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Nobody likes to hear about bowel movements. The only exception is the bowel movements of infants – their bowel movements are avidly studied, followed and discussed. Since no two children pass stools of the same colour, consistency and frequency, there is a lot to discuss. Young parents and caregivers have an anxious time trying to differentiate the “normal” from an illness.
Babies float in amniotic fluid in the uterus. Some of it is swallowed, which is why babies pass a black and sticky motion (called meconium) soon after birth. Within a few days the colour changes, gradually becoming the usual golden yellow stool. In 2-3 per cent of newborns as the change in colour occurs around day four there may be frequent watery stools – a “transitional diarrhoea.” This is normal and requires no treatment.
Exclusively breast-fed babies pass soft golden yellow semisolid motions. The frequency varies from once a day to up to 10-12 times a day. As long as the consistency and colour are normal, there is no need to worry. Formula-fed infants have beige stools, which are more solid and occur only once or twice a day.
Breast-fed babies are less likely to develop diarrhoea than formula-fed infants. If breast milk is inadequate and artificial feeding has to be done, a sterilised stainless steel bowl and spoon are safer than a feeding bottle. If bottles and nipples are used, they must be cleaned thoroughly and then sterilised by boiling for 10 minutes.
The signs that signal danger in diarrhoea are:
• Watery motion
• Projectile motion that shoots out at a distance
• Change in colour to green
• Blood or mucous in the stool
• Dehydration. This can be picked up by sunken eyes, depressed fontanel ( the gap in the skull bones at the front of the head), loss of skin turgor, lack of tears and failure to pass urine for 3-4 hours.
• Fever
• Vomiting
Diarrhoea in children may be infective, and be caused by a variety of viruses, and parasites.
Of these, the rotavirus has been proven to cause 35 per cent of the diarrhoeal deaths in children before the age of five. The maximum mortality occurs in children less than a year old.
Diarrhoea may have non-infective causes such as a total or relative lactose or sugar intolerance, allergy to certain foods, fructose in fruit and fruit juices, sorbitol or mannitol in artificially sweetened juices. It may have a surgical cause such as appendicitis or intussusception.
The diarrhoea may also be a manifestation of disease elsewhere in the body, like an infection in the urinary tract. If it lasts for two weeks or more, it may be caused by malabsorption, endocrine abnormalities (especially thyroid), tumours, and pancreatic or liver disease. Investigations have to be done to diagnose the problem accurately.
In any diarrhoea, it is important to prevent dehydration as that is responsible for most fatalities. Fluid loss should be replaced. Children can be given commercially available, correctly reconstituted ORS (oral rehydration solution), salted buttermilk, rice kanjee with salt or watery kitchdi. It is best to avoid fruit juices and aerated cola drinks.
Anti diarrhoeal medications such as loperamide and lomotil, which are available over the counter, should not be given to children. Antibiotics will not work unless there is a bacterial infection; they do not work against viruses. If prescribed, they should be given in adequate doses for the duration prescribed and not discontinued as soon as there is symptomatic improvement. If there is lactose deficiency, stopping milk temporarily, and substituting it with soya milk will help control the diarrhoea.
Chronic diarrhoea or frequent recurrent attacks can result in slight zinc deficiency, which perpetuates the diarrhoea. Zinc supplementation causes a reduction in the frequency of the stools, weight gain and an improvement in general health.
Before preparing food for a child or feeding him or her, you should wash your hands with soap or use a hand sanitizer. The child should also be taught the importance of washing her or his hands before eating.
Children should not return to school for 48 hours (two days) after a diarrhoeal illness.
In India, diarrhoea is responsible for 13-14 per cent of the deaths in children under the age of five. Of this, rotavirus is responsible for 34 per cent of the deaths. Rotavirus infection can be prevented with timely childhood immunisation. The vaccine is given orally. The schedule should be started in the second month for maximum benefit.
Proper sanitation, sewage disposal and safe drinking water are not available in most of India. Until these deficiencies are rectified, bacterial and parasitic diarrhoea will remain a major health problem, especially for children. Of the infective causes, only cholera and rotavirus infection are preventable with immunisation.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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