Tummy Trouble: Addressing Concerns in Childhood Diarrhea

Is your little one pooping more frequently and watery than usual? If you suspect diarrhea, it is best to contact your pediatrician. Diarrhea is a health condition that should be quickly dealt with to prevent dehydration and untoward health outcomes.

What is diarrhea?

Diarrhea is defined as the passage of unusually loose or watery stools, usually at least three times in a 24-hour period. It is the consistency of the stools that is more important rather than the number of stools per day. The degree of dehydration is the most important indicator of severity of diarrhea. The major risk factors for diarrhea are unsafe drinking water, poor sanitation, and malnutrition.^1-3

Diarrheal diseases may be due to a virus, bacteria, or parasite. Rotavirus infection is the most frequent cause of diarrhea.⁴ It is commonly spread through contaminated food or drinking water, or from person to person as a result of poor hygiene.

Diagnostic tests are not routinely recommended. However, laboratory tests may be requested by your doctor in cases of outbreaks in child care centers, if there is presence of bloody stools, and/or if your child is immunocompromised or has a chronic health condition.¹

Role of ORS and zinc in diarrhea

The standard management of diarrhea includes giving oral rehydration salts (ORS) to correct and prevent dehydration. Zinc supplementation can also help reduce the duration and severity of diarrhea. It can also aid in lowering the child’s risk of having another episode of diarrhea for up to 3 months following supplementation.⁵ One must remember that the use of antidiarrheal drugs and antibiotics should not be routinely used in diarrhea.

Nutritional support

A child should be well-nourished during episodes of diarrhea. Early resumption of feeding is also recommended and breastfeeding should not be interrupted. ⁶

Diarrhea may impair a child’s ability to process lactose and lead to signs of tummy discomfort such as abdominal pain, nausea, flatulence, bloating, and more frequent stooling. Studies showed that a lactose-free formula with proven and precise nutrition solution may help promote fast recovery from diarrhea and lactose intolerance.^4,7

Probiotics and diarrhea

Probiotics are live microorganisms that confer a health benefit on the host when given in adequate amounts.⁸ Several probiotic strains have been found to aid in shortening the episodes of diarrhea in children.^4,9 Studies also show that a probiotic called Lactobacillus reuteri DSM 17938 helped reduce the mean duration of diarrhea and the incidence of watery stools in children.^10-15

Diarrhea is both preventable and treatable. Key measures for prevention are handwashing with soap, better water quality, and the use of improved sanitation, which have been proven to reduce the risk for diarrhea by 47%, 17% and 36% respectively.16 Good personal and food hygiene, health education about how infections spread, and rotavirus vaccination should also be considered. Children with diarrhea should be nourished with optimal nutrition. A lactose-free diet and clinically-proven L. reuteri have also been found to help promote fast recovery from diarrhea and lactose intolerance. Keep in mind to consult your pediatrician to know more about precise nutritional solutions for your little one’s diarrhea.

 References:

1. Cajacob N, Cohen M. Update on Diarrhea. Pediatrics in Review.2016.37:8.

2. Troeger, C et al. Estimates of the global, regional and national morbidity, mortality and aetiologies of diarrhea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases.2018;18(11):1211-1228.

3. Clinical Management of Acute Diarrhea. World Health Organization/UNICEF Joint Statement 2004.

4. European Society for Pediatric Gastroenterology, Hepatology and Nutrition/European Society for Pediatric Infectious Diseases Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Update 2014. JPGN 2014;59: 132-152

5. Bajait C, Thawani V. Role of Zinc in Pediatric Diarrhea. Indian J Pharmacol. 2011 May- Jun; 43(3):232-235.

6. Stephen J. Pathogenesis of infectious diarrhea. Can J Gastroenterol 2001;15(10):669-683.

7. Saneian H, et al. Lactose-Free compared with lactose-containing formula in dietary management of acute childhood diarrhea. Iranian Journal of Pediatrics.2012;22(1).

8. Seven World Gastroenterology Organization Global Guidelines. Probiotics and Prebiotics. February 2017.

9. Dalby-Payne J, Elliott E. Gastroenteritis in children. BMJ Clinical Evidence. 2011;07:3

10. Eom et al. Therapeutic effect of Lactobacillus reuteri in Acute diarrhea in infants and toddlers.Korean Pediatr.2005; 48:986-990

11. Shornikova et al. Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. J Pediatr Gastroenterol Nutr.1997; 24 (4):399-404.

12. Dinleyici et al. Lactobacillus reuteri DSM 17938 effectively reduces the duration of acute diarrhea in hospitalized children. Acta Paediatr. 2014 Jul;103(7).

13. Francavilla R, et al. Randomized clinical trial: Lactobacillus reuteri DSM 17938 vs. placebo in children with acute diarrhea–a double blind study. Alimentary Pharmacology and Therapeutics 2012; 36(4):363-9.

14. Weizman Z, Asli G and Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics 2005 Jan;115(1):5-9.

15. Karvonen A, Casas I, Vesikari T. Safety and possible antidiarrhoeal effect of the probiotic Lactobacillus reuteri after oral administration to neonates. Clin Nutr 2001;20.

16. Caincross, S et al. (2010) Water, sanitation and hygiene for the prevention of diarrhea. International Journal of Epidemiology, 39 (suppl_1), i193-i205.