How to manage diarrhea: a further explanation

I’ve already briefly given an explanation about the management of diarrhea in child, particularly in baby, according to American Academy of Pediatrics. In this particular posting, I want to make a deeper explanation on how to manage diarrhea in child, specifically in baby. Diarrhea causes a messy and unpleasant condition for both parents and baby, because it can lead to “bowel accidents”. Therefore, it is important to try to manage the diarrhea’s symptoms if at all possible.

Before trying to manage diarrhea, you have to know the several conditions which may lead to the increasing of diarrhea risk. Those are:

1. having an infection


2. having an abdominal radiation


3. taking medications that make the bowel more active, eg: some chemotherapy, antibiotics, antacids


4. stressing


5. eating some kinds of food or nutritional supplements or is using some types of tube feedings


6. constipating and the waste has formed a hard clump (fecal impaction). This creates a block in the bowel and some watery stool leaks around it all the time


7. having a worsening disease that affects how the bowel works

In order to prevent diarrhea you can check your baby with your doctor or nurse to see if any of your baby’s medications or treatments may cause diarrhea, because sometimes small changes can prevent it from happening. You can also consult with the nurse or dietitian about what foods can be consumed to avoid if diarrhea is a risk because of your child’s condition or treatment.

Here are the following you have to avoid in case of diarrhea:

1. Try not to eat greasy, fried, spicy, fats, caffeine, nicotine, or very sweet foods.


2. Some people with diarrhea may begin to have trouble digesting milk. If this is a problem for you, try limiting milk and milk products to no more than 2 cups a day during this time. If limiting milk products does not relieve diarrhea, gas, or bloating, switch to milk and milk products that have the lactose removed. It suggests that you having lactose intolerance. Lactaid and Dairy-Ease are examples of two such products.


3. Avoid drinks and foods that cause gas, such as carbonated drinks, and gas-forming vegetables. (You may drink carbonated beverages if you leave them open for at least 10 minutes before drinking).


4. Limit use of sugar-free gums and candies made with sorbitol. Foods that have sorbitol can cause diarrhea, gas, and bloating.


5. Avoid grape, prune, or full strength apple juice (apple contains sorbitol). These make the diarrhea worse.

Early diarrhea management in the right away.

You can manage the diarrhea by knowing its causal factor then trying to address the treatment to the cause of diarrhea.

1. Infection: think about whether it will benefit the child to treat the infection


2. Medication: consider reducing the dose or changing the drug. Check with your doctor or nurse about this.


3. Foods/nutritional supplements: stop or dilute foods or nutritional supplements that cause diarrhea.


4. Laxatives: speak with your doctor or nurse about stopping or reducing the dose. (If the diarrhea is caused by constipation, your doctor may want you to continue giving laxatives.)

As noted on my previous posting that the main goal of the diarrhea treatment is to keep your baby from getting dehydrated since baby had lost liquids in a significant number. Therefore, we have to replace lost fluids, salt and minerals without irritating the bowel further.

1. Don’t give any formula, tube feedings, milk, or solid food for 24 hours unless your doctor advises otherwise.


2. Offer (or if tube feeding, try giving) small amounts of any of the following clear fluids often.
   
   
   
   1. If your child is under 2 years: Pedialyte® or Lytren® or Gastrolyte® (Buy these at the pharmacy).
   
   
   2. If your child is older than 2 years: same as above or Gatorade®.
   
   


3. After about 24 hours, if the diarrhea is less, offer small amounts of soft foods such as apple sauce, mashed banana, rice cereal, crackers, or Arrowroot® biscuits.


4. Give a baby his regular formula, but start with it diluted to half the usual strength. Dilute with boiled water.


5. Encourage as much drink as possible. If you are tube feeding your child, give half strength feeding at a slower rate.


6. After another 24 hours, if the stools are more solid, start full strength formula or, for older children, slowly go back to a normal diet. Include a little milk and milk products. If you are tube feeding, go back to the regular formula..

Followings are the other things in managing diarrhea in your baby:

1. In order to manage diarrhea in baby you have to avoid on giving them antidiarrheal medicine, such as Kaopectate®, Kaocon®, Lomotil®, Imodium®, Diban®, Donnagel®, Mitrolan®, or Pomalin®, because it can cause problem in children under 3 years.


2. Keeping the skin clean. Wash the area gently with mild soap and water after every stool.


3. Check often for signs of infection - redness, swelling, pain. Ask a health professional for help if you notice sores or rashes around the anus. Use a mild lotion/cream/petroleum jelly to protect the skin (refer to “Personal Hygiene” for more suggestions).


