Diarrhea (diarrhea) in children

Diarrhea, or diarrhea, is a re-emptying of liquid feces. Diarrhea can sometimes be so watery that feces can be taken for urine.

Diarrhea - rapid bowel movement with a change in the character of the stool, from mushy to watery. At the heart of diarrhea lies the accelerated passage of the contents along the intestine, the slowing of the absorption of the liquid, and also the increased mucus formation. In healthy children, especially breast-feeding, sometimes there is a chair after each feeding or eating, which is due to gastroeleocecal or gastroeolithic reflex. Distinguish diarrhea with a large (with diseases of the stomach, pancreas, celiac disease), the amount of feces and small (with ulcer disease, colitis with a predominant lesion of the distal intestine, myxedema).

Remember: the liquid stool for infants is normal. Sometimes when feeding with cow's milk, the child's chair is green - this is not dangerous. Diarrhea in a child may be the first symptom of a urinary tract infection. A frequent mushy stool (4 to 6 times a day) can be observed in normal infants; this should not cause concern, unless there is evidence of anorexia, vomiting, weight loss, slowing the rate of weight gain, blood separation with stool. For children with breastfeeding, frequent stools are common, especially if they do not receive lures. The risk of diarrhea in children at any age is considered depending on whether it is acute (less than 2 weeks) or chronic (more than 2 weeks).

[1], [2], [3], [4], [5], [6], [7]

Causes of diarrhea in a child

Acute diarrhea (diarrhea) in a child is more likely to have infectious causes, especially if the onset is sudden or is combined with vomiting, stools with an admixture of blood, fever, anorexia. Diagnosis is made clinically, treatment is supportive, until there is a spontaneous improvement.

Chronic diarrhea is a more serious condition. The causes include gluten enteropathy, pancreas cystic fibrosis (cystic fibrosis), allergic gastroenteropathy, disaccharidase insufficiency. Inflammatory bowel diseases and certain infections can also be the cause of diarrhea.

With gluten enteropathy (celiac disease), the gluten fraction of the wheat protein causes damage to the intestinal mucosa and impaired absorption of fats, leading to malabsorption, anorexia and an abundant stool stool. Changes in stools begin when the products of wheat flour and other gluten-containing foods are introduced into the child's diet.

In cystic fibrosis, pancreatic insufficiency develops, which leads to deficiency of trypsin and lipase, and this in turn leads to large losses of protein and fat with stools and, consequently, to malabsorption and delay in physical development. The stool is plentiful and often fetid. Children with cystic fibrosis often suffer from respiratory diseases and growth retardation.

In case of disaccharidase deficiency, the intestinal mucosa enzymes , such as lactase, which breaks down lactose into galactose and glucose, may be innately absent or after temporary GI infection, their temporary insufficiency may develop. Improvement after exclusion of lactose (or other carbohydrates) from the diet or after the introduction of mixtures that do not contain lactose, reliably confirms the diagnosis.

With allergic gastroenteropathy, cow's milk protein can cause diarrhea, often with vomiting and an admixture of blood in the stool, but one should also suspect an intolerance to the carbohydrate fraction of food eaten. Symptoms often decrease significantly when soy is administered instead of the mixture in cow's milk and is returned when it is reconstituted in the diet. Some children with cow milk intolerance also do not tolerate soy, so that the mixture should contain hydrolyzed protein and should not contain lactose. Often a year comes a spontaneous improvement.

[8], [9], [10], [11], [12], [13]

Gastroenteritis

Gastroenteritis is an infectious lesion of the small intestine, accompanied by diarrhea and vomiting. The main danger in this case is dehydration and disturbance of the water-electrolyte balance. The most common cause of such gastroenteritis is rotavirus infection; often the disease is combined with otitis media or infection of the upper respiratory tract. If the child is not in a state of dehydration, the treatment measures consist in the frequent weighing of the baby (in order to track the progression of the disease in time and quantify the degree of dehydration if, of course, the previous initial mass of the child is known); The child is stopped to give both milk and dense food, replacing it all with inward-administered rehydration mixtures (for example, Rehidrat).

If a child is given a sweet vodka, three full (but without top) teaspoons of sugar (3x5 ml) should be placed in 200 ml of water and given at a rate of 150 ml / kg per day. Practice has shown that if a child feels well, the addition of salt is rarely necessary, and mothers do not need to add salt to the portion for feeding the baby - it's dangerous. After 24-48 hours of abstinence from milk, it should be gradually started to be given again. If the baby is breastfed and its condition is not very severe, then it can be allowed to continue breastfeeding (so that he receives antibodies from the mother and to maintain lactation in the mother).

Portions of a sick child's chair should be sent to the laboratory for examination for the presence of eggs of worms, cysts and parasites.

Causes of secretory diarrhea in a child

Usually these are: bacterial infections (Campylobacter, Staphylococcus, E. Coli, and in poor sanitary conditions, Salmonella, Shigella, Vibrio cholerae ), giardiasis, rotavirus infection, amoebiasis, cryptosporidiosis. The cause of secretory diarrhea can be inflammatory bowel disease.

