Fall diarrhea, as the name implies, is a diarrhea that tends to occur in the fall. The epidemic season for fall diarrhea is from September to January each year, with October to December being the peak of the epidemic. Autumn diarrhea generally occurs in infants and children aged 0.5-3 years, and is more likely to occur in infants and children with malnutrition, rickets, anemia and frailty, and to be severe and long-lasting. Children with more frequent diarrhea also suffer from varying degrees of dehydration, acidosis and electrolyte disorders, which can be life-threatening in serious cases, so it should not be underestimated.
Why are children prone to diarrhea in autumn?
What are the key points of treatment for diarrhea in autumn? In addition, some primary care physicians may have referred some children with fall diarrhea due to inadequate treatment. Here we ask the receiving specialist to tell us where you may have gone wrong.
The principles of treatment for fall diarrhea include prevention of dehydration, correction of dehydration, adjustment of diet, and rational use of medication. Care should be taken not to blindly fast and blindly apply antibiotics and antidiarrheal medications during treatment.
Disease characteristics
”Bullying”, more likely to invade infants and children
Fall diarrhea generally occurs in infants and children aged 0.5-3 years, although adults also occasionally have fall diarrhea, but the condition is mild and usually heals in 2-3 d. Why does fall diarrhea come on so aggressively in the fall and is more likely to affect infants and young children? This starts with the physiological characteristics of infants and young children and the microorganisms that cause the disease.
Infants and young children have poor immune function and are vulnerable to pathogenic microorganisms. The main pathogenic microorganism that causes autumn 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 characteristics of autumn diarrhea are vomiting followed by diarrhea with fever and watery or egg-flake like stools, with a self-limiting course, and the clinical manifestations of the child are as follows.
1, the onset of the disease is rapid, the initial period is often accompanied by cold symptoms, such as cough, nasal congestion, runny nose, some children with fever, generally low fever, rarely high fever.
2, the number of stools increased, about 10 times / d (> 3 times should be considered autumn diarrhea), the stool is white, yellow or green egg flower soup-like, with a little mucus, no fishy smell.
3, half of the children will appear vomiting. Most of the vomiting symptoms occur at the beginning of the course of the disease, generally ≤ 3 d.
4, heavy diarrhea may appear dehydration symptoms, such as thirst obvious, urine volume decreased, irritable.
5. The course of the disease is self-limiting, usually 5-7 d. The duration of diarrhea may be longer in malnourished, rickets and frail patients.
Tips for patients
When a child has diarrhea, parents should pay attention to his or her specific conditions, such as changes in mental state, mental status, facial color, temperature of the limbs, pulse, etc.; pay attention to the presence of dehydration and whether it improves or worsens; observe the number, amount and character of the child’s stools and urine, and keep careful records. At the same time, pay attention to keep some fresh stools and send them to the hospital for laboratory tests in time to provide a reliable basis for diagnosis and treatment of the disease.
Treatment points and common misunderstandings
Prevention and treatment of dehydration is the top priority
For those who are mildly dehydrated or vomiting is not serious, they can be treated at home, and the most important thing is to take in enough fluids to prevent dehydration. There are three ways to prevent and treat dehydration.
① Rice soup with salt, 500 mL 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, and then add fine salt 1.75 g.
③Take oral rehydration salts, which are available in major pharmacies, and take them with water as prescribed.
For moderate or severe dehydration, intravenous rehydration solution should be given.
Common misconceptions: generalized advice to “drink more water”
A small number of children were referred from the primary care level, and we learned from their parents that there are two situations.
(1) The initial doctor only tells the parents in general terms that the child should “drink more water” without knowing that electrolyte replacement is also needed.
Some doctors know that they cannot just drink more water, but tell parents to “drink sugar and salt water at home: put some sugar, salt and water and drink more” – these are the easy methods that many rural doctors often implement. As a doctor, you should know that the sugar and salt in oral rehydration solution must be in a certain ratio and used properly to be effective, otherwise it may be counterproductive.
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 one has diarrhea, and one cannot rely on infusions, 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. So, what kind of meals should be eaten during diarrhea in order not to aggravate diarrhea but also to prevent and control malnutrition? This is a concern for diarrhea patients and an important subject of research by experts at home and abroad.
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. If possible, add broth, chopped beef and chicken, cook for 1-2 h on a gentle fire, remove the dregs and cool, then skim off the upper layer of oil. If necessary, drink fresh fruit juices such as watermelon juice.
Common misconception: blind fasting without differentiating the situation
Some children referred from the primary care level have had diarrhea for two or three days and have passed the vomiting period, but are still fasting. When asked why, family members say: the primary care physician does not allow milk or food. When asked about the reason, the family said that the initial doctor did not allow them to take milk or eat.
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.
Protection of the mucosa of the digestive tract
Montelukast can make pathogens less likely to invade the intestinal wall, protect and promote the 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 pack needs to be taken manually in 3 oral doses for 3-6 d.
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 Emmentaler, which is prohibited for children <5 years old, and Antidiarrheal, which is prohibited for children <2 years old.
Misuse 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 more harmful they are, and haloperidol and tetracycline should not be used.
Scientific care helps to recover from the disease
In addition to hydration and dietary adjustments as recommended by doctors, scientific care by parents can help children recover from the disease.
1, once diagnosed with fall diarrhea, parents should minimize taking their children outside, to keep the indoor air fresh and air circulation.
2, home isolation and disinfection. All items used by the child (diapers, clothing, toys, books, etc.) should be thoroughly cleaned and disinfected.
Parents should wash their hands carefully before and after caring for the child to prevent cross-infection.
4. Pay attention to the child’s abdomen to keep it warm. The climate is getting cooler in autumn, 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 faster, which will aggravate the diarrhea. Parents can appropriately use hot water bags to apply hot compresses to the child’s abdomen, and can also help the child rub his or her stomach lightly to relieve his or her pain.
5, protect the affected 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.