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DIARRHOEA IINN IINNFFAANNTTSS AANNDD 
YYOOUUNNGG CCHHIILLDDRREENN 
Dr. Taher Y. Kagalwala 
M.D., D.C.H. 
Hon. Pediatrician...
Don’t wwee aallll wwaanntt kkiiddss ttoo bbee 
ttooiilleett--ttrraaiinneedd lliikkee TTHHIISS?? 
October 15, 2014 Dr.Kagal...
WWhhaatt iiss ddiiaarrrrhhooeeaa?? 
• It is the passage of liquid or watery stools 
• Usually, this is more than three tim...
CCoommmmoonn EEttiioollooggiiccaall CCaauusseess 
1. Infectious causes: 
• Viral – esp. rotavirus, respiratory and 
entero...
CClliinniiccaall FFeeaattuurreess -- 11 
1. Symptoms and signs of the primary 
illness. 
2. Symptoms and signs of dehydrat...
CClliinniiccaall FFeeaattuurreess -- 22 
1. Primary Illness: 
• Bacterial – dysentery and not diarrhoea – 
marked by high ...
CClliinniiccaall FFeeaattuurreess –– 33aa 
2. Dehydration (1 of 2): 
Grade of 
dehydration/Sym 
ptoms 
Mild 
5 – 7% wt los...
CClliinniiccaall FFeeaattuurreess –– 33bb 
2. Dehydration (2 of 2) 
Grade of 
dehydration/Sy 
mptom 
Mild Moderate Severe ...
CClliinniiccaall FFeeaattuurreess -- 44 
3. Symptoms and signs of complications: 
• Hypovolemic shock 
• Acute renal failu...
CCaassee SSttuuddyy -- 11 
18 – month old female child from a middle-class 
family presents with: 
• Fever , mild – 4 days...
CCaassee SSttuuddyy –– 22aa 
On examination (1 of 2): 
• Average child, 9.5 kg, fever 99.2* F 
• Crying continuously, eage...
CCaassee SSttuuddyy –– 22bb 
On examination (2 of 2): 
• CRT 3 seconds 
• Skin turgor – slightly prolonged (3 
seconds) 
•...
CCaassee SSttuuddyy –– 33 
• What is the likely diagnosis? 
• Is the girl dehydrated? How much? Why are 
there inconsisten...
CCaassee SSttuuddyy -- 44 
Management (1 of 4): 
ORS: Sip by sip, at least 40-50 ml/kg as 
deficit plus about ¼ to ½ of a ...
CCaassee SSttuuddyy -- 55 
Management (2 of 4): 
• The child’s mother should be asked to continue 
breastfeeding her (if s...
CCaassee SSttuuddyy -- 66 
Management (3 of 4): 
What is the role of : 
• Anti-diarrhoeals – norflox +metro, for example 
...
CCaassee SSttuuddyy -- 77 
Management (4 of 4): 
• When will you refer for hospitalisation? 
• What home-based fluids are ...
SSoommee rreecceenntt iinnffoo oonn OORRSS 
ORS : 
• Presence of salt and sugar together facilitate the 
reabsorption of w...
TTaakkee--hhoommee mmeessssaaggeess 
• Monsoon diarrhoeas may be bacterial in origin, 
but winter diarrhoeas are almost al...
JJuusstt oonnee mmoorree sslliiddee:: 
October 15, 2014 Dr.Kagalwala/Diarr 20
TThhiiss bbooookk iiss oonn ssaallee!! 
• This comprehensive book 
on parenting is written for 
the layman. 
• It is price...
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Pediatric Infective Diarrhoea in Developing countries

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Brief and relevant information on infective diarrhoea in children The emphasis is on developing countries, but the principles of treatment are the same.

