What are causes of Diarrhoea and how to treat?

Diarrheas is a pass loss stools more than three time a day
Diarrhoea can be of sudden onset and lasting for less than two weeks (acute) or persistent (chronic). This leaflet deals with acute diarrhoea, which is common in children. In most cases, diarrhoea eases and goes within several days but sometimes takes longer.
    
The main risk is lack of fluid in the body (dehydration).

The main treatment is to give your child lots to drink; this may be by giving special rehydration drinks. Also, once any dehydration is treated with drinks, encourage your child to eat as normally as possible. See a doctor if you suspect that your child is dehydrating, or if they have any worrying symptoms such as those which are listed below.

What causes acute diarrhoea?

      Infection of the gut is the common cause. (The medical term for infection of the gut is gastroenteritis.)
    A virus is the common cause of infective diarrhoea in the UK. Sometimes it is just 'one of those germs going about. Various viruses are easily spread from person to person by close contact, or when an infected person prepares food for others. For example, infection with a virus called rotavirus is the most common cause of diarrhoea in children in the UK. Almost every child in the UK has a rotavirus infection before they are 5 years old.
Adenovirus is another common cause.

Food poisoning (eating food infected with germs called microbes) causes some cases of diarrhoea. Food poisoning infection is usually caused by a germ called a bacterium. Common examples are species of bacteria called Campylobacter, Salmonella and Escherichia coli(usually shortened to E. coli).

Poisons (toxins) produced by bacteria can also cause food poisoning. Another group of microbes called parasites can also be a cause of food poisoning.

Water contaminated by bacteria or other germs is another common cause of infective diarrhoea, particularly in countries with poor sanitation.

Non-infectious causes of sudden-onset (acute) diarrhoea are uncommon in children. For example, inflammation of the gut (colitis), food intolerance and various rare disorders of the gut.

The rest of this leaflet deals only with infectious causes of acute diarrhoea.

What are the symptoms of acute infectious diarrhoea?

Symptoms can range from a mild stomach upset for a day or two with slight diarrhoea, to severe watery diarrhoea for several days or longer. Diarrhoea means loose or watery stools (faeces), usually at least three times in 24 hours. Blood or mucus can appear in the stools with some infections.

Crampy pains in the tummy (abdomen) are common. Pains may ease each time some diarrhoea is passed. Being sick (vomiting), high temperature (fever), aching limbs and headache may also develop.

Diarrhoea often lasts for 3-5 days, sometimes longer. It often continues for a few days after any vomiting stops. Slightly loose stools may continue (persist) for a week or so further before a normal pattern returns. Sometimes the symptoms last longer.

Symptoms of lack of fluid in the body (dehydration)

Diarrhoea and vomiting may cause dehydration. Seek medical advice quickly if you suspect that your child is becoming dehydrated.
Mild dehydration is common and is usually easily and quickly reversed by drinking lots of fluids.
Severe dehydration can be fatal unless quickly treated because the organs of the body need a certain amount of fluid to function normally.

Symptoms of dehydration in children include:
Passing little urine.
A dry mouth.
A dry tongue and lips.
Fewer tears when crying.
Sunken eyes.
Weakness.
Being irritable or lacking in energy (lethargic).

Symptoms of severe dehydration in children include:
Drowsiness.
Pale or mottled skin.
Cold hands or feet.
Very few wet nappies.
Fast (but often shallow) breathing.
This is a medical emergency and immediate medical attention is needed.

Dehydration in children with sudden-onset (acute) diarrhoea is more likely to occur in:

Babies under the age of 1 year (and particularly those under 6 months old).
This is because babies don't need to lose much fluid to lose a significant proportion of their total body fluid.Babies under the age of 1 year who were a low birth weight and who have not caught up with their weight.A breast-fed baby who has stopped breast-feeding during their illness.Any baby or child who does not drink much when they have infection of the gut (gastroenteritis).Any baby or child with severe diarrhoea and being sick (vomiting). (In particular, if they have passed six or more diarrhoeal stools and/or vomited three or more times in the previous 24 hours.)

Does my child need any tests?

For most children, diarrhoea will usually be quite mild and will get better within a few days without any treatment other than drinking plenty of fluids. You will often not need to take your child to see a doctor or seek medical advice.

