Diarrhoea indicates the passage of frequent, loose motions. The stools may also contain blood, in which case the condition is called dysentry. Babies who are breast-fed often have stools that are soft and frequent; this is not diarrhoea.

CAUSES OF DIARRHOEA

Acute diarrhoea can be caused due to:
          1. Infection
          2. Drugs
          3. Ischaemia
          4. Inflamatory bowel disease etc.

Diarrhoea in children mainly results from infection of the intestines with microbes or germs which are ingested if the milk, food or water is contaminated.

The infections are mostly caused by:
       1. viruses
       2. bacteria
       3. parasite agents.


WHAT HAPPENS IN DIARRHOEA:

There is a loss of water and salts (electrolytes) in the diarrhoea stools. A deficit of a large amount of water and salts leads to

Dehydration is aggravated by:
     1. vomiting
     2. withholding milk and water, as is frequently done
     3. fever
     4. hot cilmate.

MANAGEMENT OF A CHILD WITH DIARRHOEA :

Essential elements in management of a child with diarrhoea are:

A) PROVISION OF ORAL REHYDRATION THERAPY (ORT)

    The modern management of childhood diarrhoea principally involves the use of balanced electrolyte solutions to reverse dehydration and maintain hydration.

The WHO recommended ORS {oral rehydration salt} solutions which contain:

    20gm---glucose
    3.5gm--sodium chloride
    2.5gm--sodium bicarbonate
    1.5gm--potassium chloride.
This is dissolved in 1 litre of water.

It should be given in small quantities at frequent intervals till the dehydration is corrected.

    The quantity required depends on
    extent of dehydration
    age
    weight
    thirst is a good indicator at times.
Thus a year old may need 1000ml/1litre of ORS SOLUTION IN 24 HRS
To compensate for ongoing additional losses with continuing diarrhoea-----extra 100 ml ORS should be given for each diarrhoea stool.

The quantity of ORS solution required for 6 hours has to be prepared at one time to avoid contamination during storage. Also remember to give plain boiled water during this period.

For babies a dropper or a syringe (without the needle) can be used to give the solution.For children under two years a teaspoonful should be offered every 1-2 minutes.If the child vomits,wait for 10 minutes and restart more slowly.

NEW ORS SOLUTIONS:
Super ors--contains amino acids
Cereal based ORS.

B) CONTINUING FEEDING:

Traditionally fasting during the first 24 -48 hours was practiced. However, delayed refeeding has a deletenous effect on an overall nutritional status of the child. Delayed feeding contributes to increased villous atrophy, while early refeeding enhances the ability of the intestine to regenerate after the insult.

FOR INFANTS BELOW 4 MONTHS:

encourage exclusive breast feeding
if animal milk must be given, replace with yoghurt.
lactose free formula.

OLDER INFANTS AND YOUNG CHILDREN:

The first diet : Reduce lactose diet containing starch given 6 times a day.
The second diet : Lactose free reduced starch diet.This contains whole egg or chicken meat.
Give supplementary multi vitamins and minerals:

    Folate
    Vit.A
    Copper
    Zinc
    Iron
    Magnesium

C) RATIONAL USE OF DRUGS :

Antimicrobials should only be used for those with:
    Blood + mucous in stools
    Suspected cholera
    Serious non-intestinal infections(which also can be present as diarrhoea).

ADVISING MOTHERS ON HOME MANAGEMENT AND PREVENTION :

AIM OF MANAGEMENT

A) TREAT DE HYDRATION
B) PREVENT DEHYDRATION COMPLICATIONS

TREAT DEHYDRATION

How to prevent dehydration at home?
Dehydration can be prevented if a child drinks more fluid than usual as soon as diarrhoea starts.

BREAST FEEDING SHOULD BE CONTINUED AND GIVEN FREQUENTLY

Home therapy uses water, salt and starch (or protein) alternatingly from fluids and food available at home.

Select more than 2 -3 different types of fluids.Water should always be one of the selected fluids

What Fluids should not be given :

Potentially dangerous fluids can draw water by their high osmotic activity thus aggravating dehydration

* Sweetened Fruit Drinks
* Sweetened Tea
* Most Soft Drinks

HOW TO DETECT DEHYDRATION:

Initially the child is thristy & irritable, the skin becomes less elastic, mouth is dry and lips are parched, eyes appear sunken and there is a reduction in the quantity of urine.

SEVERE DEHYDRATION;

Grave danger to life!!
Child becomes apathetic
Extremities becomes weak
Eyes are markedly sunken
Complete stoppage of urine

RUSH TO THE HOSPITAL ... EARLY

* When the child passes 10 Watery stools
* When there is associated vomiting
* When he is very thirsty
* When he has sunken eyes
* When he has fever
* When he refuses to eat and drink
* When he seems not to get better
* Associated Complications
Convulsions
Abdominal distention
Anemia


PREVENT DEHYDRATION COMPLICATIONS

HOW TO PREVENT DIARRHOEA

The crucial measure is to observe hygienic practices when feeding the baby and using safe drinking water.

THE FOLLOWING ARE IMPORTANT :

1. Breast feeding exclusively until the age of 4 months 2.Hygienic weaning (introduction of semisolid food) a) cups, katoris, spoons and all utensils should be cleaned well or boiled b) Avoid using bottles c) Fresh and hygienically prepared food, protect food from flies and dust d) Avoid thermos and plastic ware which can not be boiled 3. Use boiled water. Store in covered containers 4. Wash hands with soap before feeding the baby and after defaecation, keep nails short 5. Immunizations like - Typhoid, Measles, Hepatitis etc.

IMPORTANT  NOTE :
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