How to Manage Diarrhea in Children

Diarrhea is a common condition among children and, although it may not appear life-threatening, it is actually a leading cause of child mortality in developing countries, including Vietnam. As parents, it is crucial not to be complacent or negligent when it comes to treating diarrhea in children. Let's explore how to effectively manage this condition.

1. Understanding Diarrhea in Children

The frequency of bowel movements varies among children. Babies under 1 month of age may have bowel movements between 4 to 10 times a day, while babies between 1 to 3 months old typically have more than 2 bowel movements daily.

However, each child is different, and bowel movement patterns can vary. Some children may have immediate bowel movements after meals, while others may have bowel movements every 2 days or even once a week. For children under 2 years old, it is common for them to have soft and moldable stools.

Diarrhea in children is characterized by having more than twice the usual number of bowel movements for infants or more than 3 bowel movements per day for older children. The stools are typically loose or watery. Diarrhea can be classified into three main types:

• Acute diarrhea.
• Persistent diarrhea: Diarrhea that persists for 14 days or more.
• Invasive diarrhea with bloody mucus.

2. Seasonal Factors Affecting Diarrhea in Children

While diarrhea can occur throughout the year, there are two peak seasons when the disease is more prevalent:

• Hot season: The favorable conditions for bacterial growth, combined with increased consumption of food outside the home, can lead to bacterial infections causing diarrhea.
• Cold season: During this time, people tend to stay indoors in crowded environments, facilitating the spread of viruses. Rotavirus, in particular, can cause epidemics of viral diarrhea in children.

3. Risk Factors for Diarrhea in Children

Parents should be aware of the following risk factors associated with diarrhea in children:

• Unhygienic bottle-feeding: This significantly increases the risk of diarrhea compared to exclusive breastfeeding or non-bottle feeding.
• Improper feeding of complementary foods: Offering children foods that have been cooked and left at room temperature for extended periods or consuming contaminated foods.
• Consumption of unclean drinking water, such as untreated or boiled water left standing for a long time, or exposure to contaminated domestic water.

• Contamination from utensils or the hands of food handlers.
• Improper management of infected waste due to the misconception that children's feces are less harmful than those of adults.
• Lack of hand hygiene practices, including failure to wash hands after using the toilet, before food preparation, and before feeding children.

4. Diarrhea Treatment for Children

The treatment of diarrhea in children involves addressing dehydration, electrolyte imbalances, and the underlying cause. For mild cases, after a medical examination, the doctor may prescribe medication for at-home treatment and monitoring.

4.1. Treating Dehydration and Electrolyte Loss

Diarrhea can lead to dehydration and electrolyte imbalances. The primary treatment approach is rehydration and electrolyte replacement. Oresol, a commonly known oral rehydration solution, is effective in treating diarrhea-induced fluid and electrolyte losses. It is important to use Oresol correctly, following these guidelines:

• Oresol is designed to address water and electrolyte losses caused by diarrhea; it is not a medication for diarrhea itself.
• Follow the instructions on the product packaging for correct mixing. Use only boiled water and avoid mixing it with other types of water. Ensure the proper ratio of mixing, never using less water than recommended.
• Administer the solution slowly, giving the child approximately 50-100ml (about 10-20 teaspoons) after each episode of diarrhea.
• Children over 6 months old can replace Oresol with other fluids such as coconut water, rice water, or soup.
• If a child refuses to drink or vomits immediately after drinking, closely monitor for signs of dehydration.

4.2. Medications

• Antibiotics: Since most cases of diarrhea in children are caused by viruses, antibiotics are not necessary as they only target bacterial infections. They are ineffective against viral diarrhea.
• Antidiarrheal drugs: The use of antidiarrheal medications is generally not recommended for children, as they can mask symptoms and delay proper treatment, potentially prolonging the illness and adversely affecting the child's health.
• Probiotics: Probiotics can help alleviate diarrhea by approximately one day.
• Zinc: Zinc supplementation is generally not required for well-nourished children who are not at risk of zinc deficiency. However, it may be necessary for children at risk of zinc deficiency, such as those experiencing weight loss or acute diarrhea. Zinc supplementation can also reduce the risk of future episodes of diarrhea.

5. When to Seek Immediate Medical Attention

While mild cases of diarrhea can be managed at home, parents should seek immediate medical attention if any of the following signs occur:

• High fever that persists.
• Severe thirst or signs of dehydration, such as dry lips, sunken eyes, concave fontanelle (for children under 18 months), absence of tears when crying, lack of urination for 4-6 hours, or increased irritability and demand for water.
• Poor feeding or difficulty nursing.
• Vomiting excessively.
• Blood in the stool.
• Diarrhea worsening to dysentery.

Lethargy or difficulty waking the child or occurrence of seizures.
When any of these signs are present, it is important to take the child to a medical facility for prompt examination and treatment, thus preventing potentially dangerous complications.

Remember, prompt and appropriate management of diarrhea in children is crucial to prevent dehydration and ensure their well-being.