Health Tips

Diarrhoea is a common problem among children. It involves passing watery and loose stools, and your child may go to the bathroom more often. In many less developed parts of the world, diarrhoea in children can get so severe that it kills. 

On the other hand, in the developed world or upper middle-class countries such as Malaysia, diarrhoea among children typically resolves on its own within 1 to 2 days. Nevertheless, if your child experiences diarrhoea for more than 2 days, you should take him or her to see a doctor for further checkup.

Beside frequent and loose stools, your child may also experience the following:

• Urgency with bowel movements, which means that children feel that they have to get to the bathroom immediately or they will have an accident.

• Abdominal pain and/or bloating

• Rectal pain

• Nausea and/or vomiting

• Weight loss

• Fever

• Blood in the stool

The symptoms coloured in red are red flag symptoms that warrant a medical check-up, as these may be signs of infection and not just any ordinary diarrhoea.

What causes diarrhoea?

Diarrhoea can be caused by many reasons, including:

• Infection from bacteria, virus or parasites. Children who visit some foreign countries are at risk for traveler’s diarrhoea. This is caused by having food or water that is not safe because of bacteria, viruses, or parasites.

• Trouble digesting certain food, such as dairy products if the child has lactose intolerance.

• Food allergy

• After taking certain medications, such as antibiotics, that may cause diarrhoea as a side effect.

• An underlying stomach or intestinal disorder, such as irritable bowel syndrome

• Surgery on the stomach or gallbladder

In some cases, it may be difficult to find out what’s causing your child’s diarrhoea, as not all causes of diarrhoea can be investigated properly in hindsight. Nevertheless, talk to your child’s doctor if the diarrhoea doesn’t seem to go away or has hindered your child’s normal daily routine.

How is diarrhoea treated in children?

The treatment of diarrhoea for children and adults are mostly the same, with a few exceptions of medications that children cannot take.

1. Ensure adequate hydration using oral rehydration solution (ORS)

One of the dangerous consequences of profuse diarrhoea and vomiting is dehydration. Signs of dehydration in children include:

• decrease in urine output/wet diapers

• dry lips and mouth

• lack of tears when crying

• increased irritability and fussiness

• increased sleepiness/decreased energy level

As such, it is crucial that a child experiencing diarrhoea receives proper rehydration through an oral rehydration solution (ORS). ORS is inexpensive and widely available in all pharmacies stores. Contrary to popular belief, drinking ‘100plus’ is not a better approach than ORS. ORS itself is already adequate to replenish the lost electrolytes from diarrhoea and vomiting in children. You may read the instructions on preparing ORS for your child on the product’s packaging or here.

Image credit: https://shopee.com.my/ORS-PLUS-(ORAL-REHYDRATION-SALT)-SACHETS-(ORIGINAL-ORANGE)-i.53384175.2638496005

2. Diet 

In a child who is otherwise healthy, it is very important to start feeding them their regular diet as soon as possible. Breast fed babies should be nursed normally during episodes of diarrhoea unless doctor instructed otherwise. Formula fed infants can continue their regular diet and older children should be reintroduced to their regular diet as soon as possible. Older children may avoid dairy initially and try a bland diet consisting of bananas, apple sauce, rice, and toast.

3. Medications and supplements

• Medications that stop diarrhoea are generally not encouraged among children. The medications typically taken by adults who experience diarrhoea, such as loperamide (Lomotil®, Imodium®) and diphenoxylate + atropine (Dhamotil®) are unsafe for children and should be avoided. Alternatively, children with diarrhoea can receive racecadotril (Hidrasec®) in combination with ORS to relieve diarrhoea symptoms. Note that regardless of adults or children, one should not take medications that stop diarrhoea without finding out the reason that causes the diarrhoea in the first place. This is because if the diarrhoea is caused by an infection, taking such medication can actually ‘trap’ the microorganisms in the intestines and worsen the infection.

• Antibiotics may be prescribed by a doctor for children with specific bacterial or parasitic illnesses, although in most cases antibiotics do not change how long the diarrhoea lasts or its severity.

• Probiotics were found to improve diarrhoea in infants and children, as well as diarrhoea caused by long-term antibiotic treatment. Studies show that taking probiotics that contain single or more strains can shorten the duration of diarrhoea and the number of times to pass motion. You may find probiotics products in any nearest pharmacy stores. Read more about probiotics in our previous article.

References:

1. https://gi.org/topics/diarrhea-in-children/

2. https://www.hopkinsmedicine.org/health/conditions-and-diseases/diarrhea-in-children

3. http://www.myhealth.gov.my/en/diarrhoea/

4. UpToDate

5. MIMS Malaysia

Written by

Ms Joyce Toh