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
- Acute watery diarrhea
- Dysentery (Presence of blood or mucus in loose stools)
- 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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