Dr. J P Singh

Here are symptoms, cause & treatment of Diarrhoea

Hi I am Dr JP Singh, Senior consultant in pediatrics and neonatologist at Tirath Ram Hospital Civil Lines Delhi. Today Vishal will discuss a very common problem in children that is Diarrhoea and how we can prevent its complication and also how we can prevent diarrhoea.

Diarrhoea is one of the most common problems which you see in all children and newborn specially in 3 to 5 years of age. Now it is associated with loose motions which may be either totally watery or may have blood. The number of stool and frequency can also vary. Diarrhoea can lead to serious problems like dehydration and if accompanied with blood it can frequently progress to septicemia and severe infections. In addition to loose motions the child may also have fever, cramps, nausea and vomiting. Now the next question is what are the causes of diarrhoea and why do they occur. The main causes of diarrhoea can be either infectious or noninfectious. Among the infections, viral infections are the commonest and out of the viruses it is the rotavirus diarrhoea which is most common now. This is the diarrhoea which causes a lot of dehydration because here the stools are copious and in larger number. In addition there is frequently associated when vomiting.

So when the child is unable to take adequate fluids. If he is not able to take adequate fluids, the urine output also goes down. If there is severe dehydration it can affect the Kidneys, leading to acute renal failure and therefore inability to pass urine. However the majority of viral Diarrhoeas and rotavirus diarrhoeas are self limiting and if you take care of adequate hydration and keep on giving the child Fluids by mouth they get controlled by itself. Other infectious causes can include bacteria infections and things like amoebiasis and Giardiasis. There are also some non infectious causes of diarrhoea which would include Cow's milk protein allergy, crohn's disease and other problems. In India nearly two million people suffer from rotavirus diarrhoea annually.

Out of this 6 to 8 million children needs hospitalization and nearly about 1 to 1.5 lacs children died because of this disease. That is why it is very important to prevent this diarrhea. Now talking about prevention of rotavirus diarrhoea alone we have a very effective vaccine which is available. This is a oral vaccine and therefore need no injection. This is given at monthly intervals and three doses are required. The starting age for this vaccine is between 6 to 13 weeks. This vaccine has also been added into the Government of India, national immunization programme and has been given in some States. Somehow Delhi still does not have this vaccine from the government of India. Teerathram Shah Hospital and Triveni turbine limited has combined to act and prevent the rotavirus diarrhoea. We are giving free rotavirus vaccination to all newborns between 6 to 13 weeks at Tirath Ram Shah Hospital.

I would like to end by mentioning that in case you want any more information about diarrhoea rotavirus diarrhoea and its prevention you are free to contact us at Teerath Ram Shah Hospital Civil Lines, New Delhi or contact us through lybrate.

If your child comes out of bathroom and cries that while he or she poops it hurts, it's time that you start doing something for his or her constipation. This is a problem that is found among many children and most of the times, if left unnoticed, it can prove to be dangerous. There are many signs that will let you know that your child is suffering from constipation. For instance, if you find your child complaining about stomach pain, or bloating, there are chances that he or she is suffering from constipation.

In such a situation, your child needs your help, and you can do so by:

• Take a peek: It is something your child may not love you to do, but you must see his poop. The consistency of the poop must be of peanut butter. If it seems hard or is sticking to the walls, then your child is suffering. Take action soon.
• Give him more fiber: This is something that most children hate in their diet. Give him or her whole grains or food that is rich in fiber like carrots, brown rice, nuts, beans, lentils, banana, pasta and bread. Foods rich in fiber helpsin preventing constipation, and thus it may be of great help to your child too.
• Increase water in take: Children seldom drink water! They drink only when they are very thirsty. Do not promote this habit; instead ask them to drink more water. With the help of water your child can push through the food that they have eaten.
• A little juice may also help: Fruit juice is good for constipation, especially prune juice that acts as a laxative. Too much fruit juice is not good for them, but depending on their age, four to five ounces of fruit juice can be given as that helps in relieving constipation.
• Stimulate the rectum of your baby: Although it may seem a bit odd, yet it can be tried to help your baby get rid of constipation. Sometimes rectal stimulation helps the movement of bowel. Take a bit of Vaseline on the tip of thermometer and put it inside his rectum. Wiggle the tip very gently a few times before you remove it from there. This stimulation may help in the movement of bowels.
• Switch formula: If you are breastfeeding you baby, then there are very less chances that your baby will suffer from constipation. But if they are on instant food, the formula you are using may be a reason. Thus, you can switch formula and see if it helps.