Published in: Health & Medicine
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Pediatric Infective Diarrhoea in Developing countries

  1. 1. DIARRHOEA IINN IINNFFAANNTTSS AANNDD YYOOUUNNGG CCHHIILLDDRREENN Dr. Taher Y. Kagalwala M.D., D.C.H. Hon. Pediatrician Saifee Hospital, Masina Hospital, Habib Hospital Saboo Siddik Mat. And Gen. Nsg. Home October 15, 2014 Dr.Kagalwala/Diarr 1
  2. 2. Don’t wwee aallll wwaanntt kkiiddss ttoo bbee ttooiilleett--ttrraaiinneedd lliikkee TTHHIISS?? October 15, 2014 Dr.Kagalwala/Diarr 2
  3. 3. WWhhaatt iiss ddiiaarrrrhhooeeaa?? • It is the passage of liquid or watery stools • Usually, this is more than three times a day. • More important than this is: when there is a recent change in the consistency, frequency or character of the stools. • Frequent stools in an exclusively breastfed baby is NOT diarrhoea. • Teething can cause a few loose stools; diarrhoea lasting more than 24 hours is NOT due to teething. October 15, 2014 Dr.Kagalwala/Diarr 3
  4. 4. CCoommmmoonn EEttiioollooggiiccaall CCaauusseess 1. Infectious causes: • Viral – esp. rotavirus, respiratory and enteroviruses • Bacterial – esp. E. coli (ETEC, EPEC) • Others – fungal, protozoal, helminthic and miscellaneous 2. Non-infectious causes: • Intussusception • Endocrine – hyperthyroidism • Secondary to a remote cause – e.g. pneumonia October 15, 2014 Dr.Kagalwala/Diarr 4
  5. 5. CClliinniiccaall FFeeaattuurreess -- 11 1. Symptoms and signs of the primary illness. 2. Symptoms and signs of dehydration. 3. Symptoms and signs of complications and side-effects of treatment. October 15, 2014 Dr.Kagalwala/Diarr 5
  6. 6. CClliinniiccaall FFeeaattuurreess -- 22 1. Primary Illness: • Bacterial – dysentery and not diarrhoea – marked by high fever, toxicity, tenesmus and sometimes rectal prolapse while defecating; stool will show mucus, visible or occult blood and at times, frank blood. • Viral – watery stools with absence of most of the above findings, though there may be mucusy stools. Slight to moderate fever and presence of cough/cold, conjunctivitis and recurrent vomiting are all compatible. October 15, 2014 Dr.Kagalwala/Diarr 6
  7. 7. CClliinniiccaall FFeeaattuurreess –– 33aa 2. Dehydration (1 of 2): Grade of dehydration/Sym ptoms Mild 5 – 7% wt loss Moderate 7 – 9 % wt loss Severe 10% or more wt. loss Fontanelle and eyes Normal to mildly sunken Moderately sunken Severely sunken Pulses Normal but fast Faster, slight low volume Thready, peripheral pulses not palpable Mucous membranes Moist but sticky Slightly dry Dry Skin turgor Normal Recoil 1-3 seconds Recoil > 3 seconds October 15, 2014 Dr.Kagalwala/Diarr 7
  8. 8. CClliinniiccaall FFeeaattuurreess –– 33bb 2. Dehydration (2 of 2) Grade of dehydration/Sy mptom Mild Moderate Severe Capillary refill time Normal (< 3 sec) Normal (< 3 sec) Delayed 3 or > 3 sec Urine Output Normal Slightly less (anuria < 4 hours) Definitely less (anuria > 4 hours) Mental status Normal but thirsty Irritable Irritable to lethargic October 15, 2014 Dr.Kagalwala/Diarr 8
  9. 9. CClliinniiccaall FFeeaattuurreess -- 44 3. Symptoms and signs of complications: • Hypovolemic shock • Acute renal failure (pre-renal) • Venous thrombosis • Septicemia October 15, 2014 Dr.Kagalwala/Diarr 9
  10. 10. CCaassee SSttuuddyy -- 11 18 – month old female child from a middle-class family presents with: • Fever , mild – 4 days • Red eyes, running nose and a mild to mod. cough – 3 days • Vomiting – 2 days ( frequent, whitish yellow) • Loose motions – yellow, 13 – 15 since the last 24 hours, curdy smell, with mucus • Not passed urine since the last four hours, with h/o passing concentrated urine earlier too. October 15, 2014 Dr.Kagalwala/Diarr 10
  11. 11. CCaassee SSttuuddyy –– 22aa On examination (1 of 2): • Average child, 9.5 kg, fever 99.2* F • Crying continuously, eagerly drinks water if offered by the mother • P 120/min, RR 34/min, nonacidotic, BP not taken • AF closed, eyes look okay but reduced tears while crying • Oral mucosa is moist October 15, 2014 Dr.Kagalwala/Diarr 11
