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If you have just had a baby or have a toddler at home, you must know how nerve-racking it is for a parent to see their child ill. Right from worrying about the food they eat to a minor cough can send parents into a tizzy. So when a child has diarrhoea it can be quite an alarming situation. In this post Dr Maiya PP, Consultant Paediatrician, Agadi Hospital, Bangalore, answers all your questions about how you can manage diarrhoea in children.
Diarrhoea is a common problem in infants and children, but if not managed well, it can quickly turn deadly. It is the second biggest cause of child deaths globally, after pneumonia. According to the WHO, more than 2.3 million children below the age of five die in India each year, of which 334,000 are attributable to the condition. This is a needless tragedy because the illness is easy to prevent and manage. (Read: How can we solve India's diarrhoea problem?)
When is a child said to suffer from diarrhoea? What causes it?
A child is said to be suffering from diarrhoea when he/she passes at least three loose or watery stools per day. Other symptoms of diarrhoea include vomiting, stomach ache, headache and fever.
The condition is mostly due to a gastro-intestinal infection caused by some types of bacteria, viruses or parasites that are transmitted to humans through contaminated food or water. So-much-so that about 88% of the children who die due to diarrhoea, contract it because they consume unsafe water, live with sub standard hygiene and in poor sanitation conditions. The most common cause of diarrhoea is the rotavirus and it is responsible for about 40% of all hospital admissions among children under the age of five, worldwide. (Read: Diarrhoea and Pneumonia: The biggest killer diseases of kids!)
Here are some tips on how to manage the condition:
Make sure he/she drinks only clean water and maintain high hygiene levels
As a precautionary step, make sure your drinking water is clean by either boiling it, filtering it or by using chlorine tablets. Once cleaned, make sure it is stored in a hygienic place. Moreover, it is important for parents and care givers to focus on hygiene including washing one's hands with soap before feeding the child, after visiting the washroom, or after touching any foreign objects.
Keep your child hydrated
During diarrhoea since the child frequently passes stools, it drains a child's body of water. This can have serious consequences since 75% of our body weight is made up of water, more so in children. A child suffering from dehydration shows symptoms like having a dry and sticky mouth, dark yellow urine or no urine at all, no tears while crying, and cool or dry skin.
Remember that it is not diarrhoea which is dangerous for a child but dehydration that alters the body's natural balance of water and electrolytes. Severe dehydration can cause seizures, organ failure, and brain damage. Children below two years are particularly vulnerable. They can die from dehydration within a couple of days or even earlier since watery stools flush out several electrolytes and nutrients from the body, including potassium and sodium, without which internal organs cannot function properly. The aim of diarrhoea treatment is to prevent dehydration by continuously replenishing the child's body with water and electrolytes.
Supplement water with electrolytes
Even though water is an important element in rehydrating the body, it doesn't have sufficient amounts of electrolytes which the child badly needs. Therefore the appropriate treatment for diarrhoea includes oral rehydration therapy, zinc, Vitamin A and folate supplementation and continued feeding.
Keeping this fact in mind doctors say that oral rehydration salts or ORS should be immediately begun with the very first vomiting or loose stool. Pre-packaged packets of ORS are widely available. When mixed with safe water and fed to the child, the ORS drink rehydrates the body and supplies salt and other electrolytes in sufficient quantities. More importantly combining zinc and ORS is crucial since zinc helps decrease the severity and duration of diarrhoea. The combination is highly recommended by the World Health Organization for the treatment of simple diarrhoea in children.
Maintain a proper diet and don't neglect breastfeeding
A very important aspect of managing diarrhoea is the child's diet. The child if breastfed needs continued feeding. Many mothers think giving water to a child would worsen diarrhoea or that the stomach needs 'rest' from eating to recover. In fact, breastfed infants suffering from diarrhoea need to be breastfed more often to replace the lost fluid and essential nutrients. These are dangerous myths that may turn counterproductive in terms of a healthy recovery. (Also read: The importance of breastfeeding)
For those children who can eat solid food, should be put on a diet consisting of non-spicy and easy digestible foods. Boiled white rice and preparations made from it like khichri of moong dal, idli, rice kheer and rice kanji are very beneficial. There is evidence to suggest that rice based cereals help better manage persistent diarrhoea along with fluid and electrolyte replenishment.
By complementing ORS with rice-based cereals, one not only rehydrates a child, but also shortens the duration of the disease, cuts down the volume of stool and reduces the frequency of diarrhoea and vomiting, thereby helping in the management of diarrhoea holistically.
Parents should especially avoid foods that are high in fibre, fat or grease and those foods that are hard to digest, such as daliya, whole wheat flour, whole dals (dals with husk), dairy products like ice cream and cheese (except curd), peas, beans, citrus fruits and others like apple and guava. Sugar rich foods like cake and cookies should also be avoided. Concentrated fruit juices can make diarrhoea worse, so keeping the child away from them is essential.
It is essential that parents continue giving the child a bland diet for about three to four days after the diarrhoea has stopped to ensure full recovery.
Children with poor health and who do not get adequate nutrition are more vulnerable to diarrhoea and suffer many episodes every year. Recurrent diarrhoea in early childhood may have long-term effects like stunting and developmental delays caused by poor nutrients absorption by the body. Exclusive breastfeeding for the first six months of life helps reduce the incidents of diarrhoea and other infections.
Read more about causes, symptoms, diagnosis and treatment of diarrhoea.
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