Diarrhea with children

Diarrhea (diarrhea) insists, if your child has bowel movement considerably more often than common and the consistence of the stool is fluider as or else. The most frequent cause is a stomach intestine mucosa inflammation or gastroenteritis which is caused by pathogens. Vomiting is frequently another symptom of this disease (summer chol-era). Besides this nutrition errors (primarily at infants), allergies, the hereditary dis-ease cystic fibrosis or celiac disease, a food intolerance also can be the reasons for the diarrhea. With children, (primarily at infants), by the strong fluid loss, diarrhea ill-nesses have an effect more rapidly and more strongly than with adults since their water share in the fat-free body mass is higher around a third. A diarrhea illness pri-marily into combination with vomiting and/or fever can expand up to the shock.

The pathogenes of the diarrheas in the childhood are mainly viruses and bacteria. Diarrheas caused by viruses in large numbers appear in winter, diarrheas more fre-quently caused on the other hand in summer bacterially.

¾ of all diarrhea illnesses are caused by the rotavirus with children up to four years. Sometimes the infants already catch it in the birth clinic.

The but also following causative agents are responsible for the diarrhea:

  • Viruses: Adeno, Entero, Astro and Norwalk viruses,
  • Bacteria: Salmonellae (the most frequent causative agent at food poisonings), Shigellen, certain E. coli stems (EHEC), Campylobacter jejuni, Yer-sinien, Colstridium difficile; rare Choleravibrionen or Staphylococcus aureus,
  • Single-celled organisms (Protozoen): Giardia intestinalis, Entamoeba histolyt-ica.
The assignment of the causative agents frequently happens to ice, water, unwashed fruit and salads by food, such as eggs, meat, mayonnaise, milk. Becoming mainly bacterial shoots by improper positioning and processing of food, transferred such as salmonellae. The infection with rotaviren happens virtually about the air (breathe in). Also an infection is possible, alone by use of the same toilet (nursery school)!. The incubation period is 4 to 48 hours for common. The clinical picture appears as follows:

There are two manifestations of the gastroenteritis. The inflammation is accompanied by colicky abdominal pains and mucously till bloody diarrheas but without vomiting or with stomach intestine troubles, like diarrhea and vomiting.

The first symptom of an acute gastroenteritis is the appetite loss among the children. Babies are often already whining in the front-end, don't have much interest in their environment and are drinking decayed. A light till high fever can appear. It can very suddenly then come to vomiting and diarrhea. The stool smells more putrid and worse than common. The abdomen is blown out and lively bowel sounds can be heard. Older children complain of intense, convulsive stomach ache. The heaviness of the illness depends on the set of the water loss and the loss con-nected with that of essential salts (electrolytes). The younger one child is, the more rapidly the loss can lead and get life-threatening to waters and electrolytes for the end drying of the body.

A clear weight loss is accompanied by the water loss. The elasticity of the skin de-creases. A raised skinfold smooths itself more slowly or even stops. The eyes are shiny and lie deeply in the orbits. The child is sluggish, indifferent till dazed. It has to be observed primarily at infants that they get apathic after a phase of the hyperkine-sia (cries and whine) suddenly. The entered rest isn't a sign that everything is all right but, that the water loss (dehydration) is already far advanced. If the water loss is very big, the child into a shock condition advisable, seizures can be able appear.

A diarrhea illness always represents a seriousness increasing illness at an infant which can get life-threatening without medical treatment. You always therefore go , if your infant breaks and/or has diarrhea longer than 6 hours or you notice symptoms like in table described below at your child to the physician. With nursery school children you not longer than 12 hours, with schoolchildren don't wait until the physi-cian visit longer than 18 hours unless the condition of the child improves. Diarrhea and abdomen spasms also can point to a typhlitis. Inform your physician color, con-spicuously nasty smell as well as mucus or blood additions of the stool.

The symptoms of the end drying as a result of acute diarrheas are judged by a cer-tain score. Your physician will derive its therapy from it.

  Weight loss Symptoms
Lighter From drying condition < 5% Thirst and hyperkinesia (cries)
Of medium difficulty From drying condition 5 - 10 % Fontanelle at infants sunk in, Indifference (apathy,) gray skin color, flabby skin, dry mucosas (tongue), rare urination,
Heavy end drying condition more than 10% of the body weight Orbits sunk in, Consciousness ring opacity up to the coma, Shock symptoms

The objective of every medical treatment at gastroenteritis is primarily the replenish of the body with fluid (rehydration). Electrolyte and nutrients also must be supplied again. The damaged intestinal mucosa is spared by a diet.

