Screening intervention process for common gastrointestinal problems in infants – loose stools

History and clinical assessment: 1. The number of bowel movements, the nature of the stool, the amount of stool each time, the relationship between bowel movements and food intake; whether the stool has mucus, pus and blood; if the stool has blood, whether it is bright red or dark red. 2, accompanying symptoms whether the infant is accompanied by irritable crying, nausea or vomiting, fever, the presence of skin and respiratory allergy signs and symptoms (rash, episodic cough, etc.). Perform stool routine and occult blood test if necessary. 3.Feeding to understand the feeding method, feeding frequency, feeding amount; whether the formula is newly added or replaced recently, whether new food is added recently; the cleaning and sterilization of infant feeding utensils (including bottles, bowls, spoons, cups, etc.). 4.Growth and development: To understand the gestational age, body mass at birth, body mass and length before the onset of dilution, and current body mass and length, and to assess whether there is poor growth in body mass and length and growth retardation. 5. Personal and family history to understand recent illnesses and medications, whether there is a history of recurrent urinary tract infections, gastrointestinal diseases (colon polyps, inflammatory bowel disease, etc.) and family history of other diseases (allergic diseases, thyroid and parathyroid diseases), etc. Danger signs The presence of pathological conditions should be considered if you have one of the following symptoms: 1. infectious diseases of the gastrointestinal tract, food allergies such as milk proteins, inflammatory bowel disease, etc., requiring prompt referral or consultation; 2. purulent and bloody stools, mucus stools; 3. watery stools with a large volume of stool; 4. mild dehydration (slightly poor mental status, fair skin elasticity, slightly dry mucous membranes, slightly depressed fontanelles and eye sockets, still warm extremities, slightly low urine output 5. fever, lasting >2 weeks; 6. frequent vomiting; 7. allergic symptoms such as eczema and episodic cough; 8. poor growth (poor growth in length and body mass). Soothing education Infants with dilute stools, but with a small amount of stool each time, and with a normal growth rate in body mass and length and without other serious symptoms can continue to be observed and fed. Some newborns (especially breastfed infants) have up to 6-7 stools per day and night and pass a small amount of stool at each feeding, which may be related to the imperfect development of the infant’s anal sphincter. It is not uncommon for infants to have milk lumps or other undigested food in their stools, which is related to the immaturity of the infant’s intestinal tract and lack of digestion and absorption ability. Care instructions Careful care of the buttocks. Wash the perianal area with water after defecation, dry the buttocks with a soft towel, and apply buttock cream. Instruct parents to properly clean and disinfect infant feeding utensils. Advocate breastfeeding and a balanced diet for mothers to avoid excessive grease. Try using lower lactose formula or other special formula for formula-fed children. Appropriately lowered lactose formulas can reduce increased acid production, gas production, and resulting loose stools in infants due to lactose intolerance, but note that lactose-free or lower lactose formulas are not suitable for long-term use. Continue breastfeeding and add complementary foods at the right time, gradually transitioning from pureed to semi-solid or solid foods, and do not restrict infants from eating because of loose stools or stools with food residues. Infants with high suspicion of milk protein allergy causing loose stools should be referred to specialists or diagnosed and intervened according to evidence-based recommendations for the diagnosis and treatment of milk protein allergy in infants and children in China (Chinese Journal of Pediatrics, Vol. 51, No. 3, 2013). Infants with high suspicion of acute diarrheal disease should be referred to a specialist or diagnosed and intervened according to, for example, the Expert Consensus on Principles of Diagnosis and Treatment of Diarrheal Disease in Children (Chinese Journal of Pediatrics, vol. 47, no. 8, 2009).