Diarrhea in children

Dr. Hodan S. Ahmed,

Dept of Pediatrics and Child Health
Amoud Medical School, AU
Introduction
 Passage of loose or watery stools with
increased frequency
 Symptom not a disease
 Rarely life threatening
 Can lead to dehydration and Electrolyte

imbalance
 Consistency, Colour and frequency of bowel

movements varies
 Duration: Acute <2week
Introduction
 Major cause of morbidity and mortality
 Assessing hydration status is a crucial step in

preventing mortality
Pathophysiology

 Intestinal fluid output overwhelms the

absorptive capacity
 Damage to the villous brush border leading

to an osmotic diarrhoea
 Release of toxins leading to secretory

diarrhoea
 Hypo/hypermotility leads to motility

related diarrhoea
 Intestinal inflammation causes

inflammatory
Epidemiology

 Children younger than 5 years experience an

estimated 1.4 billion episodes of diarrhoea
each year
 123 million clinic visits
 9 million hospitalizations
 1.87 million deaths

◦ 98% of these deaths occurring in the developing

world
 Etiology
• Viralinfection
•Rota, Adeno, Noro, Astro
• Bacterial infection

•ETEC, Campylobacter, Salmonella, Shigella

• Parasitic infection

•Amoeba, Giardia, Cryptosporidium

• Drug side effects

•Antibiotics
• Systemic infections

•AOM, Pharyngitis, Pneumonia, UTI

• Rare causes
Clinical Features
 Diarrhea
 Vomiting
 Fever
 Headache
 Abdominal cramps
 Lack of appetite
 Muscle aches
Evaluation
 History and Physical Examination
◦ Rule out non GIT causes
◦ Degree of dehydration
◦ Type of pathogen
 Diagnostic tests
◦ Aetiology
◦ Complications
Assessment of Dehydration
Symptom or Sign No Dehydration Some Dehydration Severe Dehydration

Mental status Alert Restless, irritable Lethargic, unconscious

Thirst Drinks normally Drinks eagerly Drinks poorly

Heart rate Normal Normal to increased Tachycardia

Quality of pulses Normal Normal to decreased Weak or unpalpable

Breathing Normal Normal or fast Deep

Eyes Normal Slightly sunken Deeply sunken

Tears Present Decreased Absent

Mouth and tongue Moist Dry Parched

Skin fold Instant recoil Recoil < 2 seconds Recoil >2 seconds

Capillary refill Normal Prolonged Prolonged or minimal

Extremities Warm Cool Cold, mottled, cyanotic

Urine output Normal Decreased Minimal

MMWR Recomm Rep. 2003;52(RR-16):1-16

WHO Classification - Dehydration
SHOCK Cold hands plus weak pulse+/-
 CRT >3s
 AVPU <A
SEVERE DEHYDRATION Unable to drink/AVPU <A +/-
Sunken eyes
Skin pinch return>2s
SOME DEHYDRATION Able to drink +2 or more of
 Sunken eyes
 Skin pinch return1-2s
 Restless
NO DEHYDRATION  <2 of the above
Investigations

RBS

Stool MCS, Urine MCS

Virology
Haemogram CRP, Blood Culture

UEC CXR, LFTS

Principles of management

• Replace lost water

• Replace lost electrolytes
• Nutrition care
• Manage complications
• AKI/ARF
• Convulsions
• Diaper area care
 
Dietary Recommendation
 No dehydration – Feed or breastfeed normally
 Dehydration – Rehydrate then feed or

breastfeed normally
 Monitor hydration status as you replace fluids
Oral Rehydration Solution
 Safer, less expensive alternative to IV Fluids
 Contains glucose and electrolytes (sodium,

potassium, chloride)
 Does not cure diarrhea, but it does help to

treat the dehydration

 Given in frequent, small amounts over three

to four hours
Medications
 Antibiotics are generally not necessary, but
may be used in specific cases
 Antidiarrheal agents are not recommended
 Antiprotozoals are used specifically
Complications
 Hemolytic Uremic Syndrome
 Lactase deficiency
 AKI/ARF
 Intussusception
 Circulatory collapse
Consider Admission
 Bloody diarrhoea
 If an infant refuses to eat or drink anything

for more than a few hours

 Severe dehydration
 Abdominal pain that comes and goes or is

severe
 Behaviour changes, including lethargy or

decreased responsiveness
Preventing spread
 Hand washing
 Alcohol based rubs
 Using diapers
 Isolation
 Vaccination – Rotavirus

◦ Rotateq®
◦ Rotarix®
Summary
 Diarrhea is common in young children
 A common cause of morbidity and mortality
 Assessment of hydration status prevents

mortality
 Vaccination is helpful in prevention of

Rotavirus diarrhea
?