Childhood diarrhoeal disease

Acute diarrhoea disease kills more than 1 million children under-5 every year. World health organisation estimated that each child may suffer from 3 episodes of acute diarrhoeal disease each year. Therefore it has significant impact on family.
Acute diarrhoea is characterised by loose motions with more frequency than normal bowel habit. It is mostly caused by infectious organism, hence doctors may use the term gastroenteritis.

What causes diarrhoeal disease?
Most childhood diarrhoeal illnesses are caused by viruses, especially Rotavirus, which is easily spread in nurseries. Occasionally the bacterial organism may be the cause, especially if the loose stool is mixed with blood.

What food can give my child when he has diarrhoea?

• For babies <1-year-old, continue breastmilk/ infant formula if the child can tolerate. If not, best check with a doctor as they may lose water (dehydrated) too quickly.
• For children >1-year-old, simple food such as rice, wheat bread, pasta, oat/ rice porridge, potatoes, boiled egg, lean meat, and mashed apple, can be given. ORS should be given after each diarrhoeal episode.
• DON'T GIVE fatty foods (french fries, roti canai, cheese, fried chicken)
• DON'T GIVE sugary drinks including soft drinks (coca-cola, pepsi, juice)

What to do for vomiting?

• Give small sips for clear fluids every 10-15 minutes
• If the child vomits but is NOT dehydrated, wait for 30-60 minutes before trying again. Stop if the child vomits again, bring to see a doctor.

Can I give anti-vomiting medicine?

No, some of these medicine are suitable for children, and can be harmful at times.

Can I give anti-diarrhoeal medicine?

Most diarrhoeal illness lasts 3-6 days. Don't worry if your child acts well and is eating and drinking as usual. If he develops danger signs, do bring him to see a doctor.

What is the ORS sachet that my doctor has given?

ORS is Oral Rehydration Salt, if follow instruction correctly, this rehydration regime contains a perfect balance of salt, sugar and water for children suffering from diarrhoeal illness. The small amount of sugar and salt helps the water to be absorbed faster from the gut into the body. Do not use flat soda drink or sugary juice, which may have make the diarrhea worse. Extra fluids need to be given with ongoing diarrhoea or vomiting.

What about zinc supplement or probiotics?

Probiotics and zinc supplement have been showed to be beneficial in some countries, but as an adjunct treatment to rehydration regime, and needs to be taken under medical supervision.

Will antibiotics help?

Most acute diarrhoeal illnesses are caused by viruses, so antibiotics rarely help, and may make symptoms worse. However, in exceptional, e.g. those  with dysentery (stools mixed with mucus and blood), antibiotics may be used.

Preventive measurements for diarrhoeal disease

• Exclusive breastfeeding is known to reduce acute diarrhoea episodes for those under 2-year-old.
• Good hand hygiene practice: wash your hands before- and after- meals; wash your hands before- and after-meals, wash your hands after been to toilet.
• Good hygiene practice for food preparation and storage.
• Rotavirus vaccines: There are two types of vaccines available in the market, and are given to children from 2-month-old. (Please ask your doctor for further details)

Danger signs (watch for the following signs, if they are present, please bring your child to see a doctor)

• A fever >39*C
• Blood in the stool or vomit
• Green vomit
• Persistent vomit >12-hour or diarrhoea >2-day
• Abdominal pain or distension
• Having wet nappies <6 times a day
• Refuse to drink anything you offer
• Has a dry sticky mouth
• Has sunken eyes
• Acts very tired and not interested in playing
• Looks like he has lost weight

Cough, running nose and flu

Cough and running nose are common symptoms that parents brought their young babies and toddlers to seek medical attention. Most children will get 8-10 colds before 2-year-old. Most of these episodes are caused by viruses, therefore antibiotics do not work, and children will get better with just rest and syrup paracetamol if fever is present.

Is it a common cold or a flu?
Both cold and flu are caused by viruses, they share similar symptoms that both causes fever, running nose and cough. However, there are some differences between the two:

Flu:
- Children get sick very quickly, usually within a day.
- Most feel sick and complain of body pain
- Most will become less active, and lose all appetite
- Cough is more severe with sore throat
- Flu is commoner in winter in temperate countries; in Malaysia, it is commoner in Nov-Jan over raining season

Common Colds:
- Milder cough, and less body ache
- Children usually main their appetite and usual activity
- Cold can happen any time of the year

How long does common colds or flu last?
Most colds last about a week, but some may last up to 10 days. Fever usually starts at the beginning of the episode, then goes away within 3-5 days. Mucus in the child's nose may turn yellow or green after 3-4 days, which is common, and do not necessary mean that antibiotic is needed.

Danger signs. Please consult the doctor immediately if the child has developed the following symptoms:
- Fever >38*C in young infants
- Fever that has lasted more than 3 days
- Coughing has got worse after 1 week
- Difficulty in breathing or feeding
- Ear pain
- Become very lethargy or irritable

Since both cold and flu are caused by viruses, antibiotics do not help, what can we do to help the child?
1. Clearing a blocked nose by putting a cool-mist humidifier in the bedroom; Eucalyptus or vaporub can be put in the water, but do not use these for an asthmatic child. For young infants younger than 6-month-old, we can use saline nasal drops to make the nasal discharge thinner, and clear with a suction bulb or tube. All these are easily available at pharmacy outlets. Nasal decongestant can be useful in older children, but its ingredient may not be suitable for younger infants, so do consult doctors before usage.
Some parents reported using  Vicks Warm Steam Vaporiser/ essential oil vaporiser help, but this may give headache to some, or trigger asthmatic attack. DO use with caution.

2. If the child has fever and body aches, syrup paracetamol can be given under medical instruction. Do not use aspirin for children under 12-year-old, because this can cause Reye's syndrome, a serious illness that affects liver and brain.

3. To ease the cough or sore throat by simple remedy of mixing one part of honey and one part of lemon juice. The child can take one teaspoon of these mixture every 2-3 hours. Do not use honey in infant under 1-year-old, because it can cause paralysing muscles and breathing difficulty. Paediatricians do not encourage over-the-counter cough medicine, as per American Academy of Pediatrics guideline, because some may lead to serious side effects.

4. Make sure the child is drinking enough to prevent dehydration.

5. Maintain good hand hygiene- teach the child to wipe runny nose and cover his nose/ mouth when coughing or sneezing. Do not let children share pacifiers, cups, spoons or towels.

6. Early use of vitamin C and zinc supplement may shorten the infection duration. Do consult doctor on this.

Can common colds or flu be prevented?
There is no special way to prevent colds or flu. But we can limit the spread of the viruses by maintaining good hand hygiene- cover mouth and nose when sneezing or coughing, regular hand washing or hand sanitiser. Avoid smoking environment.
Exclusive breast-feeding can also reduce respiratory tract infections due to unique immune factors in the breastmilk that help babies to fight against infection.
Annual flu vaccines are usually given to children at risk, such as those with congenital heart disease, asthma, etc. The flu vaccine will prevent all the viral infections, but it will certainly reduce the seriousness of the infection.