Acute Diarrhea In Children

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Acute Diarrhea In Children
Acute Diarrhea In Children
Video: Acute Diarrhea In Children
Video: Pediatric Diarrhea – Pediatrics | Lecturio 2023, February
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Acute diarrhea (gastroenteritis)

In the case of acute diarrhea, the stool suddenly becomes more fluid and emptied more frequently than usual. In children, the most common cause of this is an infection with viruses or bacteria (infectious gastroenteritis). In addition, reactions to food or general illnesses can be behind it.

With diarrhea, the child loses excessive amounts of water, valuable minerals and electrolytes. If the loss cannot be compensated for through fluid intake, there is a risk of dehydration (dehydration). Electrolyte imbalances are also possible complications. The younger the child, the greater the risk.

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  • When do we speak of acute diarrhea in children?
  • What are the causes of acute diarrhea?
  • What are the symptoms?
  • Why can diarrhea quickly become dangerous in children?
  • How is the diagnosis made?
  • How is acute diarrhea treated in children?
  • When should a doctor be consulted immediately?
  • How to prevent diarrhea in children
  • Whom can I ask?
  • How are the costs going to be covered?

When do we speak of acute diarrhea in children?

We speak of diarrhea when the stool is thinner and is emptied more often than usual. As a guideline for children, more than three thin chairs per day or at least two more chairs per day than usual.

Note How often stool is usually defecated and the consistency of the stool depends on the age and diet of the child. For example, infants who are exclusively breastfed or given milk formula generally have softer and more frequent stools than older children who already eat solid food.

If the diarrhea occurs suddenly and lasts for less than two weeks, it is called acute diarrhea. In our part of the world, more than 90 percent of diarrhea in children is acute. Symptoms that last more than two weeks are called persistent or chronic diarrhea.

More on the topic: Chronic diarrhea in children

What are the causes of acute diarrhea?

The most common cause of acute diarrhea in childhood is infection (acute infectious gastroenteritis). In most cases these are viruses, and infection with bacteria or parasites is less common overall. The following pathogens are possible:

  • Viruses: About 70 percent of acute infectious diarrheal diseases in the first five years of life are caused by viruses. In most cases, these are noroviruses or rotaviruses, but adenoviruses and enteroviruses are also possible triggers. More on the topic: norovirus gastroenteritis
  • Bacteria: Bacterial pathogens (especially Campylobacter and Salmonella, Shigella, pathogenic E. coli or Clostridium difficile) are detected in the stool in around 20 percent of the sick children. Children aged two and over are more likely to be affected.
  • Parasites: Lamblia, cryptosporidia, entamoebs and other intestinal parasites are further, but in our latitudes, rare triggers for diarrhea. There is a particular risk of infection when traveling long-distance. More on the topic: Infectious diseases while traveling

The infection takes place in different ways depending on the pathogen. A so-called fecal-oral infection or a smear infection is very common, ie the germs are passed on from person to person through contaminated hands, food, drinking water or utensils (e.g. door handles, fittings, light switches). A droplet infection is also possible (e.g. with noroviruses). The incubation period is a few hours to seven days, depending on the pathogen.

Bacterial gastroenteritis usually occurs in connection with food consumption, e.g. after consuming raw or incompletely cooked meat (Yersinia, Campylobacter, Salmonella) or dishes made from raw eggs (Salmonella). Other sources of infection include raw milk, types of raw sausage and direct contact with infected cows. More on the topic: food infections

Other causes

Acute diarrhea in children does not always have to be the result of an infection. Other possible causes are:

  • unfavorable diet (e.g. high-fat food),
  • (excessive) consumption of certain types of fruit (e.g. watermelon, apple), fruit juices or smoothies,
  • psychological stress (e.g. stress, fear).
  • Taking medication: Particularly when taking certain antibiotics, thin stools can occur as a side effect. In this case, for example, the administration of probiotics can counteract this or the dosage can be divided into several smaller individual doses. It may be possible to switch to another antibiotic if there is an alternative for the diagnosis. In general, this form of diarrhea is harmless, depending on any underlying illness and the overall condition of the child.