4. According to the research conducted by Subijanto, et al. the administration of high-lactose Bifidobacterium bifidum-containing formula positively influences the rate of recovery in acute pediatric diarrhea.

You have to get professional help when appropriate. Call your doctor or nurse during the day if:

1. your child’s diarrhea is not getting any less after 24 hours on clear fluids


2. your child has a stomach ache for more than 2 hours


3. your child is very irritable and very drowsy


4. your child’s lips, tongue or mouth lining is very dry


5. the diarrhea does not clear up in 5 days

Regards and stay healthy

Precious source :
www.cw.bc.ca
American Academy of Pediatrics
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Diarrhea related to vitamin K deficiency

The reduction in number of intestinal bacteria is profoundly influence the occurrence of diarrhea. It is related to the concentration of vitamin K in our body since the intestinal bacteria play a significant role in synthesizing vitamin K. Deficiency of vitamin K in baby with diarrhea is probably more frequent and more severe in developing countries due to the possibility in increasing of malnutrition and lack of vitamin K supplementation at birth. Deficiency of vitamin K does not occur in healthy babies given a normal diet. Those are several cause of vitamin K deficiency, such as insufficient intake, failure of synthesis due to a shift in the bacterial flora caused by diarrhea or administration of antibiotics, and decreased absorption from the intestinal tract.

According to Bern C, et al. (1992), there is a relationship between diarrheal illness and vitamin K deficiency. In term of vitamin K is able to prevent acute and intractable diarrhea, vitamin K has an important role in blood coagulation, so it can prevent bleeding in diarrhea baby. In this case, vitamin K influences the improvement of prothrombin time and activated prothrombin time and also influences the increasing of coagulation factors.

Now, it is known that vitamin K can prevent the bleeding in baby with diarrhea. But, according to Shearer, et al., the level of vitamin K in human milk is low. Also, Branchet, et al., reported that vitamin K deficiency is more frequent among breastfed infants who have diarrhea. Those are indicate that whether baby or mother who are breastfed their babies should consume vitamin K supplement to fulfill the baby’s needs on vitamin K.

Vitamin K is found chiefly in leafy green vegetables such as spinach, swiss chard, and Brassica (e.g.cabbage, kale, cauliflower, broccoli, andbrussel sprouts); some fruits such as avocado and kiwifruit are also high in Vitamin K. By way of reference, two tablespoons of parsley contain 153% of the recommended daily amount of vitamin K. Some vegetable oils, notably soybean, contain vitamin K, but at levels that would require relatively large caloric consumption to meet the USDA recommended levels. Phylloquinone (vitamin K1) is the major dietary form of vitamin K. Menaquinone-4 and Menaquinone-7 (vitamin K2) are found in meat, eggs, dairy andnatto. MK-4 is synthesized by animal tissues, the rest (mainly MK-7) are synthesized by bacteria during fermentation. In natto 0% of vitamin K is from MK-4 and in cheese 2-7%. (Wikipedia)

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Breastfeeding and diarrhea

Breastfeeding is certainly provided many health benefits to baby. It is surely able to increase immunity to baby by improving the growth of good bacteria in human intestine. Besides, breastfeeding giving the best protection for baby from vary pathogens that may harmful and dangerous to baby’s health. Therefore, every parent should realize this particular thing in order to fulfill the baby’s right in getting breast milk from mother.

There’s absolutely nothing wrong by breastfeeding your baby. Event, it will give many advantages for your beloved one, such as preventing and treating diarrhea. There is a data showed that increasing the duration and exclusivity of breastfeeding could save an estimated 1.5 million infants live each year. In fact, up to 55 percent of infant deaths from diarrheal disease and acute respiratory infections may result from inappropriate feeding practices. However, breastfeeding provides infants with protection from many infections, including diarrheal diseases. Breastfeeding also stimulates the development of the infant’s own immune system, improves response to vaccinations, and provides many health-enhancing molecules, enzymes, proteins, and hormones (UNICEF, 1999).

As noted before, breastfeeding is able to increase the immunity since it contains prebiotics which are consumable by intestinal microflora. Consequently, it seriously affected baby’s health, nutritional status, and survival. So when breastfeeding stops, infants are exposed to food-borne germs and lose the protection of breast milk’s anti-infective properties. Therefore, it really important to understand the necessary of food hygiene and safety before and during the introduction of complementary foods, and ensure that infants receive sufficient nutrition to maintain their resistance to infections like those that cause diarrhea.

