Manage Your Infant Diarrhea

Manage Your Infant Diarrhea

Diarrhea occurring in infant (up to 1 year of age) is known as infantile diarrhea.Young babies, especially breastfed babies, often have very soft or liquid bowel movements. However, if your infant's stools become extra watery, she may have diarrhea. Monitor her bowel movements and see whether the diarrhea continues.


Most of the time, vomiting in children is caused by gastroenteritis, usually due to a virus infecting the gastrointestinal tract. (Gastroenteritis is sometimes called the "stomach flu," which can also cause nausea and diarrhea.).These infections often don't last long and are more disruptive than dangerous to your child. However, if kids (especially infants) are unable to take fluids adequately, and if there's also diarrhea, they could become dehydrated.

In the United States, rotavirus causes more than 3 million cases of childhood diarrhea during the cooler months of each year, leading to an estimated 500,000 doctor visits, 55,000 to 100,000 hospitalizations and 20 to 100 deaths. Rotavirus illness costs theU.S. health care system an estimated $400 million in direct costs annually, rising to $1.4 billion when indirect costs, including lost work time for parents, are included.

An early Clinical Sign of HIV infection in children is persistent diarrhea that is diarrhea that last for more then 14 days. In some eastern and southern African countries where HIV infection rates are very high in children (from 5-10 of newborns), a child with persistent diarrhea is often presumed to be HIV+.

Classification according to etiology:

1. Dietetic:

a) Overfeeding specially fat and carbohydrate, cream rich milk and due to sugar in milk

b) Under feeding

c) Feeding with wrong formula

d) Earlier weaning diet.

e) Certain foods, e. g. newly sprouted potatoes, cow-milk intolerance, disaccharide intolerance.

For infants in developing countries where infant mortality is already so high from diarrhea and other illnesses, they can't afford to lose the antibodies, other anti-infective agents and the optimal nutrition found in breast milk.WHO guidelines have recommended that after six months of exclusively breastfeeding, HIV-positive mothers wean their babies as soon as other foods are available. Even then, while weaning may decrease the risk of HIV transmission, studies have shown that it increases the risk of malnutrition, diarrhea and other diseases that can lead to infant mortality.

2. Infective:

(A) Bacterial : a) Salmonella b) Shigella c) E. Coli d) Staph. aureus coagulase positive

Instead of saving children, the intersection of floods, formula supply shortages and the uptake of anti-breastfeeding recommendations appears to have led to a 25-fold increase in deaths due to diarrhea diseases among infants.The floods overwhelmed the city's ability to maintain clean water facilities, and soon after the flooding notice a disturbing increase in hospitalizations for diarrhea among children under six months of age. Most of those children were being fed with formula.

(B) Parasitic:

(i) A. duodenal (ii) A. tumbricoids (iii) T. triturae (iv) Giardia (v) Taenia (iv) E. histolytica

(C) Viral:

a) Specific viruses, e. g. Rota virus (commonest virus for epidemic gastro-
enteritis), other entero-viruses like poliovirus, coxsackie virus and echovirus. b) Non specific viruses.

Rotaviruses are the most common cause of severe dehydration and diarrhea in infants and young children, causing some 500,000 physician visits, 50,000 hospitalizations and 20 deaths in the United States each year. In developing countries, rotavirus diarrhea is a leading cause of infant mortality, killing 600,000 to 800,000 infants and young children annually.

