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Diarrhoea

Definition
Passage of more than 3 episodes of loose stool in a day

Loose stool
Faecal matter that takes the shape of the container

What are the other signs and symptoms?

  • Your child may have fever.
  • He/she may have vomiting
  • There may be abdominal discomfort
  • You may observe blood in the stool. When this happens, your child may have dysentery.
  • If the child is dehydrated:
    • The skin and the linings of the body orifices may be dry. He/she may be unable to produce tears or saliva
    • The elasticity of the skin may be reduced. This will be apparent when you lightly pinch the skin over the abdomen.
    • The child may be weak and uninterested in the environment. He may be unable to drink anything as a result.

ALL THESE FEATURES MAY BE ABSENT AND THE CHILD MAY JUST HAVE DIARRHOEA ALONE

What causes diarrhoea?

  • Most diarrhoeal illnesses are caused by viral infections and the most common culprit is the rota virus. Most of the time, the illness is self limiting.
  • A few may be as a result of bacterial infections. These bacteria are known as enteric bacteria.
  • Diarrhoea due to infections may be worsened by reduced immunity as in HIV disease.
  • Spread of diarrhoea due to viral or bacterial infection is faecal-oral i.e. through ingestion of food or water contaminated by infected stool.
  • Diarrhoea may also be due to inborn problems in metabolism, abnormal structures of the gut and food intolerance

Children on exclusive breast feeding may produce loose stool and this should not worry you.

What is toddler's diarrhoea?

  • Some children aged between the 1 and 4 years may suffer intermittent bouts of loose stool. The stool may contain partly digested foods.
  • This happens for a few days and then resolves to happen again later.
  • It may be associated with stress of the child.
  • It is thought to occur due to over-activity of the intestinal gut thus not giving the food enough time to be digested.
  • This condition is not dangerous and passes with age.

What should you do when your child has diarrhoea?

  • Take note of the number of episodes your child is passing stool. This will help you determine the severity.
  • Examine the stool for colour, presence of worms and blood stains
  • Look for other signs of illness
  • Provide oral rehydration solution to your child. Oral rehydration salt can be bought from the shop or the nearest chemist. Formulate with clean water according to instructions on the sachet's cover. Aim to give at least 5mls per Kilogram of the child's weight every hour and with every episode of diarrhoea.
  • If your child blood in the stool or has signs of dehydration and is vomiting a lot or unable to take orally, rush him/her to the nearest health facility. Meanwhile, still give ORS.


Alternative terms: Diahorrea, diarrhea, loose stool, "the runs"

Drugs, Diet and the Unborn Child

After trying for a baby successfully and enduring nine months of pregnancy, the best gift a couple can get is a healthy bouncing baby. However, up to 3-4% of newborn babies manifest with congenital abnormalities at the time of birth. A further 2% manifest later, at about the age of 5 years. These abnormalities may be inherited or due to environmental factors. We can control some of the environmental factors that affect the unborn child. This should be done right from the moment you decide to try for a baby as you may not know when you actually conceived and yet most abnormalities occur within the first 3 months, when the organs are forming!

How do environmental factors affect the unborn child?
Environmental factors are in the form of nutrition, drugs and poisons and infections. These factors are referred to as teratogens.
There are various known nutritional states, drugs and chemicals and infections that have been associated with occurrence of congenital abnormalities. Some of these are:

  1. Smoking - Fetal growth retardation, increased incidence of miscarriage and prematurity
  2. Alcohol - Fetal growth retardation, abnormalities of the face, mental retardation
  3. Anti-coagulants e.g. warfarin - abnormalities of the bone, facial abnormalities, mental retardation
  4. Anti-cancer drugs - Impaired development of some organs
  5. Tetracycline - impaired teeth and bone development
  6. Chloroquine - increased occurrence of abnormalities of hearing and vision
  7. Infections e.g. Toxoplasmosis, rubella (german measles), herpes, syphilis, Cytomegalovirus, malaria, HIV - these infections pass on to the unborn child and affect the development of the brain and other organs.
  8. Poorly controlled maternal illnesses like diabetes and hypertension may result in impaired development of the child and mental retardation
  9. Folate deficiency - Impaired development of the child's nervous system.
  10. Iron deficiency - Retarded growth of the child.

THESE EXAMPLES ARE MODEST AND THERE ARE SEVERAL OTHER KNOWN CAUSES.

What can you do to avoid exposing your child to potential teratogens?

  • Visit the antenatal clinic at the earliest possible time. Then, a couple of blood tests will be done to investigate for some common infections that may be harmful to your child and to find out the level of your blood. You will be advises on the type of diet you should favour and what nutritional supplements you can take.
  • When attending the clinic, your pregnancy will be monitored and any abnormalities in progress will be discovered.
  • Do not take any drug when you are trying for a baby or during pregnancy without consulting your doctor.
  • Avoid smoking, alcohol and use of illicit drugs
  • Avoid radiological investigations like X-rays. Alert the doctor of your pregnancy should he/she make such a request.
  • Prolonged sauna and hot tub baths may expose your child to high temperatures which may be injurious to its development.
  • Eat plenty of proteins (fish, eggs, meat) vegetables and fruits
  • If you have any sexually transmitted disease (including HIV), seek treatment.
  • Plan for your delivery with your obstetrician and paediatrician.