Diarrhoea refers to loose, watery stools. A person with diarrhoea generally passes more than 3 stools per day. Acute diarrhoea usually lasts for 1-2 days and does not require special treatment. Chronic diarrhoea poses a more serious problem, especially in children and the elderly who run a higher risk of dehydration. Dehydration means that the body lacks sufficient fluid to function properly. Chronic diarrhoea may also be a sign of a chronic disease (NDDIC, 2008).

Causes

Acute diarrhoea is most commonly related to bacterial, viral or parasitic infections. Chronic diarrhoea is often related to a chronic disorder such as irritable bowel disease or inflammatory bowel disease (NDDIC, 2008).

Some of the most common causes of diarrhoea

Bacterial and viral infections

One of the most frequently occurring and concerning causes of diarrhoea in children is known as gastroenteritis, or an inflammation of the stomach and intestines, that causes diarrhoea and vomiting. Gastro may be viral in origin, where it is transmitted through the air or by contact with infected faeces, or when food or drink is contaminated by bacteria. It is also common for children to develop diarrhoea during or after having a cold (Collins, 2003).

Food intolerance and allergy

Intestinal allergies to certain foods, such as cow’s milk, may produce chronic diarrhoea, until the offending allergen is removed from the diet. Other children may develop diarrhoea because their bodies lack the necessary enzymes to digest certain foods, e.g. lactose, the sugar found in milk (Leary, 1990; NDDIC, 2008).

Medication

Diarrhoea is one of the possible reactions to certain medications. In children, this most commonly occurs when they are given an antibiotic to treat infections such as URTI (NDDIC, 2008).

Functional bowel disease

Diarrhoea can be a symptom of IBS (NDDIC, 2008).

Intestinal diseases

Crohn’s disease, ulcerative colitis and inflammatory bowel disease (NDDIC, 2008).

Symptoms

·         abdominal pain

·         bloating

·         cramping

·         nausea

·         an urgent need for the bowels to move

·         sometimes a fever (NDDIC, 2008).

Why and when is diarrhoea potentially dangerous?

The effective functioning of body organs requires a balance between water and electrolytes (body salts and minerals). Electrolytes have several important functions, such as controlling the amount of water in the body and muscle activity. The watery stools produced by diarrhoea may cause your child to lose too many fluids and mineral salts. When your child loses more water and salts than she takes in, a potentially dangerous condition known as dehydration may arise. Babies and infants are particularly at risk as they dehydrate within 1-2 days. A child can die from dehydration within a few days. Therefore, never hesitate to call your doctor if your child has diarrhoea (Leary, 1990; NDDIC, 2008).

Signs of dehydration

·         dry mouth and tongue

·         high fever

·         listlessness or irritability

·         producing no tears when crying or dry eyes

·         a lack of wet nappies for 3 days or more, or little urine output in older children

·         sunken abdomen, eyes or cheeks

·         skin that does not flatten after being pinched, or dry skin

·         drowsiness

·         lethargic behaviour (Leary, 1990; NDDIC, 2008)

Treatment

The primary treatment for diarrhoea in children is rehydration:

·                At the first sign of diarrhoea, stop all solid food, formula and cow’s milk, and resume a liquid diet. DO NOT stop breast feeding.

·                Weigh your baby with his clothes off; if he is not losing weight, he is not dehydrating.

·                The best way to give your baby or child extra fluids is by means of an oral rehydrating solution. Rehydrat or Darrowped can be bought over the counter at your pharmacy and should be reconstituted strictly in accordance with the manufacturers’ directions.

·                Alternatively, you can prepare your own rehydrating solution at home, by dissolving ½ tsp salt and 8 tsp sugar in 1 litre of water that has been boiled and cooled.

·                Give your baby or child small amounts (60-120 ml) of clear fluids every 1-2 hours.

·                If her diarrhoea is accompanied by vomiting, give her even smaller amounts every hour.

·                Older children can also be given broth that contains sodium.

·                A clear fluid diet should not be continued for more than 48 hours because it can, in and of itself, cause diarrhoea.

·                In infants, milk feeds can be reintroduced after 24 hours, if your child is not vomiting and the frequency and consistency of her stools has improved. Continue to give smaller, more frequent feeds rather than an hourly bottle. Your paediatrician may change her formula during the recovery period because soya and lactose-free formulas for example are often better tolerated by inflamed intestines.

·                In older children, as their diarrhoea improves, your doctor may recommend a bland diet consisting of foods such as, rice, boiled potato, mashed banana, toast, cooked carrots and plain chicken.

·                Most cases of diarrhoea in children are not treated with medication that stops or lessens frequent, watery stools. Since diarrhoea is often caused by viral infections, the intestines will heal themselves. In the case of bacterial or parasitic infections, if you stop the diarrhoea before these organisms have worked themselves out of your child’s system, they may become trapped in the intestines and prolong the problem.

·                Instead, doctors may prescribe antibiotics as a first line of treatment (Collins, 2003; Leary, 1990; NDDIC, 2008).

Contact your doctor immediately if your child has any of the following symptoms

·         high fever

·         any sign of dehydration

·         severe pain in the abdomen or rectum

·         vomiting (12 hrs in children/6 hours in infants)

·         refusing to drink for 6 hours

·         passing no urine for 6 hours in a day

·         diarrhoea for more than 3 days

·         blood in the stools or black, tarry stools (Collins, 2003; NDDIC, 2008)