Diarrhea in Pre-Schoolers

Diarrhea is the body’s way of getting rid of germs and viruses, but it can leave your child weak and dehydrated. Find out what causes diarrhea, when you should seek medical advice and how you can prevent the spread of infection.

It can be quite distressing for both you and your child when your child has Diarrhea, as episodes of incontinence can cause both embarrassment and fear for your little one.  Diarrhea can either be acute, which means that it has a sudden onset and a short duration (less than two weeks) or it can be chronic, which means that it is long-term and persistent. Fortunately, most cases of childhood Diarrhea are of the acute form and usually last only a few days.

What causes acute Diarrhea?

Usually, an infection of the gut (gastroenteritis) is the common cause. This infective agent is often a virus or bacteria. Viruses that cause Diarrhea are easily spread from person to person by close contact, or when an infected person prepares food which is then eaten by others. Food poisoning is usually caused by a bacterial infection; either the bacteria itself or the toxins (poisons) that it produces. Another group of microbes called parasites can also be a cause of food poisoning. Water contaminated by bacteria or other germs is another cause of infective Diarrhea, but this form of transmission is not so common in countries that have good sanitation. There are also non-infectious causes of acute Diarrhea, such as colitis (inflammation of the gut) food intolerance and various rare disorders, but these are uncommon in children.

What are the symptoms of acute infectious Diarrhea?

Symptoms can range in severity from a mild stomach upset for one or two days with slight Diarrhea to severe watery Diarrhea and stomach cramps for several days or longer. Blood or mucus can appear in the stools (faeces) with some infections. There may also be vomiting, high temperature (fever), headache and aching limbs and joints. Usually the most serious symptoms are seen when the Diarrhea causes dehydration.

Dehydration in children with acute Diarrhea is more likely to occur in those who have a severe infection, particularly if they have passed six or more Diarrhea stools and/or vomited three or more times in the previous 24 hours. It is also seen in those who may have a less severe infection but who do not drink enough fluids.

When should I seek medical advice?

Most children with Diarrhea have mild symptoms which resole in a few days without the need for medical intervention, as their immune system is usually able to clear the infection. The important thing is to ensure that they have plenty to drink to keep them well hydrated. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop. You should seek medical advice in the following situations, or if you are in any way concerned:

• If your child has an existing medical condition
• If you suspect dehydration
• If your child has a fever
• If your child appears drowsy or confused.
• If your child is drinking but unable to keep fluids down.
• If there is blood in their Diarrhea or vomit.
• If your child has severe abdominal pain.
• If they have recently returned from abroad.
• If your child’s symptoms are not settling (for example, vomiting for more than 1-2 days, or Diarrhea for more than 3-4 days).

Medication

Medication is not usually needed to treat Diarrhea in children. You should not give children medication to prevent Diarrhea unless a doctor has said that it is okay, as many such medicines slow down the motility of the gut and although this may reduce the episodes of Diarrhea, it can also prevent the organisms that cause it from being expelled from the body, allowing them to multiply even further in the gut.

Preventing the spread of infection

Diarrheal infections are highly communicable and can be very easily passed from one person to another. If your child develops Diarrhea, you should make sure that you do the following:

• Make sure your child washes their hands thoroughly after going to the toilet.
• Clean your toilets at least daily with disinfectant. Ensure that you include the handle, seat, sink taps, bathroom surfaces and door handles.
• If a potty is being used, the contents should be disposed of into a toilet, then the potty washed with hot water and detergent and left to dry.
• If your child’s clothing or bedding is soiled, it should be washed separately in the highest temperature setting on your washing machine.
• Ensure that your child has their own towel and flannel and that they exclusively use these.
• Don’t let your child help in food preparation.
• They should stay away from nursery until at least 48 hours after the last episode of Diarrhea or vomiting. Some types of infection will require a longer period of time away to be safe – you can ask your doctor about this.
• If the cause of Diarrhea is identified as (or suspected to be) an infective agent called Cryptosporidium, your child should not swim in swimming pools for two weeks after the last episode of Diarrhea. That’s because this particular pathogen has a spore phase which can survive for lengthy periods in water.

The most effective measure to protect against infective Diarrhea is the simple measure of washing hands regularly with soap and warm water. This is known to make a big difference to the chance of developing gut infections and Diarrhea. You should also take extra measures when travelling abroad to countries where sanitation might be poor. In these countries, you should avoid drinking tap water and putting ice cubes into your drink unless you are sure that bottled water was used to make them. You should take care at salad bars as well, as some hotels (even top ones) wash their salads in unsafe tap water.