Diarrhoea_in_Children_Flashcards
What is the main risk associated with gastroenteritis in children?
The main risk associated with gastroenteritis in children is severe dehydration.
What is the most common cause of gastroenteritis in children and its symptoms?
The most common cause of gastroenteritis in children is rotavirus, typically accompanied by fever and vomiting for the first 2 days, with diarrhoea lasting up to a week.
How is gastroenteritis in children treated?
The primary treatment for gastroenteritis in children is rehydration.
What is the most common cause of chronic diarrhoea in infants in the developed world?
The most common cause of chronic diarrhoea in infants in the developed world is cows’ milk intolerance.
What is toddler diarrhoea and its characteristics?
Toddler diarrhoea is characterized by stools that vary in consistency and often contain undigested food.
What are some other causes of chronic diarrhoea in children?
Other causes of chronic diarrhoea in children include coeliac disease and post-gastroenteritis lactose intolerance.
A 4-year-old boy presents with a 2-day history of passing loose stools and non-bilious vomiting. He has passed 5 loose stools and vomited 2 times over the last 48 hours. No visible mucus or blood seen in the stool, and urine output has not changed according to his mother. He is able to tolerate oral fluid and liquid food.
He has not travelled abroad recently and there are no sick contacts. His vaccination schedule is up-to-date and there are no concerns regarding his growth and development.
On examination, he appears well and is alert and responsive. He has warm extremities and capillary refill time is <2 seconds. His vital signs are normal. Peripheral pulses are strong and regular. There is normal skin turgor and there are no sunken eyes.
How should the patient be managed?
Encourage drinking of undiluted fruit juice or carbonated drinks as this will increase his fluid intake
Introduce oral rehydrating solution (ORS)
Start intravenous fluid therapy
Use anti-diarrhoeal medications
Use empirical antibiotic to shorten the disease duration
Introduce oral rehydrating solution (ORS)
Do not use antidiarrhoeal medications in children under 5 years old with diarrhoea and vomiting caused by gastroenteritis
Important for meLess important
The most likely diagnosis for this patient is gastroenteritis. There are no signs and symptoms suggesting clinical dehydration ( warm extremities, normal capillary refill time, normal vital signs, strong peripheral pulses, normal skin turgor and no sunken eyes).
Do not use antidiarrhoeal medications in children under 5 years old with diarrhoea and vomiting caused by gastroenteritis [NICE 2009]. . Antidiarrhoeal and antimotility agents are contraindicated in the treatment of acute gastroenteritis in children because of their lack of benefit and increased risk of side effects, including ileus, drowsiness, and nausea.
Discourage the drinking of fruit juices and carbonated drinks, especially in those at increased risk of dehydration [NICE 2009]. Fruit juice without extra water or carbonated drinks has too much sugar in it and this can draw water from the body into the gut, making the child more dehydrated.
Do not routinely give antibiotics to children with gastroenteritis [NICE 2009] because treatment is not effective on symptoms and does not prevent complications.
The patient does not require antibiotic treatment. Antibiotic treatment is only recommended to all children:
with suspected or confirmed septicaemia
with extra-intestinal spread of bacterial infection
younger than 6 months with salmonella gastroenteritis
who are malnourished or immunocompromised with salmonella gastroenteritis
with Clostridium difficile-associated pseudomembranous enterocolitis, giardiasis, dysenteric shigellosis, dysenteric amoebiasis or cholera [NICE 2009].
IV fluid therapy is not necessary for this patient as he is not clinically dehydrated. Oral rehydrating solution (ORS) in addition to an increment of daily fluid is sufficient to rehydrate him.
Intravenous fluid therapy is indicated for clinical dehydration if:
shock is suspected or confirmed
a child with red flag symptoms or signs shows clinical evidence of deterioration despite oral rehydration therapy
a child persistently vomits the ORS solution, given orally or via a nasogastric tube.
summarise diarrhoea in childrem
Diarrhoea in children
Gastroenteritis
main risk is severe dehydration
most common cause is rotavirus - typically accompanied by fever and vomiting for the first 2 days. The diarrhoea may last up to a week
treatment is rehydration
Chronic diarrhoea
Infants
most common cause in the developed world is cows’ milk intolerance
toddler diarrhoea: stools vary in consistency, often contain undigested food
coeliac disease
post-gastroenteritis lactose intolerance
A 4-year-old boy was discharged from the hospital six weeks ago after an episode of viral gastroenteritis. He now has 4-5 loose stools each day which has been present for the past four weeks.
What is the most likely diagnosis?
Coeliac disease
Inflammatory bowel disease
Secondary bacterial infection
Lactose intolerance
Clostridium difficile infection
Lactose intolerance
Transient lactose intolerance is a common complication of viral gastroenteritis. Removal of lactose from the diet for a few months followed by a gradual reintroduction usually resolves the problem.
