Almost every baby has had diarrhea more than once, especially younger babies. Therefore, it is one of the most common “four childhood diseases” that babies suffer from. When babies vomit and have diarrhea, moms are very anxious and can’t wait for them to get better! So, they give all kinds of medicine to the baby in one go. However, the baby is not well, but more and more diarrhea, and even dragged to several months, so that the baby’s growth and development is greatly affected, and sometimes even life-threatening. In order for babies to grow up safely and healthily, mothers should know more about the prevention and care of diarrhea in babies: What is diarrhea in babies?
Pediatric diarrhea
Pediatric diarrhea is a disease caused by a variety of pathogens and causes. Most of the children affected are under 2 years old, with a particularly high incidence in infants between 6 and 11 months. The peak of diarrhea occurs mainly from June to September and from October to January each year. Summer diarrhea is usually caused by bacterial infections and is mostly mucus stools with a fishy odor; fall diarrhea is mostly caused by rotavirus and is more common as dilute watery or pasty stools, but without a fishy odor.
The incidence of diarrhea is second only to acute respiratory infections, and the mortality rate is also high if treatment is not carried out in a timely and effective manner. An important cause of death is dehydration and electrolyte disturbances in the body caused by diarrhea.
Why are babies prone to diarrhea?
Reason 1 Since babies aged 1-2 years grow and develop particularly rapidly, their bodies require more nutrients and heat energy. However, the digestive organs are not fully developed and secrete fewer digestive enzymes. As a result, digestion is weaker and diarrhea is likely to occur.
Cause 2 Because of the poor regulation of the gastrointestinal system by the nervous system, a slight change in diet, such as not adapting to the addition of weaning foods, adding too many types for a short period of time, or feeding too much at a time, or sudden weaning; or improper diet, such as eating protein foods that are not easily digestible; low temperature and cold body accelerates intestinal peristalsis, the day is too hot, the secretion of digestive juices decreases and the temperature difference in autumn makes the small tummy easy to get cold, etc., can cause diarrhea.
Because of the low immunity of the whole body and gastrointestinal tract, diarrhea can be caused by the slightest contamination of food or food utensils; babies are prone to respiratory infections due to low resistance, and diarrhea can often be caused by colds, pneumonia and otitis media.
How can I tell if my baby has diarrhea?
Judgment 1 According to the number of bowel movements
Normal baby’s stool is usually 1-2 times a day, in yellow strips. When diarrhea is present, the number of bowel movements increases from 4-6 times in mild cases to more than 10 times or even tens of times in severe cases.
Judgment 2 According to the stool characteristics
The stool is thin watery stool, egg-flake soup-like stool, sometimes mucus stool or pus and blood stool. The baby is accompanied by vomiting, bloating, fever, irritability and poor mental health.
Clinical manifestations
(A) Diarrhea stages
1. Acute diarrhea of less than 2 weeks duration.
2.Prolonged diarrhea with a duration of 2 weeks to 2 months.
3, chronic diarrhea duration of more than 2 months.
(B) Diarrhea typing
1, diarrhea: divided into 2 types according to the degree: light (simple diarrhea), heavy (toxic diarrhea).
(1) light diarrhea: mostly due to dietary factors or extra-intestinal infections, or caused by viruses or non-invasive bacteria in the intestinal tract. Mainly gastrointestinal symptoms, its daily stool frequency is mostly below 10 times, a few cases can reach a dozen times, each stool volume is not much, thin or with water, yellow, sour taste, common white or yellow-white milk flap (soap lump) and foam, can be mixed with a small amount of mucus. Generally no fever or fever is not high, accompanied by loss of appetite, occasional overflow or vomiting, no obvious systemic symptoms, good spirits, no dehydration symptoms, mostly in a few days to heal.
(2) Heavy diarrhea is mostly caused by intestinal infections
(1) gastrointestinal symptoms frequent diarrhea, 10-30 times / day or more, more water and less fecal matter, or mixed with mucus, more dilute water stool, accompanied by abdominal distension and vomiting.
(2) Dehydration: The degree of dehydration is divided into three degrees: mild, medium and severe. Dehydration nature: isotonic, hypotonic, hypertonic three.
Dehydration is generally divided into three degrees.
Mild dehydration: water loss is about 5% of body weight (50ml/kg). The spirit is slightly poor, the skin is dry, the elasticity is slightly low, the eye sockets and fontanelle are slightly sunken, there are tears when crying, the oral mucosa is slightly dry, and the urine volume is slightly reduced.
