Diarrhea in children can be caused by physiological factors (errors in nutrition, stress) or pathological causes, which include intestinal infections, food allergies, inflammatory and drug-induced intestinal damage. To diagnose the etiological factors of the disease, ultrasound and X-ray imaging of the gastrointestinal tract, a coprogram and bacteriological examination of feces, general clinical and serological blood tests are performed. Treatment of diarrhea involves a diet, adequate oral or parenteral rehydration, etiopathogenetic therapy (enterosorbents, antibiotics, probiotics).
Causes of diarrhea in children
Frequent liquid bowel movements caused by damage to the gastrointestinal tract should not be confused with normal feces of the newborn and infancy period. Infants have pasty or runny stools with a slight sour smell if they are breastfed, and denser and more viscous feces when feeding mixtures. The physiological frequency of defecation in newborns is up to 8 times a day, which does not apply to the concept of “diarrhea”.
Short-term diarrhea occurs with errors in the diet — the simultaneous use of a large amount of sweets, fatty or junk food. In infants, stomach upset occurs when transferring to another mixture or when introducing complementary foods. The symptom goes away in a couple of days and is not accompanied by a general deterioration in well-being. Sometimes diarrhea in children begins with severe stress, but after eliminating the provoking factor, it immediately disappears.
This is the most common cause of stool disorders in children, which is detected in all age groups, but poses the greatest threat to babies under 5 years old. Infectious diarrhea is characterized by an acute sudden onset, the presence of other signs of poisoning — nausea and vomiting, abdominal pain, rumbling and flatulence. According to the etiological principle , intestinal infections are divided into the following groups:
- Viral. Rotaviruses, noroviruses, enteroviruses are the main causes of diarrhea in pediatric practice. They cause loose stools, in which mucus impurities are noticeable, with a frequency of up to 15-20 times per day. Sometimes, during defecation, watery discharge with a fecal odor is observed, which indicates a severe secretory form of diarrhea.
- Bacterial. With salmonellosis, liquid fetid feces of green color are released, with escherichiosis — bright yellow or orange bowel movements, with shigellosis, defecation occurs with a meager volume of mucus with an admixture of blood in the type of “rectal spit”. Cholera is characterized by watery bowel movements in the form of “rice broth”.
- Protozoan. Pediatricians periodically encounter giardiasis, which proceeds as a typical enteritis or enterocolitis. Less often, children develop amoebiasis, for which diarrhea is pathognomonic “raspberry jelly” – mucous feces with a large number of blood veins.
Allergic enterocolitis in children is manifested by a liquid mucous stool, in which food particles may be present. With a severe form of the disease, an admixture of blood appears in the feces. The intensity of the symptom depends on the amount of allergen eaten and the type of hypersensitivity reaction – diarrhea can occur in the interval from several hours to several days from the moment of consumption of the allergen. It is combined with respiratory and skin symptoms.
Chronic gastrointestinal diseases
Prolonged diarrhea lasting more than 14 days or occurring with periods of exacerbation and remission is observed in patients with gastroenterological profile. It is more typical for school-age children, mainly associated with non-infectious inflammatory lesions of the intestine and other digestive organs. This group of pathologies includes:
- Congenital disorders. Prolonged and repeated diarrhea develops in children suffering from celiac disease, disaccharidase deficiency. Typically, the deterioration of the patient’s condition after taking the appropriate products. During defecation, abundant mushy or liquid fetid masses are released, there may be undigested food particles in the stool.
- Somatic diseases. Periodic episodes of diarrhea occur with inadequate diet and insufficient drug control of chronic pancreatitis, cholecystitis, hepatitis. Exacerbation occurs after the use of prohibited products. Loose stools are accompanied by pain in the projection of the affected organ, nausea, vomiting.
- Inflammatory bowel pathologies. With Crohn’s disease, the child complains of multiple liquid bowel movements, severe abdominal pain. Sometimes, at the time of defecation, profuse bleeding opens, scarlet veins or dark blood clots appear in the feces. With nonspecific ulcerative colitis, diarrhea is scanty, blood impurities are visible in the bowel movements.
Acute appendicitis in pediatric surgery can occur under the guise of food toxicoinfection. The child has multiple liquid stools without pathological impurities, and this distinguishes the clinical picture of inflammation of the appendix from the “adult” version. Diarrhea is accompanied by refusal to eat, nausea and vomiting, abdominal pain. At the same time, pathognomonic physical symptoms and protective muscle tension are expressed insignificantly.
Complications of pharmacotherapy
In modern pediatrics, antibiotic-associated diarrhea occurs, and its frequency is maximal in children of the first years of life, which is associated with the inferiority of the intestinal microflora. Usually, the symptoms of gastrointestinal disorders are provoked by treatment with cephalosporins, tetracyclines, lincosamides and macrolides. The child has stool up to 10-15 times a day. Fecal masses are liquid or foamy, fetid, with a greenish tinge.
