Diarrhea in Young Infants

Introduction:

India has made steady progress in reducing deaths in children younger than 5 years, with total deaths declining from 2.5 million in 2001 to 1.5 million in 2012. This remarkable reduction was possible due to the inception and success of many universal programs like expanded program on immunization, program for the control of diarrheal diseases and acute respiratory infection. However, the proportional mortality accounted by diarrheal diseases still remains high. Diarrhea is the third most common cause of death in under-five children, responsible for 13% deaths in this age-group.

The Culprit:

Rotavirus is the most common cause of diarrhoeal disease among infants and young children. It is a genus of double-stranded RNA viruses in the family Reoviridae. Nearly every child in the world is infected with rotavirus at least once by the age of five.

Mode of transmission:

Rotavirus is present in the gut of an infected person and can pass out in their diarrhoea, making it very contagious. It usually takes about 48 hours after first contact with rotavirus before symptoms develop. The first symptoms are usually a high fever and vomiting. Watery diarrhoea then follows. The diarrhoea can range from mild to severe. The diarrhoea may clear up in about three days but, in some cases, it can last for up to nine days. With vomiting and diarrhoea, there is a risk of your child getting dehydrated. Mild dehydration is common and is usually easily and quickly treated by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to work normally.

Symptoms of Dehydration:

 

Symptoms of dehydration in children include passing little urine, a dry mouth, a dry tongue and lips, fewer tears when crying, sunken eyes,weakness, being irritable or having no energy. Symptoms of severe dehydration in children include drowsiness, pale or mottled skin, cold hands or feet, very few wet nappies, and fast (but often shallow) breathing. This is a medical emergency and immediate medical attention is needed.

Dehydration is more likely to occur in:

Children under the age of 1 year (especially those under 6 months old). This is because babies don’t need to lose much fluid to become dehydrated. Any child who does not drink much when they have rotavirus infection. Any child with severe diarrhoea and vomiting; especially if they have passed six or more very loose stools (faeces) or vomited three or more times in the previous 24 hours.

Diagnosis:

Rotavirus is usually diagnosed after a sample of your child’s stool (faeces) is
sent to the laboratory for testing. But, mostly its not necessary.

Treatment:

RotaVirrus Treatment

There is no special medication to treat rotavirus. The aim is to make sure that your child has plenty of fluids and does not become lacking in fluid in their body (dehydrated). Children can usually be cared for at home. Occasionally, admission to hospital is needed if symptoms are severe or to treat any dehydration

1) Oral Rehydration Solution (ORS) – Rehydration drinks provide a perfect balance of water, salts, and sugar. The small amount of sugar and salt helps water to be absorbed better from the gut (intestines) into the body. If your child vomits, wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger
children who may not be able to take sips.
2) Eat as normally as possible once any dehydration has been treated
Breast-fed babies should continue to be breast-fed if they will take it.
Older children – offer them some food every now and then.

Medication:

Zinc supplements and probiotics are usually prescribed alongside ORS

Complications:

Dehydration and salt imbalance in the body- most common complication. Perianal rash – easily treated by barrier creams

Acquired Lactose intolerance –due to lack of an enzyme called lactase that is needed to help the body digest the milk sugar lactose. Lactose intolerance leads to bloating, tummy pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the intestinal lining heals. Immunisation against rotavirus There is an effective oral vaccine against rotavirus. 2 or 3 doses are given to infants starting at 6 to 12 weeks of age.

Dr.Amit Saxena

 

 

 

 

 

 

 

 

Consultant Pediatrician, SSD Hospital
Dr. Amit Saxena

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