According to World Health Organization diarrhea is defined as “The Passage of three or more loose or liquid stools per day”. Increase in frequency of formed stools is not labeled as diarrhea. Diarrhea may last from few days to several weeks dividing it into acute and chronic conditions.
Impact Of Diarrhea
Diarrhea is the second most common cause of the death in children under 5 years of age. As per WHO, diarrhea effects 1.8 million children under 5 years worldwide. Pakistan is is in the top 5 countries affected by Diarrhea. Diarrhea is also a leading cause of malnutrition in children under 5 years and kills about 525,000 children per year worldwide.
A cross sectional study Prevalence and correlates of diarrhea published in Indian Journal of Peadriatics states: “In this population-based study the two-week point prevalence of diarrhea among children 0-3 years was 51%, and these rates were higher among females (53.4%) than among males. A study done in urban Karachi noted a lower prevalence (14.4%) of diarrhea.” According to Mr. Masood Abbasi, Director Save the Children Diarrhea Prevention Programme 27,000 children die of diarrhea annually in Punjab only and is the second most common cause of the death in children.
Source of diarrhea is variable and has a long list. Following are the some common causes of diarrhea in toddlers.
Diarrhea can be viral or bacterial. Viral diarrhea caused by Rota virus is the most common infectious cause of diarrhea in toddlers. It presents as watery tools associated with vomiting, fever and stomach ache. Salmonella and Giardia are the most common bacterial and parasitic causes of infectious diarrhea respectively. Bacterial diarrhea may present with severe bloody diarrhea along with abdominal cramping.
Lack of Clean Drinking Water
A major cause of Diarrhea is lack of access to clean drinking water. WHO states that “A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene”.
Children introduced to solid food mostly suffer from this, the reason being introduction to new food. The toddler will have complains of increase in frequency of loose, foul smelling stools without any associated symptoms.
Some children develop immunity against some otherwise harmless proteins found in different foods. These children suffer from watery or mucus containing diarrhea on exposure to that particular food item along with bloating, abdominal cramping, gas etc. Common allergies are against peanuts, eggs, pulses, gluten, wheat etc.
Food intolerance does not involve immunity but is rather sensitivity to certain foods. The most common is the “lactose intolerance” in toddlers i.e. allergy to cow’s milk. In this condition, the child’s body cannot produce enough enzymes “Lactase” required for the digestion of lactose (sugar found in cow’s milk). Toddler will suffer from severe diarrhea having foul smelling loose stools together with abdominal pain within few hours of consuming dairy products.
Diarrhea can present with other infections especially ear infections. This mostly presents with runny nose, ear pain, cold and fever and is quite common among toddlers on top feed. Antibiotics are another reason of stomach upset and diarrhea in children as a result of killing of normal flora of gut. Ingestion of non-edible particles can also lead to diarrhea. Excess of juices and soft drinks in children can lead to diarrhea as well as abdominal cramping.
Home Based Management
Diarrhea itself is not lethal, but the associated dehydration is the basic cause of death in toddlers. Dehydration due to diarrhea leading to loss of water and electrolytes is a severe threat and should be kept on the top when managing diarrhea either at home or at a clinical setup.
Hence “Oral Rehydration Therapy” is the key towards managing diarrhea and ORS is used for this purpose. ORS is a mixture of salts and sugars that is dissolved in clean water to replace the lost water and salts. In absence of ORS, a similar solution can be made at home with the help of clean water, salt, sugar and lemon juice. This is a home based alternative for people living in rural areas. The fluid replacement must be done post every episode of loose stool.
Breast milk in toddlers is another source of nutrient rich food which helps in doing away with diarrhea.
Moreover, Khichdi(rice and pulses boiled together) is the best source of nutrients and energy for a child suffering from diarrhea. Feeding child with small meals every 3-4 hours is a better option in diarrhea as compared to larger meals.
As diarrhea is a leading cause of child mortality and it is important to manage it appropriately whether at home or in a tertiary care setup.