiotics: Only used in cases of Shigella and cholera-related dysentery, not routinely used in acute diarrhea.

• Antiparasitic Medications: Used for amoebic dysentery or Giardia infections.

• Avoid these Medications: Anti-motility drugs, anti-emetics, adsorbent agents.

7. Prevention:

• Breastfeeding: Exclusive breastfeeding for the first 4-6 months strengthens the child’s immune system.

• Improve Weaning Practices: Introduce solid foods correctly, ensuring food safety.

• Use Clean Water: Use clean water for hygiene and drinking.

• Handwashing: Wash hands thoroughly after using the toilet and before preparing food.

• Use Toilets: Dispose of children’s feces hygienically.

• Measles Vaccination: Measles vaccination protects children from measles, reducing the risk of diarrhea.

8. Notes:

• Seek Medical Attention: Take your child to the doctor if they experience severe diarrhea, blood in stools, high fever, or signs of severe dehydration.

• Monitor Child’s Condition: Keep track of the child’s fluid intake and stool frequency.

• Adequate Fluid and Electrolyte Replacement: Replenishing fluids and electrolytes is crucial for children with diarrhea.

• Follow Doctor’s Instructions: Adhere to the doctor’s instructions on medication and child care.

9. Multiple Choice Questions:

• Question 1: Which of the following medications can be used for diarrhea EXCEPT:

• A. Anti-emetics.

• B. Adsorbent agents.

• C. Antibiotics.

• D. Anti-motility drugs.

• Question 2: Which of the following diarrhea patients requires IV fluids:

• A. Moderate dehydration but unable to drink.

• B. Severe dehydration.

• C. Mild dehydration with blood in stools.

• D. Mild dehydration with coma.

• Question 3: Which statement is incorrect regarding diarrhea treatment:

• A. Fluid and electrolyte replacement.

• B. Adding nutritional supplements.

• C. Weaning correctly.

• D. Continuing breastfeeding.

• Question 4: Antibiotics are indicated for:

• A. Viral diarrhea.

• B. All cases of diarrhea.

• C. Dysentery and cholera-related diarrhea.

• D. Absolutely not used for diarrhea.

10. Answers:

• Question 1: D. Anti-motility drugs.

• Question 2: C. Mild dehydration with blood in stools.

• Question 3: B. Adding nutritional supplements.

• Question 4: C. Dysentery and cholera-related diarrhea.