What should I do if my child has diarrhea?

In my country, diarrhea in children is the second most common disease (after respiratory tract infection). The following June to October is the peak season for childhood diarrhea, and many new parents are often at a loss as to what to do. So, what to do if your child has diarrhea?

Pediatrics in the medical field refers to children aged 0 to 14 years old, during which most of them have not yet reached sexual maturity. Therefore, there is no obvious gender distinction in the disease. All drug treatments need to be given based on the child's weight. These are all different from adults. So what is diarrhea? I believe everyone has experienced it personally. Simply put, it means: increased frequency of bowel movements (>3 times a day) and unformed, mushy or watery stools. Like a cough, diarrhea is just a symptom, a symptom that can be caused by many diseases. This symptom can cause harm, which is a little different from coughing. Acute diarrhea can cause serious harm such as dehydration, electrolyte imbalance, acidosis, etc. Chronic diarrhea can cause malnutrition, growth and development disorders, etc. Therefore, children's diarrhea should be given enough attention by parents.

Among children with diarrhea, most occur in infants under 2 years old. Why is that? It turns out that after a baby is born, the organs and tissues of the human body are immature. I believe everyone can understand this. Take the digestive tract of infants and young children for example. The stomach acid is not acidic enough and the amount secreted is small, which will lead to a decrease in bactericidal ability; the digestive enzyme activity is low and the secretion is small, which will lead to a decrease in digestive ability; and because infants and young children grow rapidly, their demand for energy and nutrition is high, which will increase the burden on the gastrointestinal tract; and the incoordination of the nervous system will lead to gastrointestinal dysfunction; and low gastrointestinal immunity, intestinal flora imbalance, etc. are all internal factors that make infants and young children prone to illness.

If you cannot breastfeed, you will also lack the anti-infection substances in breast milk. It is now known that breast milk contains hundreds of ingredients, which is impossible for milk powder manufacturers to produce. What's more, it also contains immune cells, immunoglobulins, and human growth factors. For example, macrophages, neutrophils, lymphocytes, secretory IgA, IgG, IgM, IgD, glycoproteins prevent cholera bacteria from binding, mucins prevent Streptococcus agglomerus and Escherichia coli from binding, lactose adhesion proteins prevent rotavirus binding, and so on. None of these can be replaced by artificial feeding. Artificial feeding can also lead to milk contamination, etc. These are external factors, and they are non-infectious factors.

Among the non-infectious external factors, the following reasons are often included. For example, bait diarrhea (i.e. improper feeding), primary or secondary disaccharidase deficiency, food allergies, food intolerance, and hot or cold climates, etc.

【Bait-induced diarrhea】

In short: eating too much or too little, not feeding according to scientific principles, and arbitrarily adding complementary foods can cause diarrhea. If there are too many carbohydrates, it will lead to a relative deficiency of amylase, causing indigestion and the child's stool will become green, watery or mushy. If there is too much protein, the child’s stool will be yellow-brown, watery, and have a pungent smell of rotten eggs. If children eat too much fat, their stool will be grayish white, loose and have a strong odor. How to feed scientifically is not discussed in this article.

Lactose intolerance

Lactose is a sugar found in milk and other dairy products. Due to the lack of lactase in the intestines to digest lactose, or the weak activity of lactase, lactose products will accumulate in the intestines. Lactose products are "hypertonic" and absorb water, drawing the water out of the intestinal wall, which is called osmosis. When there is too much water in the intestines, diarrhea will occur. This is osmotic diarrhea. Therefore, the treatment method is to give lactose-free or low-lactose dairy products, such as yogurt, cheese, and formula milk with lactose removed. Another thing is to drink milk in small amounts and multiple times to allow the stomach and intestines to gradually adapt.