In small children, diarrhea can also appear as a side effect of colds, otitis media or other febrile infections.

In the case of recurring symptoms, food allergies or food intolerances (e.g. lactose intolerance) or congenital metabolic diseases can be the cause.

What are the symptoms?

With infectious gastroenteritis, the stool is watery or slimy, very foul-smelling and is emptied more often than usual. In addition to diarrhea, there are typically abdominal pain, loss of appetite, nausea, and vomiting. Fever, headache, and flu-like symptoms are also possible.

In the case of viral gastroenteritis, the diarrhea usually subsides on its own after up to seven days, depending on the pathogen. Nausea, vomiting and feeling sick usually improve after one to three days. Bacterial gastroenteritis sometimes shows a longer course of the disease with a strong feeling of illness, severe abdominal pain, high fever or blood in the stool.

Note Bloody stools should be interpreted as an alarm signal - in these cases a pediatrician should be consulted immediately.

The other complaints depend primarily on the extent of the loss of fluid and electrolytes, ie dehydration (dehydration, dehydration) (see below).

Acute diarrhea from other causes, such as diet overload, medication intake, psychological factors, etc. usually subsides after a day or two or as soon as the trigger is removed.

Why can diarrhea quickly become dangerous in children?

With diarrhea, the child loses excessive amounts of water as well as valuable minerals and electrolytes. Vomiting and fever make the situation worse. If the loss cannot be compensated for through fluid intake, there is a risk of dehydration (dehydration). Electrolyte imbalances are also possible complications. The younger the child, the greater the risk: Babies and toddlers up to their second birthday have a higher fluid turnover than older children and adults and are therefore more sensitive to changes in the water and electrolyte balance.

Existing underlying diseases of the child (e.g. diabetes, malnutrition, immune deficiency) can further increase the risk of dehydration or electrolyte and metabolic imbalances.

Note The younger the child and the more severe the diarrhea, the higher the risk of dehydration.

Warning signs of (impending) dehydration are:

  • dry mouth,
  • dry mucous membranes (e.g. eyelids, lips),
  • "Standing" skin fold: if you lift up a skin fold (e.g. on the back of the hand) with your thumb and forefinger and this remains then, this is an indication of insufficient fluid in the body
  • Drowsiness, apathetic behavior, impaired consciousness,
  • decreased urine output,
  • missing tears,
  • flaccid muscle tone as well
  • fast heartbeat, fast breathing.

Danger! If there is any sign of dehydration, a doctor must be consulted immediately - especially in the case of infants and young children.

More on the topic: Emergency in children: gastrointestinal infection

How is the diagnosis made?

The pediatrician will ask the parents for the following information in particular:

  • Onset, consistency and frequency of the diarrhea, any blood
  • Onset and frequency of vomiting,
  • Fever,
  • Fluid and food intake in the past 24 hours,
  • Urine production,
  • recent stays abroad or in hospital,
  • Taking antibiotics and other drugs,
  • Environmental diseases,
  • Basic diseases of the child, especially immune deficiencies, metabolic and intestinal diseases,
  • recent diet changes,
  • Risk factors for intestinal infections, such as consumption of raw milk or raw meat.

The child is then examined and weighed, and an assessment is made of whether there is a risk of dehydration or how severe it is.

Proof of the pathogen is not required for uncomplicated infections. Evidence using a stool or blood sample should, however, be carried out in the following cases:

  • in the case of severe disease
  • in the presence of comorbidities
  • on recent long-distance trips
  • in infants under three months of age

Additional blood tests and a urinalysis, as well as imaging tests such as ultrasound or endoscopy, may be required.

How is acute diarrhea treated in children?

The therapy focuses on the replacement of fluid and electrolyte losses. In addition, sick children should, if possible, receive their usual food or be switched to an age-appropriate diet. Further treatment will depend on whether you have dehydration and how severe it is. Drug therapy is only required in severe cases.

