Diarrhoea

What Is Diarrhoeal Disease?
This is an inflammation of the stomach and intestines that causes diarrhea, vomiting, nausea and other symptoms of digestive upset. The most common causes of diarrhoeal disease in children are viruses, bacteria (food poisoning), and intestinal parasites.
• Viral diarrhoeal disease – In otherwise healthy children, viral infections of the digestive tract often are responsible for mild episodes of diarrhoeal disease. The most common cause of viral diarrhoeal disease in children are rotaviruses, adenoviruses, enteroviruses astroviruses and Norwalk-like virus (norovirus).
All of these viruses tend to spread on hands that have touched either an infected person’s stool or surfaces contaminated with infected stool.
• Bacterial diarrhoeal disease (food poisoning) – Food that has not been prepared or stored properly can grow bacteria on its surface, and these bacteria sometimes produce irritating chemicals called toxins. If a child eats the germ-filled food, symptoms of diarrhoeal disease are triggered either by the bacteria themselves or by their irritating byproducts
• Intestinal parasites – Intestinal parasites can be spread to children on dirty hands, on the soiled surfaces of toys and bathroom fixtures, and in contaminated water or food.

Symptoms
In children, symptoms of diarrhoeal disease include:
• Diarrhea
• Abdominal pain
• Cramps
• Vomiting
• Irritability (fussiness)
• Poor appetite
Some children also have a low-grade fever or complain of a headache.

Diagnosis
To help make a diagnosis, the doctor may ask the following questions:
• Has your child been exposed to a person with diarrhea, especially in a day-care center or preschool setting?
• Has your child played with a pet that is ill with gastrointestinal symptoms such as diarrhea?
• Has your child recently traveled to a location where the drinking water may be contaminated?
• Did your child recently drink unpasteurized milk or juice, eat unwashed vegetables, or eat food that was left standing at room temperature for prolonged periods?
To help assess your child’s risk of dehydration, the doctor also may ask questions related to your child’s fluid intake and fluid losses over the past several hours. Specifically, the doctor may want to know about:
• The number of episodes of vomiting
• Whether your child can drink fluids without vomiting
• The number of bowel movements
• Whether your child’s bowel movements are semi-solid, mildly “loose” or very watery
• How often your child has been passing urine, often measured as the number of wet diapers within the last 8 to 12 hours, or the number of bathroom trips to pass urine
In most cases, a doctor diagnoses diarrhoeal disease and dehydration based on the symptoms, history of exposure to someone with diarrhea, spoiled food or impure water, and the results of a physical examination. Special tests rarely are needed unless your child has unusually severe symptoms, such as:
• A high fever or fever that lasts longer than several days
• Severe, watery diarrhea
• Their skin color and whites of the eyes turn yellow
• Signs of significant dehydration, a sudden drop in weight
• Unusual sleepiness or lack of body movement
• Stool that contains blood or pus
• Diarrhea that lasts more than two weeks
If more tests are needed, they may include blood tests to check for evidence of infection and dehydration, as well as other laboratory tests, such as a stool culture.

Expected Duration
In children, most cases of mild, uncomplicated diarrhoeal disease last about three to five days. However, even after most symptoms go away, your child may continue to have occasional loose stools for more than a week.

Prevention
• Being up-to-date with your child’s vaccines can help reach that goal
• Wash your hands frequently with soap and water, especially after using the toilet, after changing diapers and after caring for a child with diarrhea. An alcohol-based hand sanitizer should NOT be used alone.
• Wash your hands with soap and water before and after preparing food, especially after handling raw meat. An alcohol-based hand sanitizer should NOT be used alone.
• Cook food thoroughly before you serve it to your family, and refrigerate leftovers within two hours.
• Make sure you do not transfer cooked foods onto unwashed plates that held raw food.
• Wash kitchen countertops and utensils thoroughly after they have been used to prepare meat.
• Never drink unpasteurized milk or untreated water.
• If you travel to an area where sanitation is poor, make sure that your family drinks only bottled water or soft drinks, and that they don’t eat ice, uncooked vegetables or fruit that they haven’t peeled themselves.
If your child attends day care, insist that all day-care personnel wash their hands frequently, especially after changing soiled diapers and before preparing food.

Treatment
In otherwise healthy children, most cases of mild diarrhoeal disease gradually go away within a few days.
In the meantime, you can try the following suggestions:
• To prevent dehydration, encourage your child to drink plenty of fluids. The doctor may recommend an oral rehydration solution (ORS)
• If your child is too nauseated to drink his or her normal intake of fluids at one sitting, try offering several smaller sips more frequently over a longer period.
• Once your child’s vomiting subsides, resume a normal diet gradually while continuing the oral rehydration solution.
• Temporarily avoid fatty foods and sugary beverages. If your child is breastfeeding, this should continue.
• Do not give your child anti-diarrhea medicines. This can make it harder to know when your child is actually getting sicker and needs more attention.
If your child is showing signs of significant dehydration and cannot drink fluids, your doctor will admit him or her to the hospital to receive fluids intravenously (through a vein). Your child may also need other medicines depending on the doctor’s assessment

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