【Milk allergy】

The symptoms of milk allergy are somewhat similar to those of lactose intolerance, both of which include abdominal bloating, abdominal pain, diarrhea, etc., but milk allergy also has allergic symptoms such as skin itching, urticaria and eczema, allergic rhinitis, etc. This is due to the difference in their pathogenesis. These days, everyone knows from popular science that protein is digested into amino acids by intestinal enzymes and then absorbed. However, some trace amounts of protein will be absorbed by the intestines without being digested and enter the blood. Such protein will become an "allergen" in the human body, stimulating lymphocytes to produce immunoglobulin E (IgE). When this trace amount of protein enters the human body next time, it will combine with IgE to produce an immune response, leading to the appearance of allergic symptoms. So for babies, the best food is breast milk. Babies who are allergic to cow's milk should use other foods instead, but do not use milk from other mammals (such as goat's milk) because cross immunity will occur. It is best to have plant protein (soy milk, soy milk), etc. After stopping taking it for 3 years, you can try again with a small amount.

In addition, if children catch a cold, it will cause their intestines to move faster and cause diarrhea. Just keep warm appropriately.

Another type of external factors is infectious factors, which are pathogens that cause diarrhea. There are dozens of pathogens known to cause diarrhea, among which bacteria and viruses account for the majority. Bacterial ones include Shigella, Escherichia coli, Salmonella, Yersinia, Vibrio cholerae, etc., and viral ones include rotavirus, adenovirus, astrovirus, parvovirus, calicivirus, etc. Among the bacteria mentioned above, except for Escherichia coli and Vibrio cholerae, you may be unfamiliar with the others. Perhaps it would be easier to understand if we mention some common names. Shigella, commonly known as Shigella dysenteriae; Salmonella includes typhoid and paratyphoid.

Diagnosis of diarrhea in children is relatively easy. But there are some new ideas in treatment.

1. According to traditional concepts, fasting is required during acute diarrhea. But the new concept is to encourage continued feeding, unless the child has severe vomiting or obvious abdominal distension or diarrhea after eating, then he can temporarily fast for 4 to 6 hours.

2. Children should be given nutritious and easily digestible food in small amounts and multiple times. Avoid eating vegetables and fruits containing crude fiber, as well as foods high in sugar. Children with acute diarrhea can continue to eat the complementary foods that have been added before, but they should avoid greasy and fatty foods. The complementary food that has not been eaten should be added after the diarrhea is cured.

3. Children with prolonged and chronic diarrhea have microvilli atrophy, intestinal epithelial cell damage, and disaccharidase deficiency due to intestinal mucosal lesions, which lead to disaccharide (sucrose, lactose, maltose) digestion and absorption dysfunction, which can easily cause disaccharide (especially lactose) intolerance. Disaccharides should be removed from the diet, and lactose-free milk powder or lactose-free soy milk powder (commonly known as diarrhea milk powder) should be selected.

4. If the child’s dehydration is not severe, he or she can receive ORS (oral rehydration salts) recommended by WHO to reduce the need for intravenous rehydration.

5. Avoid irregular antibiotic treatment for diarrhea, as such treatment is ineffective, increases adverse reactions, and can lead to bacterial resistance. Even when antibiotics are needed, some medicines should be avoided in children. For example, quinolones, which are very effective in treating bacterial diarrhea, can affect children's bone development and should be avoided.

6. A large amount of evidence shows that about 70% of watery diarrhea is caused by rotavirus or enterotoxigenic E. coli (ETEC) infection, and does not require antibiotic treatment. Children can recover on their own with proper fluid therapy. However, some doctors still prefer to use Chinese herbal injections for viral diarrhea, which have little positive effect but great side effects, such as Xi Yan Ping.

7. Literature reports suggest that zinc supplementation can reduce fecal excretion, reduce the frequency of diarrhea, shorten the course of diarrhea, and prevent recurrence of diarrhea.

Specific usage: Zinc supplementation should be given after the child is able to eat. Children over 6 months old should be supplemented with 20 mg of elemental zinc per day, and children under 6 months old should be supplemented with 10 mg of elemental zinc per day, for a total of 10 to 14 days (20 mg of elemental zinc is equivalent to 100 mg of zinc sulfate and 140 mg of zinc gluconate).

8. Other medications. Intestinal mucosal protective agent montmorillonite (Smectite); glutamine, a nutrient required for intestinal mucosal growth; and racecadotril, an enkephalinase inhibitor that can inhibit the secretory function of the small intestine. It is also a safe and effective antidiarrheal drug for children, which can control diarrhea within 24 to 48 hours.