Dehydration is serious problem that is caused by diarrhea, and also it can occur quickly. Continued breastfeeding during diarrhea, as well as increased feeding after an episode, significantly reduces risk of dehydration, mitigates loss of weight, and promotes increased weight gain. Breastfeeding can also reduce the severity, duration, and negative nutritional consequences of diarrhea. Besides, breastfeeding infants, providing access to clean water, and improving hygiene practices are proven interventions for reducing diarrheal disease.

An integrated strategy that include those practices along with new tools like zinc treatment, improved oral rehydration solution (ORS), and rotavirus vaccines form a comprehensive package of tools to reduce childhood diarrheal disease, particularly in developing countries.

Best regards.



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Diarrhea in Baby: Don't Underestimate

Diarrhea is an important cause of morbidity and mortality in developing countries, especially in infants and young children. Diarrhea is the sudden increase in the frequency and looseness of bowel movements. Diarrhea can be mild to severe. Mild diarrhea is the passage of a few loose or mushy stools. The best indicator of the severity of the diarrhea is its frequency. Green stool points to very rapid passage and moderate to severe diarrhea.

Most diarrhea in children is caused by one of several diarrhea-causing viruses and gets better by itself within a week. Although there can be many causes of diarrhea such as caused by bacteria or parasites, and also can be due to excessive fruit juice or to a food allergy. Diarrhea usually lasts from several days to a week. Most of the time mild diarrhea lasts from 3 to 6 days. Occasionally a baby will have loose stools for several days longer. As long as the child acts well and is taking adequate fluids and food, loose stools are not a great concern.

The main problem of diarrhea is dehydration. Therefore, the main goal of ttreatment is to prevent dehydration by giving enough oral fluids to keep up with the fluids lost in the diarrhea. But, don’t expect a quick return to solid stools since one loose stool can mean nothing.

When will my baby be categorized as a diarrhea sufferer with dehydration? You can know it by observe these following signs:

Signs of mild to moderate dehydration:

1. no urine (or wet diaper) for 8 hours.


2. dry lips.


3. the inside of the mouth is dry or sticky.

Signs of severe dehydration:

1. no tears when crying.


2. the inside of the mouth is very dry (no saliva) .


3. eyes seem sunken.


4. weight loss.


5. listless (has little energy).


6. hard to awaken.


7. confused.


8. weakness (hard to sit up or walk, floppy) .

As I noted above that the main goal of the treatment of diarrhea is to keep your baby from getting dehydrated since baby had lost liquids in a significant number. Following are the treatment guide of diarrhea (American Academy of Pediatrics, 1996):

Mild illness of diarrhea and diet
Most children should continue to eat a normal diet including formula or milk while they have mild diarrhea. Breastfeeding should continue. If your baby seems bloated or gassy after drinking cow’s milk or formula, call your pediatrician to discuss a temporary change in diet. There are not usually necessary special fluid for children with mild illness.

Moderate illness of diarrhea
Children with moderate diarrhea can be cared for easily at home with close supervision, special fluids, and your pediatrician’s advice. Your pediatrician will recommend the amount and length of time that special fluids should be used. Later, a normal diet can be resumed. Some children are not able to tolerate cow’s milk when they have diarrhea and it may be temporarily removed from the diet by your pediatrician. Breastfeeding should continue.

Special fluids for moderate illness
Special fluids have been designed to replace water and salts lost during diarrhea. These are extremely helpful for the home management of mild to moderately severe illness. Do not try to prepare these special fluids yourself. It is too easy to get confused by some of these complex recipes. You could accidentally make a bad fluid for your baby. Use a fluid that is made by one of the reputable manufacturers. The two most widely available products that you will find in nearly every pharmacy are:

1. Pedialyte (Ross Laboratories)


2. Infalyte (Mead Johnson Nutritionals)


3. Other brands of special fluids are available and equally effective.


4. Many drug stores have their own generic brands of special fluids. Ask the pharmacist for assistance.

If a child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again.

Severe illness
If your child develops the warning signs of illness listed on the first page, he or she may require IV fluids in the emergency department for several hours to correct dehydration. Usually hospitalization is not necessary. Immediately seek your pediatrician’s advice for the appropriate care if symptoms of severe illness occur.


Reminder–do's and don'ts

DO

1. Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.


2. Keep your pediatrician informed if there is any significant change in how your child is behaving.


3. Report if your child has blood in his stool.


4. Report if your child develops a high fever (more than 102°F or 39°C).


5. Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give your child foods that do not further upset his or her stomach.


6. Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty.

DON'T

1. Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.


2. Prevent the child from eating if she is hungry.


3. Use boiled milk or other salty broth and soups.


4. Use "anti-diarrhea" medicines unless prescribed by your pediatrician.

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