However, in some circumstances, you may need to seek medical advice for your child (see below). If this is the case, the doctor may ask you questions about:

Recent travel abroad. Whether your child has been in contact with someone with similar symptoms. Whether your child has recently taken antibiotic medication. Whether your child has recently been admitted to hospital.

This is to look for a possible cause of their diarrhoea. They will usually examine your child for signs of lack of fluid in the body (dehydration). They may check their temperature and heart rate. They may also examine your child's tummy (abdomen) to look for any tenderness.

Tests are not usually needed. However, in certain cases, the doctor may ask you to collect a stool (faeces) sample from your child - for example:

If your child is particularly unwell. If your child has bloody stools. If your child is admitted to hospital. If food poisoning is suspected. If your child has recently travelled abroad. If your child's symptoms are not getting better.

The stool sample can then be examined in the laboratory to look for the cause of the infection.

When should I seek medical advice?

As mentioned already, most children with diarrhoea have mild symptoms which get better in a few days. The important thing is to ensure that they have plenty to drink. In many cases, you do not need to seek medical advice. However, you should seek medical advice in the following situations (or if there are any other symptoms that you are concerned about):

If your child is under the age of 6 months. If your child has an underlying medical condition (for example, heart or kidney problems, diabetes, history of premature birth).If your child has a high temperature (fever).If you suspect lack of fluid in the body (dehydration) is developing (see earlier).If your child appears drowsy or confused. If your child is being sick (vomiting) and unable to keep fluids down. If there is blood in their diarrhoea or vomit. If your child has severe tummy (abdominal) pain. Infections caught abroad. If your child has severe symptoms, or if you feel that their condition is getting worse. If your child's symptoms are not settling (for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days).

What is the treatment for infectious diarrhoea in children?

Diarrhoea often settles within a few days or so as a child's immune system is usually able to clear the infection. Children can usually be treated at home. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop.

Fluids to prevent lack of fluid in the body (dehydration)

You should encourage your child to take plenty of fluids. The aim is to prevent dehydration. The fluid lost if they have been sick (vomited) and/or have had diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks, as these can make diarrhoea worse.

Babies under 6 months old are at increased risk of dehydration. You should seek medical advice if they develop sudden-onset (acute) diarrhoea.
Breastfeeds or bottles feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.

Rehydration drinks may be advised by a doctor for children at increased risk of dehydration (see above for who this may be). They are made from sachets available from pharmacies and on prescription. You should be given instructions about how much to give. Rehydration drinks provide a perfect balance of water, salts and sugar. The small amount of sugar and salt helps the water to be taken in (absorbed) better from the gut into the body. Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available but they have to be made carefully, as too much salt can be dangerous to a child. Rehydration drinks are cheap and readily available in the UK and are the best treatment for your child.

If your child vomits, wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.

Note: if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice urgently.

Fluids to treat dehydration

If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. Read the instructions carefully for advice about how to make up the drinks and about how much to give. The amount can depend on the age and the weight of your child. If rehydration drinks are not available for whatever reason, make sure you keep giving your child water, diluted fruit juice or some other suitable liquid. If you are breast-feeding, you should continue with this during this time.  It is important that your child is rehydrated before they have any solid food.

Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a nasogastric tube. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with fluids given directly into a vein (intravenous fluids).

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, encourage your child to have their normal diet. Do not starve a child with diarrhoea. This used to be advised but is now known to be wrong. So:

Breast-fed babies should continue to be breast-fed if they will take it. This will usually be in addition to extra rehydration drinks (described above).

Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above).

Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important and food can wait until their appetite returns.

Medication is not usually needed

Medicines are not normally given to stop diarrhoea to children under 12 years old. They sound attractive remedies but are unsafe to give to children, due to possible serious complications. However, you can give paracetamol or ibuprofen to ease a high temperature (fever) or headache. There is also a medicine called racecadotril available on prescription, which can be given to reduce the amount of fluid that is secreted into the gut. This will make the stool (faeces) more solid. It is used along with rehydration medicines. It can be used in babies and children from 3 months of age.

If symptoms are severe, or continue (persist) for several days or more, a doctor may ask for a sample of the diarrhoea. This is sent to the laboratory to look for infecting germs (bacteria, parasites, etc). Sometimes an antibiotic or other treatments are needed, depending on the cause of the infection.

Thanks