Mother - Dr, my son is 2 years old. He has been passing watery stool 5 times and had vomiting. The same attack occurred to him last month, too. I would like to know the reason behind having diarrhea as well as why children frequently have diarrhea.  

 

Doctor - Diarrhea is defined as having 3 or more watery stools within 24 hours. A frequent bowel movement that is not watery is not diarrhea. The main cause is the fecal-oral route. Rotavirus infection in winter often causes diarrhea. Other bacteria, viruses, parasitic and candida infections can also cause diarrhea. It is especially common in children who did not get enough breast milk from birth to 2 years of age.

 

Mother - I weaned my son at 1 and a half years old. Is this the reason why he is suffering like this now, Dr?

 

Doctor - Yes, this is also a possible cause. In the case of newborn babies, it is recommended to give the child exclusive breastfeeding (not even clean water) from birth to 6 months of age. Bottle-fed children often have diarrhea if hygiene is poor. Unlike mother's breast milk, bottle milk does not contain enough immunity and nutrients, so it is not good for the baby. Therefore, you should not give the bottle milk if it is not necessary. At least until the child is 2 years old, breast milk should be continued. This is one thing. In addition, if the preparation and serving of food is unhygienic, and water is not sanitary, it can lead to diarrhea as well. Those children with reduced immunity and children with measles also often have diarrhea. If there is mucus and blood in the stool, it can be dysentery or intussusception which are way more important, and the child needs to see a doctor immediately and get treatment.

 

Mother – Yes, Dr. Now I know the importance of breast milk. Please tell me how to take care of the child at home if he has diarrhea. What to follow, and what to avoid?

 

Doctor - Parents should know how to take care of a child at home if he has diarrhea. After each time of defecation, ORS (Oral Rehydration Solution) should be given adequately as much as he can tolerate and as much as possible. Depending on the amount of stool passed, the child needs to have enough ORS intake. Parents also need to observe and monitor the signs of dehydration in the child, such as; whether is the child drowsy or asking too much for water, whether can he still pass urine, are the eyes sunken, and whether is there depression in the anterior fontanelle area (Area at the top of the forehead) in under 1 and half years old child. If the child is not vomiting, he can still be fed with his usual diet such as rice, snacks, and suitable fluids.

Children who cannot tolerate ORS can also be given green coconut juice. Or he can be given the congee with a little salt added, yogurt with a little salt added, or some vegetable broth with a little salt added. He can also take purified drinking water as well. What to avoid are coffee, tea, and ready-made commercial carbonated beverages as they can cause more diarrhea.  

 

Mother - Yes, Dr. How can I help if he is vomiting?

 

Doctor - If a child vomits, they should be left for a while without feeding for at least 10 minutes. He can take the anti-vomiting medication prescribed by the doctor with a little water and wait for a while. If he vomits again within 20 minutes, rest for another 15 minutes and give the medicine again. If the vomiting doesn't stop and continues, he should be taken to the nearest hospital/clinic as soon as possible. If there are frequent diarrhea attacks and vomiting, and still the fluid intake is not tolerable, the child can develop dehydration and reduced blood pressure. If that occurs, it is very dangerous for him and he should be taken to the hospital in time. That’s why, please do not hesitate to go to the hospital when necessary depending on the child’s condition.  

 

Mother - Yes, Dr. So, how can we prevent diarrhea?

 

Doctor - Now, in the Expanded Program of Immunization in our country, the Rotavirus vaccine is given twice at the age of 2 months and 4 months. The child should also be vaccinated against measles. Also, the 4 hygiene measures like (1) clean hands, (2) clean food (3) water clean and (4) clean latrine should be practiced. By this means, diarrhea can be prevented to a certain extent. What else do you want to know, Mom?

 

Mother - Yes, I understand quite well and I have no further questions. Thank you for explaining so thoroughly, Dr.

 

Doctor - My pleasure.