Almost every child will experience diarrhea as they grow up. Diarrhea is a medical condition, but every year during the peak season of rotavirus infection, our pediatric surgery department also gets busier.
One reason is that rotavirus infections increase the risk of intussusception, and in the fall, intussusception increases, with nearly 10 children a day being treated with enemas and, if they can’t, surgery.
The second reason is that rotavirus enteritis often has symptoms such as vomiting and bloating, and when you arrive at the hospital, the doctor will take a picture of the child in order to rule out intestinal obstruction. And many children with enteritis will have intestinal paralysis, and the film will be taken with liquid gas flat.
When the radiologist sees the liquid gas level, he will write a diagnostic report of “intestinal obstruction is not excluded” with the attitude of “it is better to be wrong than to be spared”, and when the internist takes a look at the word “intestinal obstruction”, he will refer the child to the hospital. The internal medicine doctor will take a look at the word “intestinal obstruction” and refer the patient to general surgery.
So, every year, we pediatric surgeons have to fight rotavirus as well.
What is rotavirus?
Surgeons naturally do not have as much experience in treating rotavirus as medical doctors, but because of the above, we have had more exposure to it, so we can share some of our knowledge with you.
You may have heard that rotavirus enteritis is a “self-limiting disease”, which means that most of it will heal on its own even without treatment. But what you may not know is that until now, diarrhea was the second leading cause of death in children under 5 years of age.
It is estimated that in 2008, about 453,000 children under the age of five died from rotavirus infections worldwide, accounting for 37% of deaths due to diarrhea and 5% of deaths among children under the age of five.
Because rotavirus is highly infectious, it can survive for hours to months outside the body and longer in cold environments. The number of viruses in the stool of patients in the acute stage is more than 100 billion per gram of stool, and children can excrete the virus before symptoms appear, which lasts until 10 days after the onset of symptoms, so it is easily spread among families and kindergartens.
What happens if I get rotavirus?
Infections in children of different ages can be different.
Newborns are often asymptomatic or have very mild symptoms because the antibodies they receive from their mothers are still relatively high. The exception is preterm infants, who have not received enough antibodies, and are at higher risk of severe manifestations than full-term infants.
Severe cases occur mainly in children between 3 and 24 months of age, with only about 25% of severe cases occurring after 2 years of age. Most children have multiple infections, but the symptoms of the first infection tend to be more severe than those of subsequent infections, which are less severe or even asymptomatic, probably because of “immune protection” from the first infection.
When a child is infected with rotavirus, symptoms do not appear immediately and the child may not show any symptoms during the first 1-7 days of incubation.
Once the incubation period is over, symptoms appear.
The first signs tend to be fever and vomiting, with about half of the children having a fever, but mostly a low fever, although about 1/3 of the children will have a fever of more than 39 degrees. 80-90% of the children will vomit, and after these symptoms last for 1 – 2 days, the child will start having watery stools, which can be 10 – 20 times a day, and the diarrhea usually lasts for 3 – 8 days.
Panicked parents.
Most children infected with rotavirus go through a process that is enough to cause many parents to panic.
For example, the initial manifestation of fever, in the absence of other symptoms, parents may be judged as a cold, and then the child on the cold medicine; if the appearance of vomiting, and worry about whether to eat something bad, and began to give the child to eat antiemetic; and then over, the child began to diarrhea, watching the child non-stop poof, many parents began to feel stuffy, and then began to Similac mommy love together on The actual antibiotics are also eaten together.
It’s true that all parents have a hard time being calm when their children are sick, and they want to keep all the symptoms away from their children, so that they are free from all the pain, but many things can’t go their way.
Even in the United States, most children under the age of 5 are infected with rotavirus, and 4 out of 5 of them develop rotavirus enteritis, so it is difficult for most children to escape rotavirus.
There are no effective antiviral medications available, and like the flu, it’s mainly up to you to get better, and there’s not much you can do to shorten the process of getting sick, whether you’re in a hurry or not.
As you may have noticed, the symptoms of fever, vomiting and diarrhea exhibited by rotavirus enteritis are not specific, and other enteritis may also have these symptoms. Depending on the course of the disease and the season, doctors may have a rough idea, but without the relevant pathogen testing, there is no way for them to determine if it is, let alone the parents themselves.
Treatment of rotavirus infection: correction of dehydration The good thing is that the principles of coping with all diarrhea are really much the same.
For rotavirus enteritis, because there are no effective antiviral drugs, the goal of treatment is not to cure it, but to give help the child carry through the process of getting sick and wait for him to get well on his own. It’s like a storm is coming and you can’t stop it, all you can do is keep your house from being blown down by it.
Because rotavirus enteritis causes children to lose a lot of water and electrolytes in a short period of time, making sure your child does not become dehydrated is the primary goal, as well as maintaining your child’s electrolyte and nutritional balance.
Children need more water and electrolytes per kilogram of body weight than adults, so they are also more likely to become dehydrated.
In mild to moderate dehydration, the child may appear tired or irritable, thirsty, dry lips, mildly sunken eye sockets, inelastic skin, cold extremities, and little urination.
