A common event in infancy and childhood, normally understood as a condition in which bowel movements (or stools) are looser than normal, occur too frequently, or both. In fact, the significance of a child’sstool pattern will depend on two basic considerations. First, what is normal for the age-group and for the particular infant or child? A normal breast-fed newborn will have as many as six to ten watery stools per day, which can vary in color from yellow to green to brown. Bottle-fed infants tend to have stools that are less watery and more mushy. After a few weeks, a breast-fed baby may absorb nutrients so efficiently that a stool is passed no more often than every few days. An older child may pass a stool every two or three days or two or three times a day on a routine basis without any problem. Some infants and children vary their pattern from week to week without any particular signs of trouble.
These problems could range from merely annoying to life-threatening and include following:
- Irritation of the skin around the anus or over the entire diaper area
- Cramps or other discomfort
- Ongoing soiling of clothing, bedding, furniture, and carpeting
- Fluid losses serious enough to cause dehydration and, in severe cases, death
Increased frequency or volume of stools can occur as the result of any or all of the following three reasons which could apply to a given case of diarrhea:
- The intestinal tract is moving food more rapidly
- Some or most of the food or fluids, as well as the substantial amount of liquid produced every day by the intestine, are not being absorbed normal},
- The intestine is secreting more fluid than usual.
To understand what might be happening to your child whose stools are more loose and frequent than you may like, it is helpful to think in terms of three basic types of diarrhea: acute diarrhea, chronic nonspecifically diarrhea and chronic diarrhea related to a pathologies condition.
Acute diarrhea is usually infectious and accompanied by other signs of illness such as fever, nausea, and/or vomiting, and possibly dehydration if the child’s intake of fluids is not keeping up with loss. Around the world, this is the leading cause of diarrhea children under five years of age, causing more than 4 million deaths a year. In developed nations such as the United States, severe diarrhea leading to death is far less common (about 500 cases occur annually in the same age-group). The average American child has one to two episodes per year by the age of five. Diarrhea accounts for more than 10 percent of all hospitalization in this age-group.
A variety of viruses and bacteria can cause acutefectious diarrhea (which is often referred to as gastro-enteritis when nausea and vomiting occur). The more common offender is the rotavirus, which is seen more often among children between six months and two years of age. Bacteria that are transmitted in contaminated food or in unsanitary living conditions are also common causes of acute diarrhea, which are parasites such as Giardia lamblia, which contaminate water supplies. Occasionally, an acute somewhere else in the body (for example, an ear infection) or medications (especially antibiotics) will lead to diarrhea.
Acute diarrhea episodes will usually resolve with antibiotics, in most situations your greatest con will be keeping track of the infant’s or child’s fluid and watching out for dehydration. When fluid is mild, you will see increased thirst and a decrease in urine output (fewer wet diapers).
Your child’s doctor will give you specific advice for preventing or correcting dehydration, which will depend to some degree on the age of your child and the severity of the problem. Traditionally, treatment of diarrhea involved an attempt to put the bowel “at rest” for a day or two while the infection runs its course. This involved giving the infant or child one or more forms of clear liquids – water, soft drinks, clear soup, dear juice, etc. – which are supposed to be absorbed more easily when the bowel is inflamed or damaged by the infection. However, recent research has indicated that for a variety of reasons these liquids are not very effective and in some cases may make the diarrhea worse.
One of the most significant advances in medical care during the past 50 years has been the discovery of an extraordinarily effective and inexpensive treatment for acute infectious diarrhea. Research into the physiology of the small intestine led to the development of a variety of oral rehydration solutions (ORS), which cooperate effectively with the body’s mechanisms for absorbing fluid. These solutions contain specified amounts of sodium, potassium, and glucose mixed in water, can be safely used in infants and children of all ages, and is effective in treating both mild and severe dehydration. Premixed ORS is available at drugstores in products such as Pedialyte, Rehydralyte, and Infalyte. This type of solution, not the traditional clear liquids, is better suited to treat acute diarrhea, especially in infants and toddlers under two years of age. ORS may be given by bottle, spoon, or even dropper, sometimes in frequent, very small amounts (especially if nausea and vomiting are present). Your child’s doctor can recommend the type and minimum quantity of fluid you should give your child. If their hydrating solution isn’t flavored, its taste can be improved by adding one tablespoon of D11-0 powder to one tablespoon of boiling water and then adding this mixture to an eight-ounce bottle of the solution.
Breast-fed infants may continue nursing throughout an acute diarrheal illness. Infants who are formula-fed may also continue without stopping, although the physician might recommend switching temporarily to a lactose-free and/or non-cow’s-milk formula. Children who have been taking other foods may continue doing so, al-though foods containing a lot of simple sugars (candy, soft drinks, fruit juices) might cause more water to enter the bowel and worsen diarrhea. Complex carbohydrates such as rice, bread, and potatoes are a better choice. Bananas and applesauce contain pectin that may helpthicken loose stools. In general, recent research suggests that withholding food does not shorten the duration of diarrhea and may in fact lengthen it, because the lining of the intestine needs fuel to repair its damage. Depending upon the duration and severity of the diarrhea, your child’s physician may order stool tests to determine whether a specific, treatable bacteria or parasite is present. If this is found to be the case, appropriate antibiotic therapy may be recommended. Nonprescription products such as Kaopectate, which thicken stool, and drugs such as loperamide (Imodium), which reduce the frequency of bowel movements, are not recommended for young children.
Chronic nonspecific diarrhea is a common problem in which a child has ongoing loose stools that are not severe enough to cause dehydration, nor are they associated with weight loss, developmental problems, or other disease activity. They can vary greatly from day to day or week to week and may be associated with stress, an acute illness, a move, dietary changes, or nothing in particular. Throughout this process, the child does not appear ill. A medical evaluation should be done if an unusual pattern of loose stools continues for more than three weeks in a child who does not otherwise appear ill. If no specific cause is found and the child is otherwise doing well, the diarrhea will eventually resolve on its own. Recent research indicates that many cases of chronic non-specific diarrhea may be caused by excessive intake of fruit juices (especially apple juice). And, surprisingly, children on very low-fat diets may also have this problem. While maintaining conservative dietary habits regarding fat is important as a lifelong goal, younger children have a somewhat higher nutritional requirement for fat than adults do, and stringent restrictions on this (or any other)food group are not advisable. Your child’s physician or a dietitian can give you further advice on this subject.
Chronic diarrhea related to a pathological condition (for example, a parasitic infection or a specific defect in absorption) will usually be manifested by a failure to gain weight as well as other signs of illness (for example, fever). During a medical exam for ongoing diarrhea, a number of these conditions will be considered and appropriate tests done to determine if one of them might be the cause.