Disease characteristics.
”Bullying” and more likely to invade infants and young children
Fall diarrhea generally occurs in infants and young children aged 0.5-3 years, who have poor immune function and are vulnerable to pathogenic microorganisms. The main pathogenic microorganism causing fall diarrhea in infants and young children is rotavirus, which was discovered in 1973 in the epithelial cells of intestinal biopsies from children with diarrhea in Australia. The virus was named “rotavirus” because of its wheel-like shape. The virus thrives in the early fall when the temperature drops. When rotavirus invades the mucosal cells of the small intestine, these cells lose their ability to absorb water and electrolytes from the intestinal lumen, and water and electrolytes are excreted through the anus, causing watery diarrhea.
Almost all children will have at least 1 rotavirus infection by the age of 5 years, and it is one of the most common causes of viral diarrhea.
Vomiting followed by diarrhea with watery or egg-soup-like stools
The main features of autumn diarrhea are vomiting followed by diarrhea with fever and watery or egg-flake stools, with a self-limiting course, and the following clinical manifestations in children.
The onset of the disease is rapid, often accompanied by cold symptoms at the beginning, such as cough, nasal congestion, runny nose, some children with fever, usually low fever, rarely high fever.
The number of stools increases, about 10 times/d (>3 times should be considered autumn diarrhea), the stools are white, yellow or green egg-flower soup-like, with a little mucus, no fishy smell.
Vomiting is present in half of the children. Most vomiting occurs at the beginning of the course of the disease, usually ≤3d.
In severe diarrhea, symptoms of dehydration may occur, such as marked thirst, decreased urine output, and irritability.
The course of the disease is self-limiting, usually 5-7 d. The duration of diarrhea may be longer in cases of malnutrition, rickets and frailty.
Treatment points and common misconceptions
Prevention and treatment of dehydration is the top priority
For mild dehydration or vomiting that is not severe, it can be treated at home, and the most important thing is to consume enough fluids to prevent and treat dehydration. There are three ways to prevent and treat dehydration.
① Rice soup with salt, 500mL of rice soup with 1.75g of salt (i.e. half a cap of a beer bottle). Children <2 years old drink 1 bottle per day, >2 years old 2-4 bottles per day; adults 4-8 bottles per day. How much is appropriate to drink, mainly depending on the amount of urine and normal as much as possible.
②Salt and sugar water, boiled water 500 mL, add sugar or glucose 10 g, then add fine salt 1.75 g.
③Take oral rehydration salts (ORS), which can be bought in major pharmacies and taken with water as prescribed.
For moderate or severe dehydration, intravenous rehydration solution should be given
Diet therapy is an important treatment
In recent years, a large number of studies at home and abroad have shown that one must continue to eat when having diarrhea, and one cannot rely on fluids, tonic drugs and nutritional products instead of eating. Only in this way can the nutritional status of the patient be improved and the recovery from diarrhea be accelerated.
In principle, the diet is required to be easily digestible, nutritious, high in calories, high in protein, and not too much oil and lactose, but not an oil-free and lactose-free diet either. The concentration of white sugar should not be too high, a little sweetness is enough. General fruit (except bananas and other easy to slip intestines) can also be eaten, but fresh and clean, do not eat frozen.
Now some hospitals in China have developed dairy products suitable for children with diarrhea, with comprehensive nutrients and better results in preventing diarrhea and malnutrition. Patients who are treated at home can eat thin rice and egg noodles.
Common misconceptions: blind fasting without differentiation
Some children referred from the primary care level have had diarrhea for two or three days and have passed the vomiting period, but they are still fasting. When asked why, the family said: the initial doctor did not allow them to eat milk or food. When asked about the reason, the family said that the initial doctor did not allow them to take milk or eat. Combined with drinking only water, such children almost always have more severe hypotonic dehydration. Reasonable medication can reduce symptoms
Fall diarrhea is a self-limiting disease, and rehydration and dietary therapy are 2 important aspects. However, early and judicious use of medications can reduce symptoms and shorten the course of the disease.
