by Mommy MD Guide Stacey Ann Weiland, MD
Infectious diarrhea is one of the most common childhood diseases worldwide, particularly in babies between the ages of 6 and 18 months. While it can be deadly in developing countries, even in the Western world, infectious diarrhea can sometimes be serious enough for parents to seek the advice of a physician, or even require hospitalization for their child.
About 70 percent of all cases of infectious diarrhea are caused by viruses. The most common of these is the rotavirus, which is responsible for 40 percent. Less common, but sometimes more serious, are the bacterial-induced cases, which account for 20 percent, while parasites cause fewer than 5 percent.
Although episodes of infectious diarrhea can occur throughout the year, rotavirus outbreaks show a seasonal pattern in temperate climates, with infections peaking during the winter months.
Generally, the most serious complication of infectious diarrhea is progressive dehydration. Infants may suffer major fluid losses from a combination of continuous watery stools, vomiting, and fever. Infants who develop mild to moderate dehydration may be more agitated or irritable, have diminished tear production, dry mucous membranes, decreased skin turgor, sunken eyes, and decreased urine output. More severe dehydration can lead to lethargy, fast heart rate, deep breathing, cold limbs, and a near absence of urination.
Early and adequate oral rehydration with a glucose-electrolyte solution is the best prevention for complications of infectious diarrhea and hospitalization. Over-the-counter oral rehydration solutions (ORS), such as Enfalyte or Pedialyte, are recommended over and above cola drinks, sports drinks, or homemade mixtures of juice, sugar, salt, and water. Colas contain an excessively high concentration of sugar and little sodium and potassium. Home remedies may lead to severe alterations in a child’s fluid and electrolyte status.
ORS is best given in multiple divided doses over 3 to 4 hours. For infants between 5 and 9 kilograms (11 to 20 pounds), 2 milliliters can be given every minute (120 milliliters /hour). For infants between 9 and 12 kilograms (20 to 26 pounds), 2.5 milliliters can be given every minute (150 milliliters /hour). For infants between 12 and 15 kilograms (26 to 33 pounds), 3.0 milliliters can be given every minute (180 milliliters /hour). If there is no associated vomiting, larger volumes can be given at longer intervals (10 to 15 milliliters every 5 minutes, or 20 to 30 milliliters every 10 minutes). Even for hospitalized children, oral rehydration has proven superior to intravenous therapy.
Breast feeding, formula, and solid food should not be withheld from a child with infectious diarrhea, and should be restarted within 4 to 6 hours after rehydration is started. Further, parents should not switch formulas, change to lactose free, or soy, etc., because this may lead to future food intolerance.
Toddlers should be reintroduced to foods appropriate for their age, starting with complex carbohydrates such as bread, noodles, potatoes, and rice. Juices with a high fructose content, such as apple and pear juice should be avoided.
Probiotics have shown some efficacy in reducing the duration of diarrhea, particularly compounds containing the Lactobacillus species. Antibiotics are generally unnecessary except in certain bacterial- or parasitic-induced cases of infectious diarrhea. Zinc supplementation has undergone intensive investigation in both the treatment and prevention of infectious diarrhea. While recommended by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) since 2004 for children living in developing countries, results in the Western world remain equivocal.
Perhaps the best treatment for your child’s infectious diarrhea is prevention. As with many other infections, breastfeeding has been shown to protect against acute infectious enteritis. Good hygiene also has major benefits. Parents should always wash their hands after diaper changes and before handling food. Consumption of incompletely cooked meats, raw eggs, and unpasteurized milk also increase the risk of infectious diarrhea.
The rotavirus vaccine became available in the United States in February of 2006. Its introduction has led to a dramatic reduction in hospitalizations and emergency treatment due to rotavirus infections. Two different vaccines are currently licensed for infants in the United States, RotaTeq® (RV5) and Rotarix® (RV1). Both varieties can be given in combination with other vaccines and are often paired with the DTaP, Hib, Hepatitis B, Polio, and Pneumoccus vaccinations. The rotavirus vaccine is not a shot, but is given orally at 2, 4, and sometimes 6 months (depending on which vaccine is used).
Want to read more blogs by Mommy MD Guide Stacey Weiland, MD? Here’s her recent blog about raising children to be healthy eaters.