If none of the above mentioned remedies help, it is best advised to visit a pediatrician.

Here are symptoms, cause and treatment of Diarrhea

Namaskar! I am Dr. Charu and I have The Head of Department and senior consultant, Department of Pediatrics in Teerath Ram Shah Hospital Dr. J.P Singh and Dr. Sunil Gupta, senior consultant In the Department of Pediatrics in Teerath Ram shah Hospital. Today we’ll be talking about Diarrhea.

So Sir my first question is, tell us something about Diarrhea.

In kids, diarrhea is quite a common problem. There are multiple reasons due to which loose motions occur. Some are infections while others are non-infections. Now if we first talk about infections then the most common infection is Rautavaara Diarrhea or Rotavirus infection. Other than this some bacteria can also lead to an infection along with parasites like Amoebiasis and Giardiasis. Under the noninfectious causes, the major reason is what we call ‘Cow’s milk Protein allergy’ which is when the child is unable to digest cow’s milk or any other sourced milk.
What are the symptoms of Diarrhea? In case of a child there are loose motions, vomiting is quite common and stomach ache, low or high fever and sometimes there is blood along with loose motions. Other than this if there is an acute case of dehydration then sunken eyes may happen, skin turns less pliable and the child passes less amount of urine. If the loose motion persists then there can be a chance of acute renal or kidney failure as well which could lead to death.

My next question is to Dr. Sunil. Sir What is Rotavirus virus? Tell us something about that.

Rotavirus is that type of virus where it is found most commonly in children of 5 years or less of an age which causes diarrhea and in 40% of the cases, this virus is the cause. Overall in India 2.5 crores of children get affected by Rotavirus which causes the disease and out of that, 20 lakh children end up needing OPD consultancy and out of that almost 8.5-9 lakh children end up with admission in hospitals with 2.5 children suffering death. It has been noticed that Rautavaara diarrhea is a very severe diarrhea and often causes dehydration. As Dr. Sunit told us, this is a very common disease. Another way of looking at it is that every day 335 children die due to this particular disease which makes a total of 14 kids each hour and 1 kid in each minute. Hence, you can understand that this is a very serious problem in India.

As you said that this is a very serious problem, so Dr. Sunil I would like to know that what are the steps which could be taken to prevent this complication from occurring?

See Rotavirus Diarrhea is where there is an acute loss of water and this is mainly found in children so obviously the first treatment would be to provide the child with ORS and large quantity of fluids. However amount of liquid the child is passing through loose motion, there should be an increased amount of water intake in forms of ORs, Coconut water, rice water or even just water; as compared. And if the problem of dehydration can be curbed then further complications can also be controlled. In Rotavirus’s case Antibiotics are not required and the mother can continue with her feed but when dehydration occurs then the child should be admitted into the hospital because it will need IV fluids. Through these steps, in most of the cases, diarrhea can be controlled in hospitals as well as houses.

Sir you told us about managing the disease but are there any methods to prevent it?

Now we have a oral vaccine available for Rotavirus which is a pain free method without any injections. This is in the form of a liquid which we can provide a baby for a time period of 6-13 weeks. This dose is given thrice every month to the newborn which provides the child a protection from the Rotavirus. The Government of India has also approved the vaccine to be included in the National Immunization Programme but till now it has not been sent out to every state. Other than this, the main things is to follow through with the Priminister’s ‘Swacch Bharat Abhiyaan’, if we excrete inside bathrooms and not outside, maintain basic hygiene by washing our hands before and after using the toilet, cleaning our hands before feeding the child, and drink clean water then to an extent we can prevent rotavirus as well as various types of diarrheas.

Teerath ram shah Hospital and Triveni together have started a programme to help children from Rotavirus. Here in his hospital, we provide the vaccine at free of cost which newborns will be provided with for a time period of 6-13 weeks.
I’d like to thank both of you for providing us with this information and if you want to know more about this then you can contact us through the hospital or through Lybrate.
 

The appendix is a small, finger-shaped pouch attached to the large intestine in the right belly area. It is a vestigial organ as it has no specific role to play in humans, but the organ is still seen, though in a very small size compared to the earlier living beings in the evolutionary chain. Acutely inflamed appendix is the most common cause leading to it removal, often seen in the ages of 10 to 19.