During the examination, the pediatrician carefully collects anamnesis, asks if there were any patients with similar symptoms in the family or in an organized children’s team. In order to exclude acute surgical pathology, to assess the nutritional status, the degree of dehydration, a physical examination is performed. A number of diagnostic methods are used to determine the cause of diarrhea:
- Ultrasound of the abdominal cavity. Sonography is a fast and non-invasive method that allows you to exclude urgent surgical conditions and study the features of the structure of the gastrointestinal tract. During the examination, the doctor may detect chronic inflammatory processes, congenital malformations, signs of damage to the liver, pancreas and other organs.
- Radiography of the gastrointestinal tract. With chronic diarrhea, a gastroenterologist is interested in the condition of the walls of the stomach and intestines, so he prescribes X-rays with contrasting barium suspension. Irrigation helps to exclude colon damage.
- Stool tests. Typical deviations in the coprogram: the presence of undigested food particles, striated muscle fibers, increased mucus and leukocytes. Back-seeding of bowel movements is performed to exclude bacterial intestinal infections. Viral pathogens are identified using stool PCR.
- Blood tests. Clinical and biochemical analyses are needed to assess the general condition of the child, diagnose the presence and degree of dehydration. Serological reactions are used to identify infectious pathogens in severe course and generalization of the disease.
Treatment of diarrhea in children
Help before diagnosis
If a child has diarrhea, he should be watered regularly to prevent exicosis. For these purposes, slightly salted boiled water, dried fruit compote, weak herbal tea are suitable. The liquid is given in small portions (1-2 teaspoons) every 5-10 minutes. After liquid defecation, 50-200 ml of water should be given, depending on age and weight. If you categorically refuse to eat, you can not force the child to eat.
To quickly remove toxins from the body, enterosorbents can be used. Self-prescribe treatment with antibiotics and other medications is prohibited. If a child’s diarrhea is accompanied by blood impurities in the feces, complete rejection of water and food, a sharp increase in temperature, you need to seek emergency medical help. Another alarming sign is sharp abdominal pain, especially in the right half of the abdomen, which may indicate appendicitis.
Children with a satisfactory general condition are treated on an outpatient basis. The remaining categories of patients are subject to hospitalization in an infectious, gastroenterological or surgical hospital. Since acute infectious diarrhea is most common, the main principle of therapy is adequate rehydration. Accordingly , the severity of exicosis is carried out according to three schemes:
- Plan A. In the absence of dehydration or mild dehydration, oral rehydration with water or special solutions of oral rehydration salt (ORS) is prescribed. The child is given liquid regularly in small sips, after defecation he should drink at least half a glass of water. Infants on natural feeding are recommended to increase the frequency of application to the breast.
- Plan B. With moderate exicosis, an increased oral water load is provided in the first 4 hours in order to eliminate pathological losses with frequent defecation. After improving well-being, they switch to standard supportive rehydration, as in plan A.
- Plan C. Severe exicosis requires immediate initiation of intravenous injections of saline solutions. Their volume and electrolyte composition are calculated based on the patient’s weight and the results of blood tests. After removing the child from a serious condition, an oral method of rehydration is used.
Diet plays an important role. With acute diarrhea in the first days, a gentle diet is necessary — mashed porridges, slimy soups, dry biscuits, a small amount of stewed vegetables. Next, the diet is expanded with lean meat, fermented milk products. With diarrhea on the background of cholecystitis or pancreatitis, the menu is made up, taking into account the underlying disease. Stool disorders due to celiac disease require strict adherence to a gluten-free diet.
Medical treatment is selected taking into account the cause of diarrhea. In mild and moderate acute intestinal infections, etiotropic treatment is not carried out. However, severe bacterial infections with hemocolitis are an absolute indication for antibiotic therapy. Be sure to prescribe antibiotics to children suffering from primary and secondary immunodeficiency, severe concomitant pathologies.
Enterosorbents, antiemetic and antidiarrheal drugs (according to strict indications!) make up the pathogenetic treatment of diarrheal syndrome. Probiotics in combination with prebiotics are recommended for children to improve the intestinal microflora. Medications reduce the duration of stool disorders, accelerate the restoration of digestive tract functions in children. In case of chronic intestinal pathologies, a gastroenterologist should reconsider the therapy regimen.
Emergency care of pediatric surgeons is required for acute appendicitis. Planned surgical interventions are resorted to in children with a severe and often recurrent course of inflammatory bowel diseases —IBD) – Crohn’s disease and ulcerative colitis. Surgical treatment is prescribed to stop bleeding, excision of the ulcerated part of the intestine, segmental resection with the imposition of an anastomosis.