It can be quite distressing for both you and your child when your child has diarrhoea, as episodes of incontinence can cause both embarrassment and fear for your little one. Diarrhoea can either be acute, which means that it has a sudden onset and a short duration (less than two weeks) or it can be chronic, which means that it is long-term and persistent. Fortunately, most cases of childhood diarrhoea are of the acute form and usually last only a few days.
What causes acute diarrhoea?
Usually, an infection of the gut (gastroenteritis) is the common cause. This infective agent is often a virus or bacteria. Viruses that cause diarrhoea are easily spread from person to person by close contact, or when an infected person prepares food which is then eaten by others. Food poisoning is usually caused by a bacterial infection; either the bacteria itself or the toxins (poisons) that it produces. Another group of microbes called parasites can also be a cause of food poisoning. Water contaminated by bacteria or other germs is another cause of infective diarrhoea, but this form of transmission is not so common in countries that have good sanitation. There are also non-infectious causes of acute diarrhoea, such as colitis (inflammation of the gut) food intolerance and various rare disorders, but these are uncommon in children.
What are the symptoms of acute infectious diarrhoea?
Symptoms can range in severity from a mild stomach upset for one or two days with slight diarrhoea to severe watery diarrhoea and stomach cramps for several days or longer. Blood or mucus can appear in the stools (faeces) with some infections. There may also be vomiting, high temperature (fever), headache and aching limbs and joints. Usually the most serious symptoms are seen when the diarrhoea causes dehydration.
Symptoms of dehydration
Diarrhoea and vomiting can deplete a child’s levels of fluid in the body and lead to dehydration, which is potentially very serious. Mild dehydration is common and is usually easily reversed by ensuring an increased intake of fluids. Severe dehydration is potentially much more serious and can even be fatal, as the body’s organs need a certain amount of fluid to function properly. You should seek an urgent appointment with your doctor if you see the following symptoms of dehydration in your child:
- Only passing small amounts of urine,
- Dry mouth, dry tongue or lips
- Fewer tears when crying
- Sunken eyes
- Weakness, irritability, drowsiness, lethargy.
- Pale or mottled skin
- Cold hands or feet
Dehydration in children with acute diarrhoea is more likely to occur in those who have a severe infection, particularly if they have passed six or more diarrhoea stools and/or vomited three or more times in the previous 24 hours. It is also seen in those who may have a less severe infection but who do not drink enough fluids.
When should I seek medical advice?
Most children with diarrhoea have mild symptoms which resole in a few days without the need for medical intervention, as their immune system is usually able to clear the infection. The important thing is to ensure that they have plenty to drink to keep them well hydrated. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop. You should seek medical advice in the following situations, or if you are in any way concerned:
- If your child has an existing medical condition
- If you suspect dehydration
- If your child has a fever
- If your child appears drowsy or confused.
- If your child is drinking but unable to keep fluids down.
- If there is blood in their diarrhoea or vomit.
- If your child has severe abdominal pain.
- If they have recently returned from abroad.
- If your child’s symptoms are not settling (for example, vomiting for more than 1-2 days, or diarrhoea for more than 3-4 days).
Fluids to prevent dehydration
If your child develops diarrhoea, you should encourage them to drink plenty of fluids to prevent dehydration, as the fluid lost in their diarrhoea (and vomiting) needs to be replaced. Fruit juices or fizzy soda drinks should be avoided, as these can make diarrhoea worse. If you have sought medical advice because you are concerned for any reason, your doctor may advise rehydration drinks, which provide a perfect balance of water, salts, and sugar. These are available in sachets from pharmacies and on prescription. You should not attempt to use home-made salt/sugar drinks, as the ratio and quantities of salt and sugar need to be precise. If your child is vomiting when you are trying to give them fluids, you should wait 5-10 minutes and then try again, but with smaller sips. If they are persistently unable to keep fluids down or you suspect that your child is becoming dehydrated, you should seek medical advice urgently. They may require intravenous fluids in the form of a ‘drip’ which will need to be administered in a hospital setting.
Medication is not usually needed to treat diarrhoea in children. You should not give children medication to prevent diarrhoea unless a doctor has said that it is okay, as many such medicines slow down the motility of the gut and although this may reduce the episodes of diarrhoea, it can also prevent the organisms that cause it from being expelled from the body, allowing them to multiply even further in the gut.
Preventing the spread of infection
Diarrhoeal infections are highly communicable and can be very easily passed from one person to another. If your child develops diarrhoea, you should make sure that you do the following:
- Make sure your child washes their hands thoroughly after going to the toilet.
- Clean your toilets at least daily with disinfectant. Ensure that you include the handle, seat, sink taps, bathroom surfaces and door handles.
- If a potty is being used, the contents should be disposed of into a toilet, then the potty washed with hot water and detergent and left to dry.
- If your child’s clothing or bedding is soiled, it should be washed separately in the highest temperature setting on your washing machine.
- Ensure that your child has their own towel and flannel and that they exclusively use these.
- Don’t let your child help in food preparation.
- They should stay away from nursery until at least 48 hours after the last episode of diarrhoea or vomiting. Some types of infection will require a longer period of time away to be safe – you can ask your doctor about this.
- If the cause of diarrhoea is identified as (or suspected to be) an infective agent called Cryptosporidium, your child should not swim in swimming pools for two weeks after the last episode of diarrhoea. That’s because this particular pathogen has a spore phase which can survive for lengthy periods in water.
The most effective measure to protect against infective diarrhoea is the simple measure of washing hands regularly with soap and warm water. This is known to make a big difference to the chance of developing gut infections and diarrhoea. You should also take extra measures when travelling abroad to countries where sanitation might be poor. In these countries, you should avoid drinking tap water and putting ice cubes into your drink unless you are sure that bottled water was used to make them. You should take care at salad bars as well, as some hotels (even top ones) wash their salads in unsafe tap water.