'Running' child

POSITIVE PARENTING
By PROF DR CHRISTOPHER BOEY CHIONG MENG

It’s very likely that your child will occasionally suffer the runs. It is important to know what to do to when diarrhoea occurs and to prevent it from occurring frequently.

DIARRHOEA is characterised by the passing of increased amounts of loose, watery stools more frequently than usual. It often occurs as a result of poor digestion of ingested food, which leads to an increase in the amount of water in the intestines.

Diarrhoea can also occur when the lining of the colon is inflamed, making it less able to absorb fluids. Diarrhoea can last several days to a week, and is sometimes accompanied by abdominal pain, vomiting or fever.

Some common causes of diarrhoea include:

Infections

A variety of viruses (such as rotavirus), bacteria (such as Escherichia coli and salmonella) and parasites can cause diarrhoea. These germs are highly infectious. Your child may pick up an infectious germ from contact with another child who has it or by touching a contaminated surface such as a toy or a surface of the toilet, and then putting his fingers in his mouth.

Drinking untreated water, contaminated water or unpasteurised milk as well as eating contaminated food or improperly cooked food can also cause viral, bacterial or parasitic infections.

Lactose intolerance

Lactose is a type of sugar found in dairy products. Lactose intolerance means that your child’s body is unable to fully digest and absorb lactose after he has consumed dairy products.

One of the most common symptoms of lactose intolerance is diarrhoea. Lactose intolerance sometimes develops following an episode of acute gastroenteritis, resulting in prolonged diarrhoea.

Protein intolerance

Intolerance to protein such as cow milk protein or soy protein develops in some children and results in a variety of symptoms that include diarrhoea, vomiting, skin rashes and wheezing. Sometimes, such intolerance occurs following an episode of gastroenteritis, but at other times, no precipitating factor is found.

Irritable Bowel Syndrome (IBS)

IBS is a disorder of the intestines that is associated with diarrhoea, constipation, abdominal pain, bloating, or a combination of these symptoms. IBS affects adults as well as children.

If your child has IBS, his intestines may be overly sensitive to certain foods and stress.

Caring for your child

Most cases of mild diarrhoea usually end on their own within a couple of days without medical treatment. There is usually no cause for concern as long as your child is acting normally, drinking adequately and eating enough. You may be tempted to give over-the-counter medications to your child. However, they may not be safe for him. You are strongly advised to check with your doctor before giving any kind of medications to your child.

Anti-diarrhoeal and anti-vomiting drugs are not recommended by the World Health Organization(WHO) in the treatment of acute diarrhoea. The main issue is to maintain adequate hydration.

The most important thing that you need to focus on is to prevent dehydration from occurring in your child. Try taking these measures to help keep your child hydrated and reduce symptoms of diarrhoea:

·Give your child plenty of clear liquids to drink. Oral Rehydration Solutions (ORS) are effective in replacing body fluids quickly and is available in most clinics and pharmacies. Frequent, small amounts of fluids are usually better tolerated than a single large volume. Many toddlers prefer fluids given with a spoon to that via a cup.

·If your child is not vomiting, you can continue feeding him his regular diet. In the case of an infant on breastfeeding, you can even increase his feeds.

·Your child will most probably be able to tolerate foods such as rice, potatoes, bread, cereals, bananas, lean meats, and vegetables. Avoid giving him certain foods such as fatty foods, fried foods or highly seasoned foods for a few days.

·If your child is vomiting and is unable to tolerate fluids by mouth, you should seek your doctor’s advice. In severe cases, hospitalisation is necessary.

Watch out for dehydration

Your child needs adequate levels of salts and electrolytes (minerals such as sodium and potassium) to maintain normal functioning of the body, such as the electric currents that keep his heart beating rhythmically. Disruption of mineral levels and body fluids create an electrolyte imbalance. This imbalance can sometimes be life-threatening.

As such, diarrhoea should not be taken lightly, especially in young children, because frequent watery bowel movements can result in your child losing significant amounts of water and salts. This condition is also known as dehydration.

In the early stages, there may be few signs apart from a dry mouth and increased thirst. Signs of dehydration include: sunken eyes; sunken fontanelles in a baby; dry, wrinkled skin; little or no tears when crying; lack of urine; lethargy or irritability; fatigue or dizziness.

Do not allow your child to reach a stage where he develops signs of dehydration. However, if it has developed, it is important to recognise the signs and get your child assessed by a doctor quickly.

Protect your child

Follow these simple steps below to help prevent your child from getting diarrhoea that is caused by infections:

·Make sure you feed your child dairy products that have been pasteurised in order to destroy harmful bacteria.

·Serve food right away after it has been cooked or reheated. It is better to eat food that is freshly cooked. However, if you’re planning to save the food for later, make sure you refrigerate it. Leaving food out at room temperature can encourage the growth of harmful bacteria.

·Ensure that you serve your child well-cooked foods.

·Teach your child to wash his hands well and often, especially after using the toilet, after touching pets and before eating.

·Keep bathroom surfaces in your home clean.

·If you’re planning to serve your child raw fruits and vegetables, make sure you wash them thoroughly first. Also, ensure that your hands are clean before you peel and cut them into smaller pieces.

·Refrigerate meats as soon as you bring them home from the supermarket.

·Teach your child to avoid drinking water straight from the tap.

·Exercise caution when you buy prepared foods from street vendors for your child.

When to see the doctor

Bring your child to the doctor if:

·Your child’s diarrhoea hasn’t improved within 24 hours.

·Your child is not passing urine.

·Your child has blood in his stools.

·Your child has diarrhoea and is vomiting or suffering from severe abdominal pain.

·Your child feels weak and dizzy or has a high fever.

·Your child is unusually drowsy, unresponsive or irritable.

¦ Prof Dr Christopher Boey Chiong Meng is a professor of paediatrics and consultant paediatric gastroenterologist. This article is not in any way intended as a substitute for medical attention. When in doubt, please consult your doctor. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting Digestive Health Initiative and the Malaysian Society of Gastroenterology & Hepatology that is supported by an educational grant from Vitagen Healthy Tummies Programme. For further information, please visit . To know more about children’s digestive health, please contact 03-5621 1408 or 03-5632 3301 for a free digestive health booklet by the Malaysian Paediatric Association’s Positive Parenting in collaboration with the Malaysian Society of Gastroenterology & Hepatology.