The therapy goes by the age of the child, the fluid loss and whether vomiting still ar-rives at the diarrhea. Don't cure a diarrhea illness at your infant without a medical piece of advice. Your physician will start the corresponding medical treatment. An introduction to a clinic is necessary at a solid water loss. Perhaps a substitution of the fluid must be carried out via a drip (intravenous fluid supply). This is primarily necessary if the baby breaks open strongly. The diarrhea is in the foreground of the gastroenteritis and the fluid loss isn't critical yet, at first a tea break is carried out at infants. They then get a special diet to spare stomach and intestine.

Your child should drink about 100 to 150 milliliters of fluid per kilogram of body weight in 24 hours. Your physician will order you an electrolyte solution for this with glucose (dextrose). If your baby doesn't like this drink, then you can mix tea (fennel, chamo-miles, peppermint, herbs or black tea) to this. Apple juice or juices which it otherwise likes are as well appropriate as an addition. If all experiments with these products should fail, then you also can do a drink yourself. The child likes give you on a liter of fluid (tea, this one) sift teaspoons of dextrose and a teaspoon of salt, mineral water coal low in acid. It can be necessary to give a table spoon at first every five minutes. Increasing the supplied amount of fluid after this slowly (every 15 minutes 50 milliliters). After six hours tea break you can start with a diet construction with a definite food.

A customary therapeutic diet can already be given in the newborn child age. Rice gruel also seems stomach calming within the first two life months. As of the sixth till eighth life week carrot soup or carrot pap also can be fed as of the apple grated third month rawly and banana mouse. As of the fourth life month crushed carrots and boiled potatos are permitted in addition. Observe the diet after recovery of the diarrhea two days, too. Then go over to the usual nutrition.

With children who are already half a year oldly the following diet score can be used at summer cholera. The supply of fluid about infusions can be necessary at unquench-able vomiting and strong dehydration once.

Possible diet score at summer cholera:
  • Bei Erbrechen zunächst 1 Zäpfchen oder Teelöffel bzw. Tropfen eines
  • Anti emetics give after prescription of the physician.
  • An hour no nutrition or fluid supply!
  • Giving 3 teaspoons of Coca-Cola (no dietcoke), tea (see) above or electrolyte solution (prepared with and without tea/juice or himself) every 15 minutes only after this time. None, however, use Coke at heavy diarrheas. The tea also in the sleep, give, for example with the flask.
  • Have eaten at every tea gift a pretzel stick!
  • After stopping only the vomiting start with feeding soups (around 3 hours la-ter). Also giving the soup by the teaspoonful. Gravel, rice, rubs with inlays use a clear, low-fat meat soup as soup (asterisk, gruel, rice gruel), letters. The broth can be given of course also purely.
  • Further foods are possible: Banana and apple (grated), mashed potatoes (half water, half milk), potatoes with carrot vegetables (in low-fat broth cooked), potato soup, rice with bright sauce (no onion sauces because of winds), rusk, old rolls, old white bread, huckleberry juice or huckleberry compote.
  • A normal milk should be avoided if possible. Therapeutic diet is the best.
The meals should be kept small and not certainly be carried out at usual eating times. 10 little meals are better than 5 great ones! Ordered medicines against diarrhea should be taken only if you don't break open any more.

The duration of the illness is 3 to 5 days for common. In more difficult cases a certain bland diet (normal diet at which the fat and lactose content is reduced) must be given over some weeks until the stools of the child fallen ill have brought themselves back to normal completely.

Complications appear at gastroenteritises rarely. It can, however, come to an intesti-nal obstruction. With infants and newborn childs the development of a cow milk is protein intolerance possibly. By the attacked intestinal mucosa the blood of the baby gets in contact with the proteins from the cow milk. The child then can form antibod-ies against these proteins.

A preventive measure against diarrheas is avoiding superannuated, bad and not well-done foods. Poultry, ice, cream, mayonnaises and sweets which are prepared with raw eggs (for example tiramisu) are salmonella at risk. The sick person making shoots increase explosively primarily in summer at not sufficient cooling.

It is the best protection, the dreaded infections with the EHEC causative agent (en-terohemorrhagic E. Coli) from the way to go, to drink no raw milk or raw milk directly of the farmer and to cook beef through always before the consumption well.

Salads and fruit should always be washed well since the prolonged gestation of diar-rhea causative agents is possible also through them. If a child or another member of the family has fallen ill with diarrhea, then hygiene is supreme commandment to avoid illness of the complete family around one (hands washes, toilet, light switches and door handles disinfects). Being able to do against diarrhea preventively, already being given at infants, medicines with medical yeasts.


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