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Diarrhoea

Diarrhoea is a common childhood condition which is usually mild and brief. It usually resolves on its own without causing complications.

What is diarrhoea?

Diarrhoea is the passage of loose, watery stools. The stools are passed more frequently than normal.

  • Acute diarrhoea – sudden onset of diarrhoea that lasts less than 2 weeks.
  • Chronic diarrhoea – diarrhoea that persists for more than 2 weeks.

What causes diarrhoea?

Diarrhoea is commonly caused by infections in the gut through contaminated food or water. It can also be caused by non-infective cause which is more uncommon.

Infective causes

Transmission is usually contaminated food/water/items to person or from person to person;

  • Virus – eg Norwalk virus, Rotavirus.
  • Bacteria – eg. Shigella, Campylobacter, Escherichia coli.
  • Parasites – eg. Giardia lambdia, Entamoeba histolytica.

Non-infective causes

  • Food intolerance – lactose intolerance.
  • Reactions to medicines – certain types of antibiotics.
  • Intestinal diseases – Inflammatory bowel diseases, Coeliac disease.
  • Functional bowel diseases – Irritable bowel syndrome.

What are the signs and symptoms of diarrhoea?

  • More frequent bowel movements.
  • Watery, liquid stools with or without mucus.
  • Nausea or vomiting.
  • Fever.
  • Stomach pain / cramps.
  • Stomach bloating.
  • Loss of appetite.

Child may look normal or may have signs of dehydration.

How to recognize dehydration

Mild to moderate dehydration :

  • Dry mouth / tongue.
  • Cracked lips.
  • No or few tears when crying.
  • No urination for 4 – 6 hours (no wet diapers during that period).
  • Soft spot on top of baby’s head looks sunken.
  • Fretful behaviour.

Severe dehydration

All the signs above and additional signs such as :

  • Dry, wrinkled skin.
  • Child looks listless, very tired and inactive.
  • Sunken eyes.
  • Breathing seems laboured/difficult.
  • Pulses feels weak and very fast.
  • Child’s limbs feel very cold.
  • Refusal to feed.

What are the danger signs to be aware of?

Seek medical attention urgently if your child has these signs :

  • Signs of dehydration.
  • Blood in stools or black stools.
  • Persistent diarrhoea lasting more than 48 hours.
  • Weight loss.
  • Drowsiness.
  • Fever > 38 degrees Centigrade.
  • Refusal to feed.

What problems can severe diarrhoea cause?

  • Organ dysfunction including kidney failure.
  • Systemic infection.
  • Secondary lactose intolerance.
  • Sore area around the anus (sore bottom).

How to manage a child with diarrhoea

Treatment for Acute Diarrhoea

Rehydration

It is important to replace lost fluids and electrolytes to prevent dehydration.

Breastfed babies – continue to breastfeed on demand and give oral rehydration salt (ORS) solution.

Non breastfed babies – continue to give babies normal food and give oral rehydration salt (ORS) solution.

Use spoon or small syringe to severe ORS as much as possible.

Usually not more than what your child usually takes. If your child has signs of dehydration or any of the above danger signsor you are unsure of what to do; consult your doctor and do not continue to self treat at home.

Recovery stage

  • When your child starts getting better, continue to give the ORS solution and breastfeed.
    Slowly increase the amount as child starts to regain appetite.
  • Normal diet can be resume after 24 to 48 hours if child continues to improve.
  • Stools may take up to 7 days to become completely normal (part of healing process).

Milk

  • Avoid changing milk formulas unnecessarily.
  • Consult your doctor for advice if you feel the present formula is not suitable for your child.

Medications

Medications to stop diarrhoea – should be avoided.

  • Unsafe for babies and children.
  • Interfere with body’s effort to get rid of infection.

Antibiotics

  • Generally unnecessary but may sometimes be prescribed by doctors for bacterial infections of the gut which are uncommon. Please consult your doctor regarding this.

Topical creams

  • Creams such as petroleum jelly and zinc oxide helps relieve baby’s sore bottom.

Treatment for Chronic Diarrhoea

  • Chronic diarrhoea is usually due to serious diseases which would require further evaluation and tests by doctors before specific treatment can be given.

How can this diarrhoea be prevented?

  • Ensure that your child drinking water is clean and has been boiled.
  • Ensure that your child uses only clean utensils for this and drinks.
  • For small babies on bottle feed, ensure that the baby’s bottles have been sterilized properly.
  • Avoid raw food unless prepared hygienically by yourself.
  • Wash hands properly after handling raw meat, going to toilet, changing diapers and before handling food.
  • Dispose of diapers properly.
Last reviewed : 26 April 2012
Content Writer : Dr. Lim Sern Chin
  : Dato’ Dr. Lim Nyok Ling
Reviewer : Dr. Chong Sze Yee