When should diarrhea in children be a concern? – 07/10/2023 – Balance

Diarrhea is one of the leading causes of death in children under five. According to the WHO (World Health Organization), the condition causes more than a thousand deaths a day worldwide, mainly in countries with poor sanitation and low vaccination rates.

The agency defines acute diarrhea as “a change in bowel habit characterized by the occurrence of elimination of three or more less consistent or liquid evacuations” daily, lasting up to 14 days. Therefore, parents or guardians should be aware of the frequency, quantity and consistency of the child’s stool.

Pediatrician Maria do Carmo Barros de Melo, from the gastroenterology department of the Brazilian Society of Pediatrics, says that exclusively breastfed babies tend to have bowel movements more often a day, sometimes after each feeding, which does not characterize diarrhea.

Parents should watch for other signs of dehydration, such as sunken eyes, dry mouth, decreased urination, lack of sweating and thirst, and excessive vomiting. If the baby or child has diarrhea but has no signs of dehydration, i.e. has not lost weight, is alert and has a moist mouth, is not excessively thirsty, and if they are crying, there are tears, the treatment can be done at home and mainly consists of keeping the child hydrated.

“The guardians should increase the supply of liquids, preferably water, and, after each episode of diarrhea, administer the oral rehydration serum, available at SUS [Sistema Único de Saúde] or in pharmacies. They should not offer soft drinks or ‘sweetened’ drinks”, guides the pediatrician.

According to the Practical Update Guide on acute infectious diarrhea, prepared by the Brazilian Society of Pediatrics, and in accordance with the guidelines of the Ministry of Health, the volume of serum to be offered after each diarrheal bowel movement varies according to the age of the child:

• Children under one year: from 50 to 100ml

• From one to 10 years: 100 to 200ml

• Over 10 years: the tolerated volume

When to seek medical help?

The pediatrician emphasizes that it is necessary to seek medical help if the condition does not improve. Warning signs include increased frequency or volume of diarrhea, repeated vomiting, and blood in the stool. Dehydration, which can manifest itself with decreased diuresis, excessive thirst or refusal of food, also indicates the need for professional evaluation.

“We always ask the parents to observe the general condition of the child. If she is very down, without peeing, very thirsty and frequent vomiting, then the time has come for a medical evaluation”, says pediatrician Gabriela Bonente, physician pediatric intensivist at Hospital Israelita Albert Einstein.

Bonente states that the treatment of a patient with diarrhea may involve administration of antipyretic, antiemetic or antibiotic drugs, and administration of intravenous rehydration serum in a hospital unit, depending on the severity of the case.

The importance of vaccination

Viruses such as rotavirus, norovirus and adenovirus are the main cause of acute diarrhea, with the first agent being the most frequent in children under five years of age. According to the Ministry of Health, rotavirus infections cause more than 200,000 deaths a year worldwide.

Results of a survey coordinated by the WHO with the participation of the Oswaldo Cruz Foundation (Fiocruz) show that rotavirus is responsible for 33% of hospitalizations. But, according to Melo, the start of vaccination against the virus has changed the scenario. “For this reason it is very important to keep the vaccination card up to date”, he says.

Transmission occurs via the fecal-oral route, personal contact, ingestion of contaminated water and food, contaminated objects and airborne transmission.

Therefore, experts cite rotavirus vaccination as one of the main preventive measures. It is possible to find the immunizer in the public and private network.

“The only difference is that the vaccine available in the SUS protects against one type of rotavirus and the one available in the private network protects against five types. But we know that the vaccine that protects against one type is already enough to reduce the numbers of serious cases because the vaccine indirectly protects against the other types as well. So, even if the child gets the virus, the infection will be much milder if he is vaccinated”, he says.

In addition to keeping your vaccination card up to date, other measures that help prevent transmission and contamination by rotavirus are:

• Always wash your hands with clean water and soap before and after using the bathroom and when preparing or handling food;

• Dispose of diapers and garbage correctly, that is, in a way that does not contaminate the soil and water sources;

• Wash and disinfect surfaces, utensils and equipment used in food preparation and store perishables in the refrigerator;

• Breastfeeding following the recommendations of the Ministry of Health, that is, exclusively until the age of six months and continued until the age of two, as the mother’s antibodies also protect the baby.