Moderate dehydration: water loss of about 5% to 10% of body weight or more (50-100ml/kg). Mental depression, dry skin, poor elasticity, slow unfolding of skin folds when pinched, obvious sunken eye sockets and fontanelle, less tears when crying, dry oral mucosa, slightly cold extremities, and reduced urine output.
Severe dehydration: water loss is about 10% of body weight or more (100-120ml/kg). Extremely depressed, indifferent expression, lethargy or coma. The skin is obviously dry and extremely elastic, the skin folds are not easily flattened when pinched, the eye sockets and fontanel are deeply sunken, the eyelids cannot be closed, there are no tears when crying, and the oral mucosa is extremely dry.
The nature of dehydration can be divided into isotonic dehydration, hypotonic dehydration and hypertonic dehydration depending on the ratio of water and electrolyte loss.
(1) Isotonic dehydration: water is lost in proportion to electrolytes, and serum sodium is between 130 and 150 mmol/L (300 to 345 mg%). The ratio of water loss to sodium loss can be different for dehydration due to various etiologies.
The ratio of water loss to sodium loss can be different for various causes of dehydration, but if the difference between the ratios is not large, the body fluid can be maintained in an isotonic state through renal regulation, so isotonic dehydration is more common. This type of dehydration mainly involves the loss of extracellular fluid and is characterized clinically by general symptoms of dehydration.
Such as weight loss, thirst and restlessness, pale and dry skin, reduced elasticity, sunken fontanelle and eye sockets, dry mucous membranes, low heart sounds, reduced saliva and tears, and in severe cases, it may lead to circulatory disorders and shock.
(2) Hypotonic dehydration: loss of electrolytes relatively more than water loss, with blood sodium below 130 mmol/L (300 mg%). This type of dehydration is due to the heavy diarrhea and long duration of the disease, and the loss of fecal sodium is often extremely high; also, because of the water loss during diarrhea, the infusion of glucose alone is not sufficient.
The extracellular fluid osmotic pressure is too low, and part of the water enters into the cells, and the blood volume is obviously reduced. Hypotonic dehydration is more common in malnourished children with prolonged diarrhea and is more severe than the other two types of dehydration when water loss is the same. Shock is more likely to occur because thirst is not evident, while circulating blood volume is significantly reduced. Irritability, drowsiness, coma or convulsions may occur due to cerebral nerve cell edema.
(3) Hypertonic dehydration: Water loss is relatively more than electrolyte loss, with blood sodium exceeding 150 mmol/L (345 mg%). This type of dehydration is due to the high osmolarity of extracellular fluid, and part of the water of intracellular fluid is transferred
The main manifestation is intracellular dehydration. If the diarrhea starts with fever and little water, and if the food intake is not reduced after the disease, it is easy to cause hypertonic dehydration. Abuse of sodium-containing solution treatment, such as oral or injected sodium-containing solution is more (e.g., pure saline rehydration).
The abuse of sodium-containing solution treatment, such as more oral or injected sodium-containing solution (such as pure saline rehydration), can also cause hypertonic dehydration. The signs of dehydration are less severe than the other two types of dehydration with the same amount of water loss, and the symptoms of circulatory disturbance are also the least severe, but shock can occur in severe dehydration. Due to hyperosmolarity and intracellular dehydration, mucous membranes and skin can become dry, resulting in thirst, hyperthermia, restlessness, increased muscle tone, and even convulsions. Severe hyperosmolarity may cause neuronal cell dehydration, brain parenchymal wrinkling, decreased cerebrospinal fluid pressure, cerebrovascular dilatation or even rupture and bleeding (neonatal intracranial hemorrhage), and cerebral thrombosis may occur.
Metabolic acidosis: The child has deep and rapid breathing, malodorous odor, cherry red lips or perioral cyanosis, irritability or depression, and lethargy. Plasma bicarbonate ions are reduced, PH < 7.3.
Hypokalemia: The child is depressed, has a small cry, muscle weakness, abdominal distention, intestinal paralysis, urinary retention, slowed heart rate, low heart sounds, arrhythmia, and in severe cases, death due to cardiac arrest and respiratory muscle paralysis. Serum potassium is lower than 3.5 mmol/l and ECG may be altered to varying degrees.
