Paediatric Diarrhoea

Paediatric diarrhoea can be classified based on its duration and cause:

• Acute diarrhoea lasts less than 14 days and is usually caused by infections, such as viruses, bacteria, or parasites.
• Persistent diarrhoea lasts 14–30 days and may be caused by prolonged infections or underlying conditions.
• Chronic diarrhoea lasts for more than 30 days, such as food tolerances, inflammatory bowel disease, or celiac disease.

The symptoms of diarrhoea vary depending on the cause and severity.

• Frequent loose stools are the primary symptom of diarrhoea and are often accompanied by cramping.
• Abdominal pain and cramping are common complaints associated with diarrhoea.
• Fever and vomiting may occur in cases of viral or bacterial infection.
• Dehydration is a critical concern and can appear as dry mouth, sunken eyes, decreased urination, lethargy, and, in severe cases, shock.

Paediatric diarrhoea may result from infectious and non-infectious factors:

• Viral infections, such as rotavirus and norovirus infections, are the most common cause of acute diarrhoea in children.
• Bacterial infections, including those caused by Escherichia coli, Salmonella, and Shigella, can cause severe diarrhoea and are often associated with severe symptoms.
• Parasitic infections: Amoebiasis and other parasitic infections, though less common, can occur in regions with poor sanitation.
• Non-infectious causes of paediatric diarrhoea include food allergies, lactose intolerance, inflammatory bowel disease (IBD), and celiac disease.
• Antibiotic use may trigger antibiotic-associated diarrhoea, especially after prolonged broad-spectrum antibiotic use.

Accurate diagnosis of paediatric diarrhoea in a hospital setting involves:

• Medical history and physical examination to assess stool frequency, consistency, duration, and associated symptoms.
• Stool analysis including microscopy, culture, and sensitivity, parasite detection, and viral PCR tests.
• Blood tests: Complete blood count (CBC), electrolytes, renal function tests, and inflammation markers are common tests prescribed to assess the cause of diarrhoea and determine its subsequent treatment.
• Imaging and endoscopy: Imaging and endoscopy are used in cases of chronic diarrhoea or when an underlying pathology (such as IBD) is suspected.

Management focuses on rehydration, addressing the cause, and preventing complications:

• Oral rehydration therapy (ORT) is the first-line of treatment for mild to moderate dehydration and can be administered at home or in healthcare settings.
• Intravenous (IV) rehydration is required for severe dehydration or when ORT is not possible. Tertiary care hospitals provide IV fluids and monitor critically ill children.

Specific treatments for diarrhoea include:

• Viral diarrhoea is usually managed with supportive care, including hydration and dietary adjustments.
• Bacterial diarrhoea may require antibiotics to be used judiciously to avoid resistance and complications.
• Parasitic infections are treated with antiparasitic medications.
• Non-infectious causes are managed according to the underlying condition, such as dietary modifications for lactose intolerance or immunosuppressive therapy for IBD.
• Nutritional support is essential in paediatric diarrhoea management. Continued feeding or breastfeeding is encouraged to maintain nutritional status and promote recovery.

Seek medical attention urgently if a child:

• Shows signs of severe dehydration, including very little urine, sunken eyes, lethargy, or dry mouth.
• Experiences persistent vomiting or bloody diarrhoea.
• Has a high fever or appears unusually unwell.
• Has diarrhoea lasting more than a few days without improvement.
   

Diarrhoea prevention measures in children focus on reducing exposure to pathogens and improving sanitation.

• Vaccination with the rotavirus vaccine significantly lowers the risk of viral gastroenteritis.
• Hygiene practices such as handwashing, safe food preparation, and clean drinking water reduce transmission.
• Nutritional support helps prevent malnutrition and support recovery during illness.

Children with severe, persistent, or recurrent diarrhoea should be evaluated by a paediatrician. In cases of chronic or complex diarrhoea, referral to a paediatric gastroenterologist may be necessary. Hospital care is essential for children showing signs of severe dehydration or systemic illness.