Summer is a time of high incidence of pediatric diarrhea, which is a headache for many parents. Most pediatric diarrhea has an acute onset and frequent diarrhea can cause rapid loss of water and nutrients in the body, resulting in acute dehydration.
The treatment of pediatric diarrhea should not be treated by stopping the diarrhea, but by paying attention to timely hydration to prevent severe dehydration. Master these four principles to effectively prevent dehydration and malnutrition.
Acute diarrhea: need to know the purpose and plan of treatment
The purpose of treatment: prevention of dehydration in children without dehydration; treatment of dehydration in children with some dehydration; prevention of nutritional problems by continuing to feed during and after diarrhea;
To reduce the duration and severity of diarrhea and the number of subsequent episodes of diarrhea through zinc supplementation.
Treatment options: Treatment goals are achieved through the choice of treatment options. Children without dehydration need more fluids and salt to replace the water and electrolyte losses due to diarrhea. Otherwise, signs of dehydration may occur.
Mothers should be taught how to give their children more fluids than usual at home to prevent dehydration and to continue feeding to prevent malnutrition, and the importance of these measures. Mothers should also know when to bring their children back for follow-up visits. These are summarized in the four principles of the treatment plan.
Principle 1: To prevent dehydration, give the child more fluids than usual
1. What fluids to give: In all cases, home rehydration should include at least one salt-containing fluid (see below). The child should be allowed to drink clean water. Fluids that the child drinks regularly, that the mother thinks are appropriate for the child with diarrhea, and that can be given more often on the advice of the doctor should also be recommended.
2. Appropriate fluids: Most of the fluids normally consumed by children can be used. Appropriate fluids can be divided into two groups.
①Salt-containing liquids such as: ORS liquids, salt-containing beverages (e.g., salt-containing rice soup or salt-containing yogurt), and salt-added vegetable or chicken broth.
Hint: Mothers can be taught to make drinks or soups containing about 3 g/L of salt for their children with diarrhea, which may require several persuasions before the mother accepts.
Home made solutions containing 3 g/L table salt (a level teaspoonful) and 18 g/L table sugar (sucrose) are also good. However, their recipes are often forgotten, ingredients are not available, or the amount added is insufficient, so they are generally not recommended.
② Liquid without salt, such as: clean water, water for cooking cereals (for example, unsalted rice broth), unsalted soup, unsalted yogurt, fresh coconut milk, light tea water (unsweetened), fresh fruit juice without sugar, etc.
3, unsuitable liquids: some potentially dangerous liquids should be avoided for children with diarrhea.
Of particular note: some sugary drinks can cause osmotic diarrhea and hypernatremia. For example: commercially available carbon dioxide containing beverages, commercially available fruit juices, sweet tea. Should also avoid some stimulating, diuretic or laxative effect of the liquid, for example: coffee, some medicinal tea or punch.
4, the amount of fluid given: the general principle is: the child or adult patient willing to drink as much as possible until the diarrhea stops. As a reference, after each dilute stool, it should be given.
Children under 2 years of age: 50 to 100 mL (1/4-1/2 large cup) of liquid;
Children 2 to 10 years of age: 100 to 200 mL (half to a large cup) of fluid;
Older children and adults: as much as they want.
Principle 2: Zinc supplementation for 10 to 14 days (10 to 20 mg/day)
Regardless of the formula used, zinc syrup or tablets can be used. Zinc supplementation at the onset of diarrhea can reduce the duration and severity of diarrhea and the risk of dehydration.
Continuous zinc supplementation for 10 to 14 days will completely replace the zinc lost during diarrhea and reduce the risk of recurrent diarrhea in children within 2 to 3 months.
Principle 3: Continue feeding the child to prevent malnutrition
During and after diarrhea, continue to give the infant the foods he or she normally eats. The food should never be reduced and the child’s usual food should never be diluted. Breastfeeding should be continued. The purpose of this is to give the child nutritious foods that he or she can accept.
Most children with diluted diarrhea regain their appetite after rehydration, while children with hemorrhagic diarrhea have a poor appetite during the healing period. These children should be encouraged to eat normally.
Tip: After feeding, children absorb sufficient nutrients to continue to develop and gain weight. Continued feeding also accelerates the return of normal bowel function, including the ability to digest and absorb multiple nutrients. Conversely, children on a restricted or diluted diet will lose weight, have a longer duration of diarrhea, and have a slower recovery of intestinal function.
1. What food to give: What food to give should be based on the child’s age, food preferences and eating habits before the disease; cultural habits are also important. In general, the foods that are appropriate for children with diarrhea are the same as those needed by healthy children. The following are some specific recommendations.
Milk
① Breastfeeding infants, regardless of age, should be done on demand. Encourage mothers to increase the frequency and duration of breastfeeding.
② Non-breastfed infants should be fed milk (or infant formula) at least every 3 hours, using a cup whenever possible.
Tip: Special formulas advertised for children with diarrhea are expensive and unnecessary and should not be consumed routinely. Clinically significant milk intolerance is extremely rare.
(iii) Breastfeeding should be increased for infants under 6 months of age who are mixed feeding. As the child improves and breastfeeding increases, other foods should be reduced (liquids other than mother’s milk should be given, and cups should be used instead of bottles). This usually lasts for about a week. The infant may switch to exclusive breastfeeding.
Tip: Routine testing of the pH of the baby’s stool or its reducing agents is of no value. Such tests are too sensitive and often indicate diminished lactose absorption, and such results are not clinically relevant.
It is more important to monitor the clinical response of the child (e.g., weight gain, improvement in general condition). Milk intolerance is clinically significant when feeding rapidly causes massive diarrhea and signs of dehydration reappear or worsen.
Other foods
(1) If the child is younger than 6 months of age or is able to eat softer foods, cereals, vegetables and other foods should be given in addition to milk.
② If the child is older than 6 months and has not been given such foods, they should be offered during episodes of diarrhea or as soon as possible after the diarrhea has stopped.
Tip: The recommended foods should be culturally acceptable, readily available, high in energy, and provide adequate amounts of essential micronutrients. These foods should be well cooked, mashed or ground so that they are easily digested; fermented foods are also easily digested.
Milk should be mixed with cereals. If possible, 5 to 10 mL of vegetable oil should be added to each serving. If meat, fish or eggs are available, give them to children. Foods rich in potassium, such as bananas, fresh coconut milk, and fresh fruit juices, are beneficial.
Note: The vast majority of staple foods do not provide infants and toddlers with enough calories per unit of body weight and can be improved by adding some vegetable oil.
2. Amount and frequency of food offered
Children should be fed every 3 or 4 hours (6 times a day). Children tolerate small and frequent feedings better than large and frequent feedings.
After the diarrhea has stopped, energy-rich foods should continue to be given, and the child should eat more often than usual each day for at least two weeks. If the child is malnourished, additional meals should be given until the child’s height and weight return to normal.
Principle 4: Follow up immediately if the child shows signs of dehydration or other problems
The mother should bring the child back for immediate follow-up if the child
The start of heavy watery stools;
Repeated vomiting;
Very thirsty;
Poor feeding or drinking;
Fever;
Blood in the stool;
The child does not improve for three days.