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By Ibironke Taiwo. Datelinehealth Africa Volunteer and Freelance Writer, with medical review and editorial support by The DLHA Team
Nurse with mother and child. Image credit: Nkafu Policy Institute
Diarrhoea in children is a common but readily preventable and treated condition. The common types and who is at risk, causes and symptoms have been described in previous reports. At this time, you will learn more about how diarrhoea in children is diagnosed and treated and also how it can be prevented.
Diagnosis is a process that doctors or nurses undertake to find out the cause(s) that explain(s) a patient’s condition or symptoms.
If your child has mild to moderate acute diarrhoea which doesn't last longer than 48-72 hours, the performance of diagnosis is not usually necessary. Instead treatment is considered promptly to address the symptoms.
Diagnosis becomes necessary to undertake when your child has any of the following with the diarrhoea:
The steps needed to establish a diagnosis of the cause of diarrhoea in your child will generally include:
The medical history of a child under the age of five years is commonly obtained from a family member who brought the child to the clinic or hospital.
In obtaining your child’s medical history, the doctor or nurse will ask for information such as:
In addition, your child’s doctor or nurse will ask about some or all of the following:
Upon completion of the medical history, the doctor or nurse will then check your child for:
To perform a rectal examination, your child’s doctor or nurse will wash and dry the hands, wear clean gloves, put sterile (i.e. germ free) lubricant on a gloved finger and insert the finger gently into your child’s anus/rectum. Upon withdrawing the finger, the doctor or nurse will check for any blood stain in the stool.
Your doctor or nurse may order some of the following tests to help in the determination of the cause of your child’s chronic diarrhoea:
You will be given a small, clean container to catch some stool sample from your child with instruction about where to take the sample for laboratory study.
Stool test is performed to look for the presence of blood, bacteria or parasites as well as nature of food residue.
Some blood samples may be obtained through a vein (blood vessel) in your child to check if malabsorption is a possible cause of your child’s chronic diarrhoea. Some of the tests that are performed include full blood count, renal profile (kidney test), liver function tests, albumin, B12, folate, ferritin and vitamin D level checks, etc.
Electrolyte (salts) levels in blood are also checked for any imbalance as children with chronic diarrhoea are often dehydrated and have salt imbalance that needs to be corrected in order for the child to make good recovery.
The hydrogen breath test (also called the “breath test” for short) is a test that is used to diagnose lactose intolerance, a condition that may cause chronic diarrhoea. Lactose is a type of sugar that is contained in milk and dairy products that some people including children are sensitive to.
The hydrogen breath tests measures the amount of hydrogen in breath. Normally, a small amount of hydrogen (gas) is detected in breath. With lactose intolerance, undigested lactose produces a high amount of hydrogen that is released in breath.
To perform this test, your child is given a beverage with a measured quantity of lactose to drink. The child’s breath is then captured in a balloon-type container that measures the hydrogen level in breath. If the hydrogen level is high, then your doctor will diagnose lactose intolerance.
Although doable, hydrogen breath test may be challenging to perform in children under 2 years old because of child stability issues.
Occasionally, the cause of chronic diarrhoea may be due to food intolerance or food allergy. To know if this is the case for your child, the doctor or nurse may ask you to avoid giving your child food with lactose, carbohydrates, wheat or other ingredients to see if your child’s diarrhoea responds to a change in the diet.
Endoscopes are special instruments that have lighted microscopes placed at their ends and are used to visualize the inside of the bowel (gastrointestinal tract or GIT) from the mouth to the anus.
There are different types of endoscopes, such as:
To perform a colonoscopy or flexible sigmoidoscopy for example, your doctor will lubricate a clean (sterile) and special size endoscope suitable for use in children and insert it through the back body (anus) of your child who would have been lightly sedated with a short acting sedative agent.
The doctor will then advance the endoscope gently through the lumen of the bowel while also taking a live look at the internal lining of the bowel for any abnormalities that may explain the cause of your child’s chronic diarrhoea.