(D) Fungal, e. g. Candida albicans

3. Parenteral or symptomatic diarrhea

a) Upper lobe pneumonia b) Otitis media c) Mastoid abscess d) Pyelttis e) Some infectious diseases, e. g. measles, chicken pox

4. Metabolic factors:

a) Cystic fibrosis of pancreas

b) Coeliac disease

5. Surgical conditions :

a) Appendicitis b) Meckel's diverticulitis

6. Physiological : Small quantity of varying colors frequent stool.

7. Antibiotic diarrhoea, e. g. Ampicillin.

CLINICAL FEATURES:

i) Diarrhea : passage of loose stool

ii) Vomiting may be absent initially

iii) Excessive thirst

iv) Fever may be present depending on the etiology

v) Signs of dehydration:

a) Depressed anterior fontanelle

b) Sunken eyes

c) Prominent zygoma

d) Dry harsh tongue

e) Loss of skin elasticity

vi) Signs of electrolyte imbalance due to —

a) Hyponatremia b) Hypokalaemia

vii) Signs of vitamin and minerals deficiency (if the diarrhea is prolong):

Vit. A : Xerosis, Xerophthalmia, Keratomalasia

Vit. B. Complex : Beriberi, Aribollavinosis, Pelagra, Megaloblastic anaemia

Vit. C. : Scurvy

Vit. D. and Calcium. : Rickets

Iron : Iron deficiency anemia

viii) The child may come with shock in acute diarrhea if he/she is severely dehydrated

Complications:

i) Dehydration and electrolyte imbalance.

ii) Abdominal distension

iii) Convulsion

iv) Paralytic ileus

v) Infections

vi) Venous thrombosis

vii) Anemia

viii) Impairment ol liver functions

ix) Intolerance of disaccharides

x) Kwashiorkor and marasmas

Management of infantile diarrhoea :

Breastfeeding causes nearly 40 percent of all pediatric HIV infections, yet also prevents millions of child deaths every year by protecting infants from diarrhea and other infections. Finding ways to make breastfeeding safer for infants of HIV-infected mothers has been an urgent research priority. A study suggested.

Study over ORT shown that after three years of intervention, the infant mortality rate was reduced 4.2 times from 65 in 1,000 to 15 in 1,000. The annual hospitalization rate decreased nearly six times, from 13 percent to 2 percent. The prevalence of the height-for-age deficit was diminished 22 percent, from 28 to 23 percent, and the use of oral rehydration therapy (ORT) during diarrhea episodes increased 2.4 times to 91 percent from 38 percent. Finally, basic immunization for children increased 31.5 percent during the three years, a change to 96 percent from 73 percent .

1.Fluid Therapy :

a) Correction of already existing deficit (Rehydration therapy)

b)Replacement of continuing loss (Maintenance therapy

c) Normal requirement of fluid.Rehydration fluids, such as Pedialyte, to treat infant diarrhea.

2. Maintenance of Nutrition

3. Correction of Acidosis i) Sodium & Chloride helps in absorption and retaining water, thus corrects dehydration
ii) Bicarbonate corrects acidosis iii) Potassium corrects K+ toss.4.Control of infection

Treatment During convalescence :

i) Correction of it. deficiency by multivitamin drop or syrup, ii) In anaemia. Fe-mexture or tablets, tii) Gradual rehabilitation to solid food (spice-free).

Is your child an infant, and is your infant crying uncontrollably, possibly while pulling his or her knees to the chest, and does your infant have red-colored diarrhea and continue to vomit all liquids ?If you're still in doubt, call your healthcare provider anyway. It's important for you to get peace of mind, and it never hurts to check with your doctor. After all, you're only acting in your child's best interests.

Vaccine:

An oral vaccine against rotavirus -- the most important cause of life-threatening diarrhea in children under age 2 -- reduced severe diarrheal illness by 88 percent in a study of more than 2,000 infants in Venezuela. This is the largest and most successful trial to date of arotavirus vaccine among children in a developing country."This is the first study designed to determine if the vaccine prevents severe illness in a developing country where rotavirus circulates year-round rather than seasonally," explains Anthony S. Fauci, M.D., NIAID director. "In this setting, the vaccine proved to be very efficacious."

In February 2006, the U.S. Food and Drug Administration (FDA) approved a new rotavirus vaccine, and the CDC's Advisory Committee on Immunization Practices now recommends that all children receive the vaccine.

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