Hypocalcemia: It is easy to appear in children with diarrhea for a long time or with active rickets, especially easy to occur after the correction of infusion and acidosis, laryngospasm, hand-foot convulsions, and convulsions may occur, and the general serum calcium is below 2mmol/l.
Hypomagnesemia: when the symptoms of hypocalcemia are not treated with calcium, the possibility of this disorder should be considered, blood magnesium is often less than 0.6mmol/l.
Hypophosphatemia: In severe cases, blood phosphorus can be less than 0.5mmol/l, the child can be drowsy, coma, weakness, weakness of myocardial contraction, shallow breathing, hemolysis, diabetes, etc.
Reasons why children are prone to diarrhea in summer
Of the 12 million deaths of children under 5 years of age worldwide each year, up to 3 – 4 million are due to pediatric diarrhea, the second highest after respiratory diseases. Pediatric diarrhea is not an independent disease, but a common manifestation of many diseases, and it can be accompanied by vomiting, fever, abdominal pain, bloating, mucus stools, and bloody stools.
Every year from June to October, most babies between the ages of 6 months and 3 years will face the rampant attack of “summer diarrhea”. It is said that “summer diarrhea” is fiercer than a tiger! With its high incidence, rapid onset, strong persistence, dehydration, complications and high mortality rate, it is important to take diarrhea seriously so that it can be prevented and treated in a timely and targeted manner.
Pediatric diarrhea in summer is determined by the physiological characteristics of the pediatric population. First, because the gastrointestinal tract of children is not mature, less gastric acid, poor bactericidal ability, if too much summer drinks, dilute the gastric acid, resulting in germs can easily break through the gastric acid barrier, into the intestinal tract and cause diarrhea; second, the gastrointestinal tract of children in a variety of digestive enzymes less, not conducive to food digestion, easy to cause indigestion; third, infants and young children grow rapidly, need sufficient nutrition, the burden on the gastrointestinal tract of children is relatively The burden on the gastrointestinal tract of children is relatively heavy and prone to digestive disorders. In addition, the high temperature in summer makes it easy for bacteria to multiply, which is also one of the reasons for increased infection.
Pathogenesis
The etiology of pediatric diarrhea is complex, and the pathogenesis varies.
(A) Infectious diarrhea. Most pathogenic microorganisms enter the digestive tract through ingestion of contaminated water or food or spread through contaminated hands. When the organism’s
defense function decreases, a large number of microorganisms invade and produce virulence can cause diarrhea. For example, rotavirus invades the intestinal tract and damages the small intestinal villus cells, and the ability of the small intestinal mucosa to recycle water and electrolytes decreases causing diarrhea; at the same time, the secondary secretion of disaccharidase is insufficient, making the digestion of sugars in the intestinal lumen incomplete and decomposed by bacteria in the intestinal tract, which increases the osmotic pressure of intestinal fluid and further causes the loss of water and electrolytes, aggravating diarrhea. Diarrhea due to bacterial infection includes enterotoxic enteritis and invasive enteritis. In contrast, pathogenic Escherichia coli does not produce enterotoxin and invasiveness, and the pathogenesis is unclear.
(ii) Non-infectious diarrhea: It is mainly caused by improper diet, mainly in children who are artificially fed. When the quantity and quality of food intake suddenly change beyond the capacity of the digestive tract, food cannot be fully digested and absorbed and accumulates in the upper part of the small intestine, causing local acidity to decrease and bacteria to move up and multiply in the lower part of the intestine, resulting in endogenous infection and digestive dysfunction and increased intestinal peristalsis, causing diarrhea and water-electrolyte disorders. Other mechanisms: such as milk allergy, pancreatic dysfunction, and pancreatic fluid deficiency can cause chronic diarrhea.
Pathogens of diarrhea
The etiology of diarrhea is mainly bacterial or viral.
Viral diarrhea can be caused by viruses, especially rotavirus infection, which occurs in infants and young children from 6 months to 2 years of age, and is generally less common in children under 6 months of age due to the presence of antibodies from the mother, and even if it does occur, it is mild. Clinical manifestations may include fever, diarrhea with watery stools, 5 to 10 times/day or more, and mild vomiting at the beginning of the illness. Because the disease can invade the respiratory tract (also known as “enterovirus”), 40% to 50% of patients have cough and other respiratory symptoms. Diarrhea affects the child’s nutritional absorption in mild cases, but in severe cases it is life-threatening because it is accompanied by dehydration and acidosis.