Early antiviral
Fall diarrhea is caused by a viral infection. Although there are no effective drugs for this virus, early use of antiviral drugs (ribavirin) can inhibit the replication and reproduction of the virus. Antivirals should not be used for too long, usually 3-5 d.
Protect the mucosa of the digestive tract
Montelukast can make pathogens less likely to invade the intestinal wall, protect and promote regeneration and repair of the intestinal mucosa. It is recommended to use montmorillonite (Simethicone 3 g), which is a protective agent for the digestive tract mucosa. Semicarb 3 g should be taken manually in 3 oral doses for 3-6 d.
Common misconceptions
Blindly stopping diarrhea, resulting in closed doors
In fact, during the acute phase of viral enteritis or bacterial enteritis, diarrhea can play a self-protective role of “detoxification and decompression”, so it is not beneficial to blindly stop diarrhea in children with fall diarrhea, especially at the beginning of the disease, but may aggravate the condition. Only after the fever and vomiting have improved can you stop the diarrhea at your discretion. In addition, we should pay attention to the safe application of some antidiarrheal drugs, such as Emmenagogue, which is prohibited for children <5 years old, and Antidiarrhealin, which is prohibited for children <2 years old.
Abuse of antibiotics can do more harm than good
Fall diarrhea is a viral disease and antibiotics are not only unhelpful but also harmful. It can lead to prolonged illness or double infection. The more broad-spectrum antibiotics, the greater the harm, and flumioxazin and tetracycline should not be used.
Health education: scientific care helps to recover from the disease
In addition to hydration and dietary adjustments as recommended by the doctor, scientific care by parents can help children recover from the disease.
Once a child is diagnosed with fall diarrhea, parents should minimize taking the child outside and keep the indoor air fresh and circulating.
Disinfect the home. All items used by the child (diapers, clothes and blankets, toys, books, etc.) should be thoroughly cleaned and disinfected.
Parents should wash their hands carefully before and after caring for their children to prevent cross-infection.
Pay attention to the child’s abdomen to keep it warm. In autumn, the climate is getting cooler, and the child’s intestinal peristalsis is already faster due to the virus, so if the abdomen is cold again, the intestinal peristalsis will be even faster, which will aggravate the diarrhea. Parents can use hot water bags to apply hot compresses to the child’s abdomen and rub the child’s stomach to relieve the pain.
Protect the child’s buttocks. The skin and mucous membrane around the anus must be damaged due to the increase in the number of stools, so the child should be gently washed with a soft gauze dipped in water after the stool, and then apply some greasy ointment. Babies should change their diapers in time to avoid rubbing the skin of the buttocks with the diapers impregnated with feces and urine.
Scientific care helps to recover from the disease
In addition to hydration and dietary adjustments as recommended by the doctor, scientific parental care can help the child recover from the disease.
Once a child is diagnosed with fall diarrhea, parents should minimize taking the child outside and keep the air fresh and circulating indoors.
Disinfect the home. All items used by the child (diapers, clothes and blankets, toys, books, etc.) should be thoroughly cleaned and disinfected.
Parents should wash their hands carefully before and after caring for their children to prevent cross-infection.
Pay attention to the child’s abdomen to keep it warm. In autumn, the climate is getting cooler, and the child’s intestinal peristalsis is already faster due to the virus, so if the abdomen is cold again, the intestinal peristalsis will be even faster, which will aggravate the diarrhea. Parents can use hot water bags to apply hot compresses to the child’s abdomen and rub the child’s stomach to relieve the pain.
Protect the child’s buttocks. The skin and mucous membrane around the anus must be damaged due to the increase in the number of stools, so the child should be gently washed with a soft gauze dipped in water after the stool, and then apply some greasy ointment. Babies should have their diapers changed in a timely manner to avoid breakage of the skin on the buttocks due to friction between the diapers impregnated with feces and urine.