Causes: The appendix gets infected by two main reasons - general infection in the abdomen that reaches the appendix or blockage of the appendix leading to inflammation and swelling within it. The appendix is a blind pouch, and there is a good chance for its blockage from food particles, lymphatic tissue, or even sometimes feces. Some of the potential risk factors for appendicitis include a diet low in fiber, high in sugar, gut flora, and family history.

Symptoms/Diagnosis: In adults, the appendicitis has very characteristic symptoms including acute pain in the right upper part of the belly associated with fever and vomiting. However, in children, the pain may not be as tell-tale a sign but is still quite diagnostic of appendicitis. However, presence of the following symptoms together is surely indicative of appendicitis.

1. Right abdominal pain, especially rebound tenderness, where pressure placed in the right upper part of the belly and released leads to excruciating pain.
2. Fever, nausea, and vomiting
3. Abdominal fullness or bloating
4. Elevated white blood count (as with most infections)

Additionally, the younger the child, the symptoms are not very clear, but ultrasound will confirm the diagnosis. The inflamed, enlarged appendix will be visible on the images and could be surrounded by free fluid. CT scan also can be considered if required to confirm the diagnosis.

Treatment: As noted above, children present with symptoms that do not pinpoint to appendicitis. Treatment usually takes two routes:

If diagnosed as appendicitis before rupture, then surgical removal is the best method to contain its symptoms. Other symptoms like fever and nausea and vomiting usually subside a couple of days after the surgery.
If the appendicitis goes unnoticed and ruptures, then the intestinal cavity can get infected, which is called peritonitis. Earlier, the preferred approach was to control the infection and then go for removal. However, lately, removing the appendix followed by antibiotics to control the infection is the preferred approach.
The prognosis and recovery from appendicitis is very good. Deaths have occurred only in very small infants, where they are not able to pinpoint the area and therefore it can go undiagnosed, leading to rupture and subsequent death.

Early identification is the key to proper identification, immediate treatment, and complete recovery from appendicitis.

Your child is fond of nuts and has eaten a chocolate with nuts but shortly after that develops a skin rash and starts to itch. The rash may even spread to the surrounding area. This is an indication of food allergy to nuts.

What happens is simple - the body's immune system recognizes specific proteins in the food as harmful (antigens) and produces antibodies which can combat them. This leads to an allergic reaction which can vary from something as simple as a skin rash to severe breathing issues.
Though any child can develop food allergies, in most cases, there is a strong hereditary linkage. If parents have had a history of allergy to certain foods, then there is a strong likelihood that the child could have that food allergy too.

Some of the common foods that can cause allergies are as follows:

1. Cow's milk
2. Eggs
3. Nuts (peanuts, walnuts, pecans, cashews or hazelnuts)
4. Soy
5. Wheat
6. Fish (salmon, cod and others)
7. Shellfish (lobsters, shrimps and others)

Of these, peanuts, seafood, and milk are the most common food stuffs that lead to allergies.

Because the child is yet to realize that he has eaten something that his system will not readily accept, the allergic reaction can be described in various ways, as below:

1. Scratching or itching on the tongue
2. Change in the voice - can become husky or hoarse
3. Burning of the tongue
4. Tingling of the tongue
5. Funny feeling in the mouth
6. Feeling of something stuck in the throat
7. Itchy feeling or bugs in the ears
8. Throat going thick
9. Bump on the back of the tongue

These are some ways that a child can describe his allergic reaction. Some of the mild symptoms of a food allergy are as follows:

1. Hives (red, swollen, itchy areas on the skin)
2. Eczema of the skin (dry, itchy rash)
3. Nasal congestion
4. Sneezing
5. Itching of the tongue and the mouth
6. Nausea or vomiting
7. Stomach pain

Severe symptoms include:

1. Severe swelling of the lips and tongue that can block breathing
2. Inability to swallow
3. Difficulty breathing
4. Turning blue
5. Dropping of pulse
6. Drowsiness

As the parent identifies a similar reaction when eating the same food item, they can suspect allergic reactions and immediately reach out to the doctor. A detailed discussion will help establish the causative agent. Once that is known, then avoiding food allergies is quite easy. In fact, a well-informed child will know that avoiding certain foods is very beneficial. This will improve the quality of life of the child, help avoid missing school due to allergic reactions, and help avoid the child (and the parent) suffering.

