Acute diarrhea in children

by Abbas Jahangir · June 16, 2024

Acute infectious gastroenteritis is the most common cause of diarrhea in children. Infants or young children up to the age of three often get sick from it. With diarrhea , the stool smells unpleasant and there are more frequent and rarer bowel movements than usual.

We talk about diarrhea in the following circumstances:

infants: more than five loose stools per day,
older children: more than three loose stools per day .

In our latitudes and longitudes, more than 90% of diarrhea occurs in an acute form (the duration of illness is a maximum of two weeks). The cause is mostly intestinal infections . In these cases, we speak of acute infectious inflammation of the stomach and intestines (acute infectious gastroenteritis ).

Symptoms

After an incubation period of 1–7 days, there is usually watery diarrhea accompanied by loss of appetite , nausea, vomiting , fever , abdominal pain and headache, or flu- like symptoms . Stool with blood is considered a warning signal – in these cases you should see a pediatrician immediately .

Other difficulties depend primarily on the extent of fluid and electrolyte loss . With adequate fluid supplementation, vomiting usually subsides within two days, and diarrhea within 2–7 days.

Causes

Acute diseases with diarrhea are almost always caused by infections with various agents:

Viruses : about 40% of acute gastroenteritis in the first years of life are caused by rotaviruses . Rare causative agents include adenoviruses , noroviruses and enteroviruses .
Bacteria : in about 20% of sick children, bacteria (mainly Campylobacter jejuni , Yersinia , Salmonella , Shigella , pathogenic Escherichia coli or Clostridium difficile ) are found in the stool.
Parasites : Giardia lamblia , Cryptosporidium , Entamoeba and others are the cause in less than 5% of cases.

The infection is transmitted mostly through hands, food, drinking water or used objects contaminated with faeces. Food-borne bacterial infection occurs mainly after ingestion of undercooked meat (Yersinia, Campylobacter, Salmonella) and raw egg dishes (Salmonella) . Other common sources of infection are raw milk or direct contact with infected cattle. Rarely, diarrhea can also occur as a result of overeating, allergies or poisoning.

What can parents do?

Assess the child’s hydration status:

Elevation of part of the skin , e.g. on the abdominal wall or on the back of the hand, between the thumb and forefinger. If the child is well hydrated, the skin will immediately return to its original position after the pressure is released. If the skin returns to its original state more slowly (typically a few seconds), this may be a sign of dehydration .
Assessment of the hydration of the mucous membranes , e.g. the eyelid , tongue or mouth: if the mucous membranes are dry, this indicates considerable dehydration. A quick reaction is necessary, especially for infants or young children.

One of the often successful first steps is the so-called tea break (recommended only for older children!): for this purpose, the absolute omission of food is observed for a period of five to six hours, i.e. children are not allowed to eat anything. During this time, they only take sufficient amounts of unsweetened black tea. It is crucial that the liquid is taken in sips, not in large quantities at once.

Diagnosis

When talking to the parents, the doctor will mainly ask about the following:

onset, consistency and frequency of diarrhoea, possibly bloody stools,
onset and frequency of vomiting,
fever,
fluid and food intake in the past 24 hours,
urine production ,
recent stays abroad or hospital,
consumption of antibiotics and other drugs ,
diseases occurring in the surroundings,
basic illness of the child: mainly immune defects, metabolic and intestinal diseases,
recently completed transitions to a different diet,
risk factors for intestinal infections, such as consumption of raw milk or raw meat.

Subsequently, the child is examined and weighed, and the extent of dehydration is then assessed. In uncomplicated gastroenteritis, proof of the causative agent is not necessary. However, in the case of severe courses, possibly concomitant diseases, short-term stays in risky countries or in the case of infants younger than three months, these proofs should be made. Alternatively, blood and urine tests or imaging methods such as ultrasound or endoscopy are necessary .

Therapy

In the foreground is replenishing the loss of fluids and electrolytes ( ions ). Furthermore, children should receive a balanced diet if possible , or switch to food proportionate to their age. Only in severe cases is medical treatment necessary .

Intake of fluids and electrolytes (ions):

If it is not dehydration, only normal losses must be replenished. For this, e.g. tea with a little salt and sugar is suitable , but also ready-made tea mixtures from the pharmacy.
Infants and children with mild to moderate dehydration can in most cases be successfully rehydrated using special drinking regimens ( oral rehydration solutions, ORR). This treatment can take place at home, on an outpatient basis in a doctor’s office or in a hospital, after being instructed by a doctor.
Children affected by very severe diarrhea, i.e. with significant dehydration, disturbed perception and circulatory shock, they must be treated in a hospital with intensive care . Children under the age of five should not be given home-made juices or mixed drinks with salt and sugar, as these solutions often have different compositions. In general, drinks such as Coca Cola and juices are unsuitable for rehydration.

Diet:

Breastfed babies should continue to be breastfed during acute diarrhea. If the baby is thirsty more often than usual due to fluid loss, he should be put to the breast more often. Breastfeeding should be continued even if oral rehydration solution (ORR) is administered.
During and shortly after diarrhea, transitions to a different diet should be avoided.
Infants who are bottle-fed are given undiluted infant formula.
It should be left for infants who receive hypoallergenic infant formula.
Young and older children with mild to moderate dehydration should receive their usual diet no later than four to six hours after starting rehydration. It is best to start with defatted pasta, potato or rice dishes, or oatmeal and semolina porridge, salty bars , bread or soups (e.g. potato, carrot). If these foods do not induce vomiting, one can switch to a normal diet.
Juices with a high proportion of fructose , sucrose or sorbitol (e.g. apple or pear) should be avoided .

Medicines:

Medicinal treatment is only rarely necessary for uncomplicated gastroenteritis. However, some drugs can demonstrably shorten the duration of diarrhea, e.g. racecadotril or probiotics (primarily Lactobacillus rhamnosus GG). The use of antibiotics is also meaningful only in exceptional cases.

Prevention

The following measures are recommended to prevent intestinal infections:

breastfeeding (even partial),
compliance with hygiene measures, especially hand washing (mainly before preparing meals, or when handling food, before breastfeeding, after visiting the toilet or after changing diapers),
avoiding undercooked meat, foods made from raw eggs (Salmonella) or raw milk,
avoiding direct contact with infected livestock,
vaccination : vaccination against rotavirus is recommended for infants and young children (see the article Rotavirus diarrhea ).

When to go to the doctor immediately?

In most cases, acute diarrhea will disappear without any problems within a few days if the above measures are followed or with the therapy recommended by the pediatrician.

You should contact your pediatrician immediately if you notice any of the following symptoms:

child refuses to drink
the child suffers from diarrhea and vomiting at the same time,
stools with blood admixture appear,
the child has a high fever and/or abdominal pain at the same time,
the baby’s abdominal wall is completely stretched,
diarrhea persists for 6 hours in infants, 12 hours in young children and 18 hours in school-aged children.