Paediatrics: Acute diarrhoea
Normal stool frequency and consistency vary, e.g. breastfed infants may pass 10–12 stools per day, primary school children may pass stool from three times a day to once every three days.
Normal stool frequency and consistency vary, e.g. breastfed infants may pass 10–12 stools per day, primary school children may pass stool from three times a day to once every three days. Diarrhoea is a change in consistency and frequency of stools with enough loss of fluid and electrolytes to cause illness. It kills 3 million children per year worldwide.
- Infective gastroenteritis. Most common cause.
- Non-enteric infections, e.g. respiratory tract.
- Food hypersensitivity reactions.
- Drugs, e.g. antibiotics.
- Henoch–Schönlein purpura (HSP).
- Intussusception (<4yrs).
- Haemolytic–uraemic syndrome.
- Pseudomembranous enterocolitis.
- Fever +/– vomiting (infectious gastroenteritis).
- Diarrhoea +/– bloody stools (colitis—infectious or non-infectious).
- Dehydration and ‘fall’ consciousness.
- Assess hydration and vital signs, pallor (blood loss), abdominal tenderness, signs of associated illness (e.g. petechial rash in HSP).
- Mild/moderate dehydration:
- no tests necessary;
- replace fluid and electrolyte losses with oral glucose–electrolyte based rehydration fluid, e.g. Dioralyte®(UK).
- Severe/shock dehydration:
- U&E, creatinine, FBC, blood gas, stool M, C&S/virology, tests for a specific disease (e.g. US in suspected intussusception);
- IV fluid and electrolyte replacement.
- Anti-motility drug treatment is not recommended; it can be harmful, particularly in acute infection/inflammation.
- Antibiotics are not indicated unless a cause is proven, e.g. Yersiniaor Campylobacter infection, parasitic infection, NEC, or proven bacteraemia/systemic infection.
- Another treatment is disease-specific. Some diarrhoeal processes require removal of the offending agent, such as lactose intolerance or coeliac disease or allergic gastroenteritis. Others may require bowel rest or surgery, e.g. NEC or intussusception.
- Once rehydrated, resume a normal diet. Replace ongoing losses. Continue breastfeeding. There is no evidence that prolonged starvation is beneficial in infective gastroenteritis.
- Prevent cross-infection with strict handwashing and barrier nursing. In the less developed world, breastfeeding, provision of clean water, and adequate sanitation are also important to reduce the risk of infection.
- The majority of cases, particularly if caused by infective gastroenteritis, make a complete recovery with appropriate treatment.