[14], [15], [16], [17], [18], [19], [20]

Other causes of diarrhea in the child

In toddlers, diarrhea can be associated with "hikes for peas and carrots", the reason for it is an increase in the motor activity of the intestine. Such diarrhea usually gradually passes by itself. The cause of diarrhea may be an allergy or enzyme deficiency (celiac disease, intolerance of disaccharides, galactose, lactose, glucose). The test for the detection of this pathology consists in mixing 5 drops of stool with 10 drops of water followed by the use of the "Clinitest" tablet. Diarrhea can also be caused by the insufficiency of certain vital substances - copper, magnesium and vitamins, as well as kwashiorkor.

Causes of bloody diarrhea in a child

This infection Campylobacter, necrotizing enterocolitis (in newborns), intussusception, pseudomembranous colitis, inflammatory bowel disease (rarely, even in older children).

[21], [22], [23], [24], [25], [26]

Mechanisms and pathogenesis of diarrhea

Intestinal hypersecretion is caused by a violation of electrolyte transport in the intestine. The ratio of absorption and secretion is determined by the total fluxes on the enterocyte; they are regulated by neuroendocrine mediators, hormones and other biologically active substances.

The main causes of hypersecretion or secretory diarrhea:

• bacterial exotoxins (enterotoxins);
• colonization of the small intestine by microorganisms, and in this connection, the accumulation of deconjugoerans and dehydroxylated bile acids, hydroxylated fatty acids, bacterial enterotoxins;
• bile acids;
• fatty acids with a long hydrocarbon chain;
• gastrointestinal hormones (secretin, VIP, etc.);
• prostatandins; serotonin; calcitonin;
• laxatives containing anthraglycosides (senna leaves, buckthorn bark, rhubarb, etc.), castor oil, antacids containing magnesium salts, antibiotics (clindamycin, lincomycin, ampicillin, cephalosporins), antiarrhythmic drugs (quinidine, propranolol), digitalis, drugs, containing potassium salts, artificial sugar (sorbitol, mannitol), chenodeoxycholic acid, cholestyramine, sulfasalazine, anticoagulants.

The secretory also includes diarrhea associated with cholera, in which this process is most pronounced. Cholera endotoxin, bacterial toxins, and the like. Increase the activity of adenyl cyclase in the intestinal wall with the formation of cAMP, resulting in an increase in the volume of secreted water and electrolytes. When this is secreted large amounts of sodium, so that, despite the functional capacity of the colon to retain sodium and secrete potassium, sodium losses in secretory diarrhea exceed the loss of potassium.

The property of reducing absorption and stimulating the secretion of sodium and chlorine is free intracellular calcium. Therefore, calcium channel blockers have antidiarrheal effect.

Increase in osmotic pressure in the intestinal cavity is observed when digestion and absorption of carbohydrates are impaired, and also when osmotically active substances enter the intestine (salt laxatives, sorbitol, etc.). Unabsorbed disaccharides lead to osmotic water retention in the gut lumen. Since the mucosa of the small intestine is freely permeable to water and electrolytes, an osmotic (RV) equilibrium is established between the small intestine and the plasma. In the large intestine, sodium is actively retained, so for osmotic diarrhea, potassium loss is niche than sodium.

Acceleration of transit of intestinal contents is caused by hormonal and pharmacological stimulation of transit (serotonin, prostaglandins, secrete, pancreosimin, gastrin); neurogenic stimulation of transit - acceleration of the eacaculatory activity of the intestine (neurogenic diarrhea), an increase in intestinal pressure (irritable bowel syndrome).

Intestinal hyperexcitation is observed with inflammatory changes in the mucous membrane of the large intestine (dysentery, salmonellosis, etc.).

What if the baby has diarrhea?

Anamnesis

The anamnesis focuses on the nature and frequency of the stool, as well as the accompanying symptoms and symptoms. Information about vomiting or fever indicates an infection of the gastrointestinal tract. Extremely important is the careful collection of nutritional anamnesis. Information on diarrhea that began after the introduction of semolina, indicate gluten enteropathy (celiac disease), information about the change in the nature of the stool with the use of certain foods - for food intolerance. The constant admixture of blood in the stool indicates the need to carefully search for more serious infections or gastrointestinal diseases.

[27], [28], [29]

Inspection

Inspection focuses on appearance and signs of dehydration, physical development, examination and palpation of the abdomen; lag in physical development indicates a more serious violation. Also, the state of respiratory organs in children suspected of cystic fibrosis should be assessed.

Laboratory and instrumental examination

The examination is prescribed if anamnesis and examination indicate a chronic disease. Determine the level of electrolytes if the child has dehydration; the level of sodium and chlorine in the sweat when suspected of cystic fibrosis; when suspected of an infectious process, an examination is conducted for viruses, bacteria and parasites; measurement of the pH of the stool if suspected of a disaccharidase insufficiency. With celiac disease, an increased level of specific antibodies is detected. Changing the diet can be used for both diagnosis and treatment.

Treatment of diarrhea in a child

Supportive treatment of diarrhea (diarrhea) consists of providing adequate oral (or less frequent intravenous) rehydration. Antidiarrheal agents (for example, loperamide), as a rule, are not recommended for children of the first year of life and early age.

In chronic diarrhea, adequate nutrition should be maintained, especially the intake of fat-soluble vitamins. When diseases are prescribed special treatment methods (for example, gluten-free diet for celiac disease).