All You Need to Know About Diarrhoea in Children

In the run-up to World ORS Day that was celebrated globally on July 29, a virtual panel discussion titled ‘Diarrhoea in children: What every parent must know’, powered by Sanofi, saw a cross section of medical experts and actor, author, and mother of a five-year-old, Soha Ali Khan, delve into diarrhoea in children and how we can prevent its occurrences as parents.

The discussion started with some context setting by establishing the significance of childhood diarrhoea in our lives. “As a parent to a five-year-old daughter, I know that diarrhoea is a common issue. I’m sure that all of us have dealt with it at some point or many times in our lives. But, I think when it affects our little ones, we get all the more concerned,” said Khan.

According to the WHO, a staggering 1.7 billion cases of childhood diarrhoeal disease are reported globally each year. In India too, its prevalence is around 9 per cent. “The more alarming factor is that it is the third most common cause of death in children less than five years of age, accounting to around three lakhs deaths per year. It is most prevalent in children who are around two years of age. In spite of improvements in overall health condition of our country over the last decade, diarrhoea is still a major public health problem in our country,” said Prof (Dr) Shrish Bhatnagar, a Pediatric Gastroenterologist and Prof and Head of Department of Pediatrics at ELMCH, Lucknow.

It is imperative to detect diarrhoea in children early on. Typically, the first symptom is loose stools, which increase in frequency and there is watery content in these stools. It can start with just once a day, or 2-3 times. If it’s a viral diarrhoea, it can go to 5-6 times and sometimes 10-20 times. The child may also complain of stomach pain or be cranky. Sometimes, it can even be associated with vomiting.

“As parents, we have to be very careful because increased diarrhoea can lead to dehydration. The signs of dehydration are sunken eyes, lethargy or an irritable child. It is very important to see the urine output. Go to a paediatrician or a medical expert as soon as you see the first signs, which is more than 2-3 watery stools. We should not go late,” said Dr Priyanka Udawat, Consultant, Paediatric Gastroenterology, Preventive Healthcare and Wellness at Institute of Gastrosciences, Sir H N Reliance Hospital and Research Centre in Mumbai.

As parents of young children, we have all experienced diarrhoea in some form or the other with our little ones. But, not all forms of diarrhoea are dangerous. Dr Bhatnagar clarified that it is not an alarming situation every time. Diarrhoea is usually a self-limiting viral infection that takes 2-3 days to resolve.

“There are certain red flags which we need to understand and take seriously. The first red flag is blood in the stool. The second is a rice-watery stool, it can be very serious and can also lead to death of the child. The third is persistent high fever and persisting vomiting along with diarrhoea. Fourth, is a child who is already malnourished. So, if we take care of these four red flag signs, it can prevent diarrhoea from causing any severe damage to the child,” Dr Bhatnagar explained.

In Indian conditions, diarrhoea is caused by water and food contamination and is usually more prevalent in the summer and monsoon months. Bacterial diarrhoea is caused by eating stale food. In smaller kids, who are less than one year, it can be caused by cow’s milk protein allergy. As a parent, you must act as soon as you realise that your child is suffering from diarrhoea.

The first step should be the use of oral rehydration solution because that is the most key. Diarrhoea doesn’t harm you. It is the dehydration which is associated with diarrhoea that harms you the most. ORS is the cornerstone of therapy and is the only rational solution to diarrhoea as it has the right balance of salt, sugar, and water in it, which is required to treat the dehydration associated with diarrhoea. Zinc is used for prevention of diarrhoea. Both should be initiated as soon as diarrhoea starts,” said Dr Bhatnagar.

It’s a myth that food should be stopped when a child is suffering from diarrhoea. Dr Udawat clarified that this is a myth. “We should never completely stop food. Don’t load the baby but give some carbohydrates which are digested well and offer energy. So, simple moong dal and rice khichdi can be given with curd, which has probiotics in it. Or potassium rich foods like banana, coconut water, and ORS. Avoid sugary or carbonated drinks or oily and spicy food,” she said

Probiotics play an important role in preventing and treating diarrhoea. As Indians, probiotics have been an important part of our diet and offer overall health benefits. A probiotic is basically a life microorganism which is put inside the body to react with your own microbiota. But, it must be taken in the correct dosage.

“Probiotics will only have their effect when you give the exact dose which is prescribed for your child. There are multiple probiotics which are now available in the market, and some are mixtures of 3-4 probiotics combined. So, it is very important that you choose a probiotic which is important in terms of strain and its dose has to be right. Probiotic is a medicine and must be given in consultation with a paediatrician,” said Dr Bhatnagar.

Dr Udawat added that one also needs good prebiotics in the body in the form of fresh fruits and vegetables to stop the bad bacteria from proliferating in the body. ORS is a solution with the right concentration of sodium, potassium, chloride, and all the minerals and the glucose in the right balance so it can be absorbed by the intestine. The children can start getting dehydrated in 6 hours so it is important to act fast.

“There are four pillars of treatment of diarrhoea in our medical literature — first and second are ORS and Zinc, avoid administering drugs, and continued nutrition,” said Dr Bhatnagar.

Disclaimer: This article is a promotional feature and does not have journalistic/editorial involvement of Hindustan Times. The information does not constitute medical/health advice. Readers are strongly advised to consult a registered medical practitione