If you are finding certain symptoms like stomach pain, cramping, frequent diarrhoea, weight loss of your child or fever, then there are chances that he is suffering from Crohn's disease. Crohn's disease is a bowel disease that causes swelling and inflammation along the digestive tract of your child. Mostly, it affects the end of the small intestine, but it can occur anywhere from the mouth to the anus.

Causes behind the disease: It is not common in children, but if your child is showing symptoms, then one of the following may be the reason:

1. Immunity system of the child,
2. Genetics, and
3. Environment.

The main cause behind such a disease can be any of the above. However, it has been found that if you have someone suffering from this disease in the family, then your child has more chances of getting affected by it.

Diagnosing Crohn's disease: If you find the above-mentioned symptoms in your child, then it is better to take him or her to a doctor. Mostly, this disease is chronic in nature, meaning that it will continue even if it is treated. However, with proper treatment the symptoms can be reduced.
For diagnosing this disease the following tests may be done

1. Different lab tests that include a blood test for blood count and white blood cell count, and stool test to look for the bacteria that cause the inflammation and urine.
2. X-Ray for detecting whether your child is suffering from Crohn's disease and what is the exact position of it in the digestive tract.
3. If further required, they may do an endoscopy to find out the exact location and get more details.

Complications arising out of Crohn's disease: If your child is suffering from this disease and is left without treatment for long, he or she may suffer from the following complications.

1. When the disease thickens, it may obstruct the intestinal walls by swelling of the intestine. Thus, the space from where the digestive matter passes becomes less and may lead to bowel obstruction.
2. Fissures may develop at the mucus membrane of the anus.
3. Fistulas or ulcers can occur as they tunnel through the affeced area to the nearby tissues. All these are painful for your child to bear.
4. Your child cannot absorb the nutrients of the food like any other child and hence there are chances that they suffer from nutritional deficiencies.

With such problems that may not seem very huge in the beginning, your child may lose his appetite and forget about normal living. Thus, the moment you find any such symptoms, discuss them with your doctor.

Cyclic vomiting syndrome (CVS) is characterized by periodic bouts of nausea and vomiting that happens at cyclical intervals. It affects all ages, but is more common in children. The condition is quite stereotypical in that there are paroxysms or bouts of vomiting that is recurrent and follows days of normal health.

Causes: There is no definite reason identified, but it is said to have a strong hereditary correlation. Studies have shown mitochondrial heteroplasmic (abnormal growth of mitochondria, which is a cellular component) to be one of the factors that can lead to CVS. The genetic correlation, however, is very difficult to establish, specifically because vomiting and nausea are common symptoms that occur with most conditions in children. And CVS is most commonly noted with conditions like infections and emotional excitement. Infection could be either tooth decay or sinusitis or anything else. Lack of sleep, anxiety, holidays, allergies, overeating, certain foods, menstruation - a host of factors have been shown to induce CVS. There is also a strong association with migraine and conditions that lead to excessive production of stress hormones.

Symptoms: The syndrome (a group of symptoms) usually has 4 phases:

1. Symptom-free interval phase: The child is completely normal in this phase, which happens in between bouts.
2. Prodromal phase: Prodrome is an indication that a disease or a condition is about to happen. In CVS, this is usually nausea and abdominal pain that can last from a few minutes to a few hours. Treatment in this phase can curb the disease. However, there could be some children in whom this may not manifest and the child may directly start with vomiting.
3. Vomiting phase: Repeated bouts of paroxysmal vomiting happen associated with nausea, exertion, fatigue, and drowsiness.
4. Recovery phase: As the nausea and vomiting begin to subside, which may take a couple of days, the child returns back to normal slowly. However, the lethargy and energy levels will take a couple of days to return to normal.

Treatment: Treatment again depends on the severity and the phase at which it is being recognized. If a child has repetitive bouts, then the parent and the doctor would have identified a pattern to it.

1. If the causative agent has been identified, for instance, infection or migraine, then managing that takes care of the CVS also.
2. If identified during the prodromal phase, again it can be managed with suitable anti-emetic medications.
3. If identified after full onset, rest and sleep and medications to control nausea and vomiting are required. Adequate hydration with electrolyte replenishment and sedatives can provide additional support.