In children with diarrhea, routine stool examination is required to determine the pathogenic bacteria and to select drugs. Patients with rotavirus infection can often see fat globules in the stool and rarely see red and white blood cells.
The pathogenic diagnosis is often made clinically by rapid rotavirus antigen testing of the stool. For patients with dehydration symptoms, attention should be paid to the correction of water-electrolyte disorders, and blood biochemical tests should be done if necessary. Rotavirus
The natural course of rotavirus enteritis is usually 7-10 days, and the prognosis is generally good, but recent studies have found that rotavirus can cause damage to multiple organs throughout the body, and rotavirus has been reported to be detected in the lung tissue, cerebrospinal fluid, pleural fluid, and ascites of sick children.
The rotavirus has been reported to be detected in the lung tissue, cerebrospinal fluid, pleural fluid and ascites of children, and we often see cases of cardiac involvement in the clinic. Therefore, we should not assume that a child with diarrhea is well just because the diarrhea has stopped; other tests should be done.
How do I know the severity of my child’s illness? Diarrhea is usually classified as mild, moderate or severe according to its severity.
Mild: no symptoms of dehydration or poisoning, the child is in good spirits and appetite is not significantly affected.
Moderate: Mild to moderate symptoms of dehydration or mild symptoms of toxicity.
Severe type: severe dehydration or obvious symptoms of poisoning such as irritability, depression and pallor are already present.
Infants and young children have poorly developed digestive system, less secretion of various digestive enzymes, lower vitality, poor tolerance of food cannot adapt to the large changes in food substances and quantity, due to rapid growth and development, relatively more nutrients are required, and the digestive tract is often under stress.
The digestive tract is heavily burdened and often under stress, which makes it easy for digestive disorders to occur. The acidity in the stomach is lower than that of adults, the antibacterial ability is poor, and the immunoglobulin and gastrointestinal SIgA in the blood are low, making them susceptible to intestinal infections.
Pediatric diarrhea can be caused by non-infectious and infectious causes.
(1) Non-infectious causes include: physiological diarrhea, which occurs when the nutrients in breast milk exceed the physiological needs of the child and the limits of digestive function; improper feeding can cause diarrhea, mostly in artificially fed children, due to irregular feeding, too much or too little amount or inappropriate food components, such as premature feeding of large amounts of starchy or fatty foods, sudden changes in food varieties or weaning; individual children are allergic or intolerant to milk or intolerance to certain food components (such as lactose deficiency), diarrhea can occur after feeding; sudden changes in climate, abdominal cold increases intestinal peristalsis; overheated weather reduces digestive juices secretion, while excessive milk consumption due to thirst increases the burden on the digestive tract, which can easily induce diarrhea.
(2) Infectious causes: divided into intestinal infections and extraintestinal infections.
Intestinal infections can be caused by viruses, bacteria, fungi and parasites, the first two are more common, especially viruses.
Pediatric diarrhea
Viral infections are.
① human rotavirus: the most common cause of diarrhea in infants and children in autumn and winter
② Norwalk virus: mostly invades children and adults, and is not closely related to diarrhea in infants and children.
Bacterial infections.
Infections mainly caused by E. coli and B. dysenteriae.
Pathogenic microorganisms enter the digestive tract with contaminated diet or water, and can also be transmitted through contaminated daily necessities, hands, toys or carriers.
In addition, when suffering from otitis media, upper respiratory tract infection, pneumonia, urinary tract infection, skin infection, etc. or acute infectious diseases, diarrhea may accompany due to fever and toxin action of pathogens to disrupt the function of the digestive tract. Sometimes, pathogens from extraintestinal infections can infect the intestinal tract (mainly viruses) at the same time.
Allergy is an important causative factor
Food allergy or food intolerance is a common cause of diarrhea in children, especially in infants and young children. Specific perceptions include.
1, previously thought that protein foods such as seafood are prone to allergy, it is now recognized that many of the most common those foods: such as rice, wheat, milk, soy, eggs, apples, watermelon, carrots, etc. are causes of diarrhea in children, especially infants and toddlers during the addition of complementary foods.
2. Allergy is a process, a journey. From sensitization to allergy clinical manifestations rash, diarrhea, coughing and wheezing, rhinitis, etc.
3. Allergy to a substance or drug is not necessarily long-term.