Fluid and electrolyte supply

If there is no dehydration, only the ongoing losses need to be replaced. Tea with a little salt and sugar, for example, or ready-made solutions from the pharmacy are suitable for this. It is advisable to take liquids only in small sips or to spoon with a teaspoon and take breaks in between so as not to induce further vomiting.

Note Children under the age of five should not be given any self-made juice / sugar-salt-water mixtures, as such solutions often have very variable compositions.

Infants and children with mild to moderate dehydration can in most cases be treated successfully with the help of a special drinking solution (oral rehydration solution, ORL). The solution contains sodium, glucose and other electrolytes and is used to compensate for the water and electrolyte losses. This treatment can either be done under medical guidance at home, on an outpatient basis in a doctor's office or in the hospital. An ORL, like other liquids, should be administered in small sips or with a teaspoon.

Note An ORL contains an optimal ratio of sodium and glucose. It must therefore only be dissolved in water, but not in cola drinks, lemonades or juices.

Very seriously ill children with pronounced dehydration, impaired consciousness and circulatory shock require intensive medical treatment.

nutrition

Breast-feeding infants should continue to be breast-fed as usual in the event of acute diarrhea. If the baby feels thirst more than usual due to the loss of fluid, it should be put on accordingly more often. Even when an ORL is administered, it is important to continue breastfeeding the baby in parallel. More on the topic: Breastfeeding

During and shortly after the diarrhea, any change in diet should be avoided at all costs. Bottle-fed infants are given undiluted formula. Infants receiving hypoallergenic formula should keep it.

Small children and older children should not eat solid foods for the first few hours so as not to put additional strain on the digestive system. However, care must be taken to ensure adequate hydration. Easily digestible, low-fat food can then be eaten, such as pasta, potato or rice dishes, porridge or semolina, pretzel sticks, bread and soups (e.g. potato, carrot soup). If these foods are not vomited, normal food can be used. Juices with a high fructose, sucrose or sorbitol content (e.g. apple or pear juice) should be avoided.

Children receiving an ORL should also be fed their usual diet about four to six hours after starting treatment.

Medication

Drug treatment is only very rarely necessary for uncomplicated gastroenteritis. The use of antibiotics only makes sense in exceptional cases.

When should a doctor be consulted immediately?

In most cases, acute diarrhea subsides without any problems within a few days if the behavioral measures mentioned or the therapies recommended by the pediatrician are observed.

A pediatrician should be contacted immediately under the following circumstances, as life-threatening complications or co-morbidities may occur:

  • The child is younger than twelve months.
  • The child refuses to drink.
  • The child suffers from constant vomiting.
  • There are bloody stools.
  • The child has a high fever and / or stomach pain at the same time.
  • The child's abdominal wall is very hard and tense.
  • The stool is emptied very frequently or the amounts of stool are very large.
  • The diarrhea has existed for more than seven days.
  • The child has existing underlying diseases (e.g. diabetes, immune deficiency, kidney disease).
  • The child shows signs of dehydration (see above).

How to prevent diarrhea in children

To avoid intestinal infections, the following measures are recommended:

  • Breastfeeding (also partially),
  • Observe hygiene measures, especially hand washing (especially before preparing meals or handling food, before breastfeeding, after using the toilet and after changing diapers). The hands should be washed with warm water and soap and, if necessary, disinfected,
  • Towels and bed linen from sick children should not be shared with others and washed at at least 60 degrees,
  • sick children should not visit community facilities (kindergarten, school, swimming pool, etc.),
  • Avoidance of incompletely cooked meat, dishes made from raw eggs (salmonella) and raw milk,
  • Avoidance of direct contact with infected cows,
  • Vaccination: The vaccination against rotaviruses is recommended for infants and toddlers as part of the free child vaccination concept. For more information, see Vaccinations for Infants and Young Children.

Whom can I ask?

For clarification and treatment of acute diarrhea in children, you can turn to, among other things

  • Specialist in paediatrics,
  • General Practitioner,
  • in an emergency to the nearest hospital outpatient department or the emergency number 144.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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