In severe dehydration, the child may appear apathetic, comatose, not drinking, and with deep sunken eye sockets, which is dangerous at that time.
Judgment of dehydration signs is somewhat subjective, and inexperienced doctors’ judgment may be inaccurate. Parents have the advantage of spending more time with their children, observing them for a longer period of time, and knowing more about their children’s usual conditions than doctors, so they can make better comparisons when they are sick.
However, it is still difficult for parents to accurately determine the degree of dehydration on their own. Moreover, dehydration can progress quickly, so if the child’s mental reaction is not right, and if the child has little urine or other situations that are not clear in mind, it is important to go to the hospital in time to avoid delaying the condition.
Mild to moderate dehydration can be rehydrated orally, and oral rehydration salts can be given to children with water to replenish not only water, but also electrolytes.
Third-generation rehydration salts, also known as “hypotonic rehydration salts”, are currently recommended by the WHO and are very inexpensive and safe.
Note: It is not recommended to make your own saline for your child at home.
Severe dehydration should be prevented as much as possible, and if it occurs, you should go to the hospital as soon as possible.
Should I continue feeding?
Generally children who do not vomit frequently and can take oral rehydration solution can also eat normally. Long-term diarrhea may affect the intestinal villi, but the intestines still have absorption function. Once the rehydration solution is almost corrected, breast milk or formula feeding can continue without dilution, and children who can usually eat rice, bread, lean meat, yogurt, fruits and vegetables can generally continue to feed.
However, care should be taken to avoid eating foods high in fat and sugar to avoid aggravating diarrhea. However, for children who are lactose intolerant, yogurt can be considered as a substitute for milk.
Should I use other medications?
This drug is mainly used in Europe, Asia and Africa. It has also been studied to reduce the number of stools and shorten the diarrhea process, but the World Health Organization does not consider it useful, and the American Academy of Pediatrics recommends against the use of “antidiarrheal” medications on their own. Premature application of strong antidiarrheal drugs is tantamount to “keeping the koan behind closed doors” (toxins out). Therefore, when diarrhea occurs, anti-diarrheal medication should not be taken immediately and blindly.
Another medicine that is often taken when diarrhea occurs is probiotics. Some current studies suggest that probiotics, including Lactobacillus, Bifidobacterium and Saccharomyces boulardii, can help restore intestinal microecology and improve immune protection. However, the current evidence is not as strong, and they are not yet considered routinely recommended for use in children with diarrhea in Nielsen Pediatrics.
What are the conditions that parents need to be aware of that accompany pediatric diarrhea?
In addition to the dehydration mentioned earlier, it is important to watch for other conditions, such as persistent and frequent vomiting, especially if the vomiting is yellowish-green, which should alert parents to intestinal obstruction.
If there is blood in the stool, you should also be on the alert for intussusception and bacterial enteritis.
Bacterial enteritis should also be considered when a child has recurrent fever with diarrhea, and the use of antibacterial agents should be recommended by the doctor.
Diarrhea is also often accompanied by abdominal pain because of abnormal bowel movements, but most of them are not serious. If the abdominal pain persists, especially if there is a fixed area of pressure, it is also important to be alert for other infections in the abdominal cavity such as appendicitis. This is because the presentation of appendicitis in infants and children can be very atypical, sometimes even presenting as diarrhea, and these need to be identified by the doctor at the hospital.
Parents should go to the hospital if they don’t know what to do.
Is there a way to prevent rotavirus?
Rotavirus was once called the “democracy virus” because it was a democratic and fair disease for every child, regardless of whether you were born in a poor or rich country, or in a temperate or tropical region, you were basically infected a few years after birth.
But since the rotavirus vaccine became available, children in poor countries have ended up very differently than children in rich countries. Because the severe cases are basically initial infections, being vaccinated does not mean that you will not get infected again, but it is equivalent to completing the initial infection, which will produce protective antibodies, and if you get infected again, the symptoms will be mild or even asymptomatic.
Rotavirus is transmitted via the fecal-oral route, and because it is highly contagious, it is difficult to completely prevent infection by taking measures such as paying attention to sanitary conditions. Still, children in developing countries, where sanitation is relatively poorer, are infected at an earlier age than children in developed countries.
In addition, most other childhood diarrhea is also related to diet and sanitation, which is why most of the children who die from diarrhea are in Africa and South Asia.
In addition to rotavirus vaccination, promoting breastfeeding, maintaining a nutritional balance in children, good dietary hygiene, and having children wash their hands regularly are the main ways to prevent diarrhea in children. Rather than waiting for their children to have diarrhea, parents should usually give them good prevention: wash hands regularly, do not drink raw water, do not eat raw food – to develop healthy habits such as washing hands regularly, not drinking raw water, and separating raw and cooked food to avoid cross-contamination; secondly, to strictly prevent disease from entering through the mouth. Therefore, before eating fruits and melons, must be washed and peeled; shellfish must be cooked thoroughly before consumption.