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Diarrhoea in Children : Causes, Types, Symptoms, & Treatment

Diarrhoea in Children : Definition, Etiology, Types, Signs, Symptoms, Management, & Prevention

Definition

  • Diarrhea refers to passage of ≥ 3 loose stools in 24 hours (WHO).
  • Cause of death in diarrhea: Dehydration

Types

  1. Acute watery diarrhea
  2. Dysentery (Presence of blood or mucus in loose stools)
  3. Persistent diarrhea (Lasting for 14 days or more)

Categorisation of Dysentery (Western system of classification)

On the basis of % loss of body weight due to diarrhea

Mild Moderate Severe
Neonates < 5% 5-10% > 10%
Children < 3% 3-6 % > 6%

Causes

Diarrhea

  • Viral > Bacterial
Virus Bacteria
Rotavirus E. coli (EPEC)
Norwalk virus
Calicivirus
Coronavirus
Adenovirus

Dysentery

Most common cause

E .coli (O157:H7) ⇒ World

Shigella dysenteriae type 1 ⇒ India

Persistent diarrhea

1. Infection

Most common cause

Rotavirus, Norwalk virus ⇒ World

E. coli (EAEC), Giardia lamblia ⇒ India

2. Non infectious

Secondary lactose malabsorption

Occurs as a complication of viral diarrhea due to lactose deficiency

Small bowel v/s Large bowel Diarrhea

Feature Small bowel diarrhea Large bowel diarrhea
Stool volume Large Small
Blood in stool No Usually present
Rectal symptoms (e.g. urgency, tenesmus) No Yes
Steatorrhea  Yes No
Carbohydrate malabsorption  Yes No
Protein malabsorption  Yes No
Pain (If any) Periumbilical pain, No reduction after passage of stool Hypogastric, Reduction after passage of stool
Color of stool Pale Normal
Smell of stool Usually offensive Normal
Nutrient deficiency Frequent Can occur due to blood loss

Note: Rotavirus diarrhea can have light green stool (1-5% cases) because of fresh bile appearing in stool due to rapid peristalsis.

Treatment

A. Non specific

  • It should be given to all patients of diarrhea.

Management of dehydration

Plan A/B/C

Oral zinc gluconate (Alternative: Zinc acetate)

Dose: 10 mg/day (If child < 6 months), 20 mg/day (If child > 6 months)

Duration: 14 days

B. Specific groups

Dysentery or Cholera

Antibiotics

Persistent diarrhea

Low lactose diet

Lactose free diet

Monosaccharide based diet

Upcoming therapies in childhood diarrhea

1. Probiotics

  • Lactobacillus
  • Bifidobacterium
  • Bacillus clausii

2. Racecadotril 

  • Peripherally acting enkephalinase inhibitor in small intestine.
  • Decrease stool in watery diarrhea.

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