  12. 12. CCaassee SSttuuddyy –– 22bb On examination (2 of 2): • CRT 3 seconds • Skin turgor – slightly prolonged (3 seconds) • Per abdomen – normal to increased peristalsis. No other findings of note. • Other systems – normal. October 15, 2014 Dr.Kagalwala/Diarr 12
  13. 13. CCaassee SSttuuddyy –– 33 • What is the likely diagnosis? • Is the girl dehydrated? How much? Why are there inconsistencies (mucosae are moist, for example)? • What investigations are needed? - CBC? - Stool routine? - Serum electrolytes? - Any other? • Will she need hospitalisation? October 15, 2014 Dr.Kagalwala/Diarr 13
  14. 14. CCaassee SSttuuddyy -- 44 Management (1 of 4): ORS: Sip by sip, at least 40-50 ml/kg as deficit plus about ¼ to ½ of a 200-ml glass for every medium to large stool passed plus 3 - 5 ml/kg/vomit to replace losses in vomiting. October 15, 2014 Dr.Kagalwala/Diarr 14
  15. 15. CCaassee SSttuuddyy -- 55 Management (2 of 4): • The child’s mother should be asked to continue breastfeeding her (if she is doing so); continue nourishing her with khichdi, rice-dal, soft bananas, grated apples, vegetables etc. There is no need to ban any food except food that is too spicy. • She can be taught how to check the hydration status from time to time (urine output, AF tension, eyeball tension, skin turgor, etc. ) • ORS substitutes may be used only to give “variety” to the child’s intake of liquids. (Buttermilk, rice water, dal soup, etc.) October 15, 2014 Dr.Kagalwala/Diarr 15
  16. 16. CCaassee SSttuuddyy -- 66 Management (3 of 4): What is the role of : • Anti-diarrhoeals – norflox +metro, for example • Anti-motility agents – atropine derivatives • Anti-secretory agents - racecadotril • Stool binding mixtures – pectin + kaolin • Starvation • Probiotics – lactobacilli, saccharomyces • Antibiotics – cefixime, gentamicin October 15, 2014 Dr.Kagalwala/Diarr 16
  17. 17. CCaassee SSttuuddyy -- 77 Management (4 of 4): • When will you refer for hospitalisation? • What home-based fluids are NOT useful? (coffee, tea, arrowroot kanji) • How often will you see the child? • What supportive medications will be needed? (anti-emetics, anti-pyretics) • Perianal excoriation and rashes will need topical antifungal and protective creams. October 15, 2014 Dr.Kagalwala/Diarr 17
  18. 18. SSoommee rreecceenntt iinnffoo oonn OORRSS ORS : • Presence of salt and sugar together facilitate the reabsorption of water from the gut-lumen along with the salt and sugar. • We have moved from a sweetish, high osmolar liquid to a salty, high Na+ ORS to ORS’s having probiotics, prebiotics, amino-acids, etc. to the most recent “LOW OSMOLAR ORS” that is approved by the WHO for use all over the world in all age groups for all types of diarrhoeal illness including cholera. • This new ORS has only 245 mOsm/L as compared to the higher osmolarity of the previous WHO-approved formula. October 15, 2014 Dr.Kagalwala/Diarr 18
  19. 19. TTaakkee--hhoommee mmeessssaaggeess • Monsoon diarrhoeas may be bacterial in origin, but winter diarrhoeas are almost always viral. • Most children with watery diarrhoea do not need metronidazole. • Most children with typical diarrhoea do not need any investigations. • ORS is the mainstay of therapy. • IV therapy is only recommended for kids with uncontrolled vomiting, very frequent diarrhoea, grade II dehydration or more and those with altered sensorium or any other complications. October 15, 2014 Dr.Kagalwala/Diarr 19
  20. 20. JJuusstt oonnee mmoorree sslliiddee:: October 15, 2014 Dr.Kagalwala/Diarr 20
  21. 21. TThhiiss bbooookk iiss oonn ssaallee!! • This comprehensive book on parenting is written for the layman. • It is priced at Rs. 395/=, but is available to doctors at a special price of Rs. 300/= only. • It carries detailed information for the care of children from 0 – 18 years. • Thank you – Dr. Taher October 15, 2014 Dr.Kagalwala/Diarr 21

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