Pictures or videos of the bowel may be taken during the test to document what is observed. Also, a tiny sample of tissue may also be taken from the bowel for further laboratory study in the determination of the cause of chronic diarrhoea.
Depending on need, any of the following imaging procedures may be performed on your child to identify the cause of chronic diarrhoea:
Imaging tests are usually performed when tumors (cancers), inflammatory bowel diseases, parasitic infection, etc., are suspected to be the cause of a child’s chronic diarrhoea.
The treatment of acute diarrhea can be quite easy as this type of diarrhea tends to clear on its own without the use of medication or any special treatment, beyond oral fluid and electrolyte replacement.
But in other cases of diarrhea such as chronic diarrhea, and infectious diarrhea, etc., more involving treatments are needed. These may include.
The use of antibiotics or anti-parasitic medications helps to treat diarrhea caused by bacteria or parasite. These agents are tailored specifically to the underlying infectious cause.
Immediate replacement of fluids and electrolytes lost through acute or chronic diarrhoea is a significant component of the treatment of diarrhoea.
In most cases of children with mild to moderate diarrhoea, an oral rehydration solution (glucose-electrolyte solution) is quite helpful in restoring the lost fluids. Oral rehydration fluid may be bought off the shelf at pharmacies and chemist shops as well as in some grocery stores. It can also be prepared at home safely for consumption by your child.
If your child’s diarrhea is severe or your child presents late in a state of severe dehydration and shock, oral replacement fluid may not be adequate. In this case, fluid and electrolyte replacement may need to be given parenterally (i.e., through a vein into the blood stream). This provides more rapid correction of fluid and salt imbalance and can be life-saving.
If a medication that your child is taking is suspected to be the cause of chronic diarrhoea, you may be asked to stop or lower usage of the medication by your doctor.
If your chid is suspected to have food sensitivities or allergies, you may also be asked by your doctor to suspend the consumption of the food for a while to see the response.
If your child’s diarrhea is diagnosed as being caused by underlying inflammatory bowel diseases like Crohn’s, Ulcerative colitis, Celiac disease etc., then the underlying condition will have to be treated first. The treatment approaches for these conditions will be the subject of a separate report.
In addition to the three treatment principles discussed above, it is important that babies with diarrhoea who are under the age of 6 months should continue to be breastfed during and after the duration of diarrhea.
Significant challenges hamper the treatment of diarrhoea disease in many sub-Saharan Africa children especially those living in rural locations. Three of these are:
Lack of potable water and limited social development infrastucture are important contributors to the great burden of diarrhoea diseases in sub-Saharan Africa.
Climate change also poses direct and indirect challenge to managing diarrhoea in sub-Saharan Africa due to its contribution to food scarcity. Children bear the greatest brunt of food scarcity as it pushes them into starvation and eventually malnutrition. Malnutrition and stunting are risk factors for diarrhea disease in children in sub-Saharan Africa. .
Prevention is better than cure and the best way to prevent infectious diarrhea is to avoid contact with agents that cause it. To do so, parents need to train or supervise their children to wash their hands regularly if an when they use the bathroom, before and after eating, and if and when they touch dirty and germs contaminated surfaces.
Also, the following precautions should be adhered to:
The diagnosis of diarrhoea in children can be simple and straight forward as in acute mild cases. It can also be tasking as in chronic and severe cases when a cause needs to be established before adequate treatment is implemented.
The treatment of diarrhoea is carried out using three major approaches that include (a) oral or parenteral replacement of lost fluid and salts, (b) use of anti-infectives and (c) treating any other underlying causes.
Prevention of diarrhoea in children calls for adoption of the WHO W.A.S.H principle. This principle calls for access to potable water, adequate sanitation and practice of good personal hygiene that includes regular hand washing.
1. World Health Organization. Diarrhoeal diseases. May 8, 2017. Available from: . https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease. Accessed August 3, 2023.
2. Kelly, KH. Old and new challenges related to global burden of diarrhoea. The Lancet Infectious diseases. 18(11); 1163-1164. 2018. DOI: https://doi.org/10/1016/S1473-3099(18)30424-9
Published: August 5, 2023
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