1.Prevention of dehydration and treatment of dehydration
(1) Prevention of dehydration.
From the very beginning of the diarrhea of the child, give enough liquid by mouth to prevent dehydration. Breastfed children should continue to breastfeed and increase the frequency of feeding and extend the time of single feeding; mixed feeding infants should be given ORS or other clean drinking water on the basis of breastfeeding; non-breastfed (artificial feeding) infants should choose ORS or food-based rehydration fluids such as soup, rice soup water and yogurt drinks or clean drinking water. It is recommended to give a certain amount of fluid supplementation after each loose stool (<6 months, 50 ml; 6-2 years, 100 ml; 2-10 years, 150 ml; 10 years or more for children or adults who can drink as much as they can give) until the diarrhea stops.
(2) Mild dehydration.
Correct dehydration in a timely manner with oral rehydration solution, using ORS, dosage (ml) = weight (kg) × (50-75), to be taken within 4 hours;
Observe the child’s condition closely and counsel the mother to give the child ORS fluid. If the patient still shows signs of dehydration near 4 hours, adjust the rehydration plan;
(3) Moderate to severe dehydration.
Intravenous fluids
The fluid should be mixed with sugar and salt solution for intravenous use, which should be carried out in hospital;
2.Continue feeding
(1) Adjust the diet
Breastfed children continue to breastfeed, non-maternal milk-fed children under the age of 6 months continue to feed formula, and children over the age of 6 months continue to eat everyday foods that they have become accustomed to, such as porridge, noodles, rotten rice, eggs, minced fish, meat, and fresh fruit juice. Encourage the patient to eat, and increase the number of feeding meals if the amount of food is low. Avoid feeding the affected child vegetables and fruits containing coarse fiber and foods high in sugar. Viral enteritis often has secondary disaccharidase (mainly lactase) deficiency, and in suspected cases may be given temporarily to low (de)lactose formula for 1-2 weeks, and then switched to the original feeding pattern after diarrhea improves.
(2) Nutritional treatment
① Glycogenic diarrhea: lactose intolerance is the most common. Treatment should be based on a de-dieted diet and can be based on de-(or low) lactose formula or soy-based protein formula.
② Allergic diarrhea: milk allergy is more common. Avoid allergic foods or use oral desensitization feeding methods without restricting foods already tolerated. Infants can usually tolerate deeply hydrolyzed casein formula; if still intolerant, amino acid-based formula or a whole-elements diet can be used.
③Elemental diet: for those with chronic diarrhea, intestinal mucosal injury, and malabsorption syndrome.
④Intravenous nutrition: for a few severe cases who cannot tolerate oral nutrients, accompanied by severe malnutrition and hypoproteinemia.
3.Zinc supplementation treatment
Children with acute diarrhea should be treated with zinc supplementation as soon as they can eat, with 20mg of elemental zinc per day for children over 6 months of age and 10mg of elemental zinc per day for children under 6 months of age for 10-14 days. Elemental zinc 20mg is equivalent to zinc sulfate 100mg and zinc gluconate 140mg.
4.Rational use of antibacterial drugs
Children with diarrhea should undergo routine stool examination and PH paper test;
Acute watery stool diarrhea, after excluding cholera, is mostly viral or enterotoxin-producing bacterial infection, and antibacterial drugs are not used routinely;
Mucopurulent stools are mostly invasive bacterial infections, requiring the application of antibiotics, which can be selected empirically according to local drug sensitivity, and followed up on the third day of medication; if the condition does not improve after 48 hours of medication, consider replacing another antibacterial drug;
Emphasize that the course of antibiotics should be adequate;
Before applying antibiotics, bacterial culture of stool specimens should be performed first, so that the selection and adjustment of antibacterial drugs can be based on the isolated pathogens and the results of drug sensitivity tests.
5, other treatment methods help to improve the condition of diarrhea and shorten the course of the disease.
(1) Intestinal mucosa protective agent: such as montelukast
(2) Micro-ecological therapy Give probiotics such as bifidobacteria, lactobacilli, etc;
(3) Vitamin A supplementation;
(4) Anti-secretory drugs: for secretory diarrhea.
(5) Traditional Chinese medicine treatment: using evidence-based prescriptions, acupuncture, acupoint injections and tui na, etc.
6.Home treatment of diarrheal disease
Patients with diarrhea without dehydration signs and mild dehydration can be treated at home, and doctors should promote the four principles of home treatment to parents, namely
(1) Give the child sufficient oral fluids to prevent dehydration;
(2) Zinc supplementation;
(3) Continuous feeding of the child;
(4) promptly send the child to a medical institution for treatment and consultation if the condition does not improve or if any of the following symptoms appear: (1) severe diarrhea, frequent stools, or large amount of diarrhea, (2) inability to eat normally, (3) frequent vomiting and inability to give oral medication, (4) fever (temperature >38℃ for infants <3 months, temperature >39℃ for children 3-36 months), (5) obvious thirst, signs of dehydration such as sunken eyes, few tears, mucous membranes dryness or decreased urine output, etc., mental changes such as irritability, apathy, lethargy, etc., ⑥ blood in stool. (7) Age <6 months, prematurity, history of chronic disease or comorbidities.