However, in most cases of childhood CSV, the pattern will be identified and that helps in better management, both the child/parent and the podiatrist.

When you have a newborn bundle of joy, no parent would be ready for constant crying bouts from the infant. However, for various reasons, even healthy, well-fed infants can be colicky.

What is it: Although a mystery, a baby is said to be colicky if it cries for more than 3 hours a day for more than 3 days a week for more than 3 weeks at a stretch. The baby is completely healthy, and the symptoms start about 2 to 3 weeks of life in both breast-fed and bottle-fed babies. The baby usually has a red face from crying and could be pulling its legs towards its chest due to the abdominal discomfort.

Causes: Though still not exactly established, some things that are believed to cause colic include:

1. The baby's digestive system that is growing and goes through spasms
2. Extreme sensitivity to noise and light in the surrounding environment
3. Accumulation of gas in the belly that is ingested with the milk (breast or bottles)
4. Hormones that are supposedly affecting the baby's moods

Treatment: As there is no specific cause identified, the treatment is also symptomatic and aims at soothing the baby's pain and discomfort.

1. Altered feeding: Given that a baby's tummy is very small and is about the size of a fist, it makes sense to feed it small amounts at regular intervals than to give a full feed once in like 4 to 5 hours. The baby is sure to feel full with this and therefore the discomfort. Burping between the feed is also shown to help avoid feeling of fullness. If you are breast feeding, try to not let the baby doze off when feeding.
2. Anti-colic bottles: These bottles have a vent inside the bottle which will help reduce the accumulation of gas within the bottle. There are various brands available in the market, these could be a good solution if the baby is even partially bottle-fed.
3. Simethicone: This is an anti-flatulent, which again helps eliminate gas bubbles in the stomach and thereby provides relief to the infant. It can be given either by a dropper or a syringe.
4. Exercise: Try bending the legs at the knee and holding it towards the baby's stomach, this can help ease the pain.

Remember that this is a very transient thing and usually disappears on its own by the 4th month, and the above measures are only to help the baby and the mother.

Celiac disease is an autoimmune disease caused due to intolerance to the protein called gluten found in common foods like wheat, barley, and rye. The exact reason for the disease is not known, but gluten attacks the small finger-like projections in the intestine called the villi, which help absorb nutrients during the digestion, leading to malnourishment.

Onset of the disease is usually once the child has started on solid foods and can include diarrhea, abdominal discomfort, underweight, skin rashes, anemia, mouth sores, etc. Diagnosis usually happens with a detailed discussion and checking the level of antibodies against gluten in the blood. In rare cases, an intestinal biopsy may also be required. Once confirmed, the following are ways to manage celiac disease.

Dietary changes: Avoiding gluten-containing foods is the first step to treating celiac disease. These are common food substances like wheat and barley. In some cases, the entire family may choose to or need to take this diet, just to provide moral support to the child.

1. Breads, cakes (made from wheat)
2. Creamed or breaded vegetables
3. Processed meats
4. Dry roasted nuts (as agents used in processing could have wheat)
5. Fried chicken
6. Pastas
7. French fries (that are coated in flour)
8. Spreads, soft cheeses, and dips
9. Salad dressings
10. Gravies and sauces (including some tomato and meat sauces)
11. Soup mixes and canned soups
12. Crab or other seafood
13. Malt or malt-flavored drinks (usually made from barley)
14. Modified food starch (modified corn starch is OK; modified wheat starch is not)
15. Nondairy creamer
16. Soy sauce and soy sauce solids (may be fermented with wheat)
17. Wheat-free products (may contain barley or rye flour)
18. Yogurts containing wheat starch

Read the labels of foods to ensure they are free of gluten. Organic/natural food stores and health food stores contain wide range of gluten-free products that can be used with minimal effect on the child's food habits.

Eating out: Just because the child has celiac disease, eating out is not ruled out. Carefully choosing what to eat is suggested. Also, letting the chef know is a good idea, as most chefs will prepare something safer for the child.

Cross-contamination: Avoid cross-contamination: In schools or in cases where the child could potentially eat from other children's boxes, make sure the child is well informed and ensure he does not eat from other kids' lunch boxes. It is also a good idea to keep the class teacher and a couple of his close friends informed of the child's condition.

Most children are easy to educate and adapt well to the changes required, knowing very well that it is for their own good.