Acute diarrhea in children

Diarrhea refers to the passage of loose or watery stools or an increased frequency of stools for the child and occurs at some point in the life of nearly every child. Diarrhea is not a disease but is a symptom of a number of illnesses. 
Although diarrhea is common and rarely serious, it is important to understand when to seek help. 
Diarrhea can lead to dehydration, which alters the child's natural balance of water, and to electrolyte (sodium, potassium, chloride) imbalance. 
It can be serious if not treated promptly.

DIARRHEA CAUSES

The most common cause of acute diarrhea is a viral infection. Other causes include bacterial infections, side effects of antibiotics, and infections not related to the gastrointestinal (GI) system. In addition, there are many less common causes of diarrhea.

Viral, bacterial, and parasitic infections are all contagious, and parents/caretakers can assist in preventing spread of the infection. Children are considered contagious for as long as they have diarrhea. However, depending on the microorganism, some children can spread diarrhea even before they develop symptoms, and a minority, with specific types of infections, will continue to spread diarrhea pathogens for weeks, months, or years after their symptoms resolve. Microorganisms causing diarrhea are spread from hand to mouth; hand washing and separating food-handling and feces disposal (eg, not changing diapers in the kitchen) are very important to preventing infection in family and other contacts. 

Bacterial infection — Bacterial infection is sometimes hard to distinguish from viral infection. Bacterial infections are more common in locations where there is unsafe drinking water and poor handling of sewage. Persistent high fever (higher than 40°C or 104°F) and diarrhea that is bloody or contains mucus are more common with bacterial diarrhea. Most children with bacterial infection do not require antibiotics and will improve with time and supportive measures. However, treatment may be necessary in certain situations.

Viral infection — Viral infection is the leading cause of diarrhea in children and is seen most commonly in the winter months in temperate climates. Symptoms of viral infection can include fever (temperature higher than 38°C or 100.4°F), watery diarrhea, vomiting, abdominal cramps, lack of appetite, headache, and muscle aches.

Viral infection usually begins 12 hours to 5 days after exposure and resolves within three to seven days. No specific treatment is available for viral causes of diarrhea. Children with diarrhea from viral infections are best treated with supportive measures (oral rehydration solution; age-appropriate diet, limiting foods high in fat and simple sugars; and rest). Vomiting is the predominant feature of gastroenteritis caused by Norovirus, and medicines to prevent vomiting may be prescribed to assist the child with oral rehydration.

Antibiotic-associated diarrhea — A number of antibiotics can cause diarrhea in both children and adults. The diarrhea is usually mild and typically does not cause dehydration or weight loss. In most cases, antibiotics should not be stopped and the child's diet does not need to be changed. The diarrhea usually resolves one to two days after antibiotics are finished. Contact a health care provider if a child on antibiotics has diarrhea that is severe, contains blood, or does not resolve after the antibiotic is stopped.

Oral rehydration therapy — Oral rehydration therapy (ORT) was developed as a safer, less expensive, and easier alternative to intravenous fluids. Oral rehydration solution (ORS) contains glucose (a sugar) and electrolytes (sodium, potassium, chloride) that are lost in children with vomiting and diarrhea. Various rehydration solutions are available. Parents should check with a health care provider to determine which solution is preferred. A child who is moderately or severely dehydrated needs to be evaluated by a health care provider. If a child refuses to accept ORS because of vomiting and/or becomes moderately to severely dehydrated, as indicated by decreased urination (>6 hours since passing most recent urine), lethargy, or other features, the child requires professional evaluation and treatment.

Parents should first measure out the total amount to be given with a standardized medicine syringe or measuring cup or spoon, rather than a regular cup or spoon.

●A total volume of 5 teaspoons per pound, or 50 milliliters per kilogram, should be given over four hours . For a 20 pound child, this would equal 100 teaspoons; for a 9 kg child, this would equal 450 milliliters.

●The fluid can be given by teaspoonfuls or oral syringe (approximately equal to 5 milliliters each) every one to two minutes, or as tolerated.

●After the total amount has been given, a normal diet can be resumed.

Medications — Medications such as antibiotics and antidiarrheal agents are generally not necessary and could be harmful for infants or children with diarrhea. Rarely, antibiotics may be used in cases of bacterial infection when a specific cause of the diarrhea has been found or is strongly suspected, particularly after recent travel. Inappropriate use of antibiotics will not improve diarrhea. Furthermore, antibiotics can cause side effects and lead to development of antibiotic resistance.

Antidiarrheal agents (including Imodium, Pepto-Bismol, and Kaopectate) are not recommended for infants or children, since the benefits do not outweigh the risks. One risk of using an antidiarrheal agent is that it could mask worsening symptoms and delay treatment.

Antibiotic treatment — Usually an oral antibiotic (metronidazole, vancomycin, or fidaxomicin) is used to treat people who are infected with C. difficile. It is important to take each dose of the antibiotic on time and to finish the entire course of treatment (usually 10 to 14 days).