Acute diarrhoeal diseases are among the most common diseases of childhood.
The causative agents are mainly viruses (rotaviruses are the most common, followed by noroviruses, adenoviruses, astroviruses, and coronaviruses), bacteria, and rarely parasites; fungal agents may also occur in immunocompromised patients. Other causes of diarrhea may be food allergies, medications, absorption disorders, vitamin deficiencies, or heavy metals. Sometimes diarrhea may be accompanied by infections that do not involve the gastrointestinal tract.
Diarrhea in children is difficult to define specifically, as the frequency, consistency, and colour of stools change during life. Often, diarrhea in children is defined as an increase in the frequency of defecation of thin stools to twice the normal rate. Acute diarrhea usually lasts up to 7 days.
Infectious diarrhoeal diseases are mainly transmitted by the fecal-oral route (contaminated food, water, ice, various objects). Rarely, aerosol transmission is possible, for example during vomiting. In our conditions, animals are the main vector for bacterial infections, in developing countries it is mainly contaminated water. Children can easily become infected by pets, e.g. puppies. The most common means of transmission for campylobacteriosis is poultry meat (poor hygiene in meat processing), other bacteria are mainly transmitted through eggs, pork or beef, or contaminated vegetables. The highest incidence of childhood diarrhoeal diseases is in the cold months of the year, as viral infections are highly seasonal.
The most common clinical picture in children is acute gastroenteritis. It usually comes on from full health and manifests itself with abdominal pain, vomiting, scanty stools, and various non-specific symptoms (headache, muscle, joint pain, etc.). The most common rotavirus gastroenteritis starts with fever (38°C - 40°C), and vomiting, followed by loose stools, which can number up to dozens. Noroviruses tend to be subfebrile (below 38°C) and vomiting predominates. Adenovirus infections resemble rotavirus infections in a milder form. In milder or atypical forms of all viral infections, some of the classic manifestations may be absent.
In bacterial infections, the picture is that of acute enterocolitis, which is characterized by fever, abdominal pain, diarrhea with frequent admixture of blood and mucus, and non-specific symptoms, but vomiting is absent.
The most common food poisoning is staphylococcal enterotoxicosis caused by golden staph toxin. The source is usually cream, confectionery, or pate. The illness starts early, between 1 and 6 hours after ingestion of contaminated food. A rapid onset is typical, with vomiting being the predominant symptom, but the disease usually disappears within 24 hours. Other poisonings may be from toxins present in pasta, rice, meat, or vegetables (causative agents Bacillus cereus, Clostridium perfingens).
Increasingly, drug-induced diarrhea is occurring in children. The most frequent diarrhea occurs during or after the use of antibiotics due to a disturbed intestinal microflora. Even in children, life-threatening pseudomembranous colitis can occur.
The main accompanying complication of diarrhea in children is dehydration, which infants and toddlers are especially at risk of. Febrile convulsions may also occur in young children. Other rarer complications may include hemolytic uraemic syndrome, rash on the extremities (erythema nodosum), arthritis, and others.
Therapy of most acute diarrheal diseases is symptomatic.
The basis of therapy is rehydration - fluid replenishment. If possible, oral rehydration is preferred. Plain water is not suitable for rehydration, because in diarrhea the body loses not only water but also minerals. Suitable rehydration solutions are unflavoured unsweetened mineral water, various oral rehydration solutions, or sweetened tea. It is necessary to cover the normal fluid consumption, plus the losses caused by vomiting, diarrhea, and fever. In breastfed children, breastfeeding is not interrupted. In older children, appropriate foods (vegetable soups, fruit purees, rice, potatoes, etc.) should also be given from the start of rehydration, and if this is not possible, start giving food at least within 4-6 hours.
Antibiotics are very rarely used in the medical therapy of acute diarrhoeal diseases, especially in severe bacterial infections. For persistent vomiting, antiemetics (anti-vomiting drugs) can be used in the hospital setting. Loperamide and other drugs that reduce bowel movements are not recommended in children and are also severely limited by age (from 6 and 12 years, respectively).
Among non-specific treatments, the use of oral adsorbents (enterosorbents) such as activated charcoal, polymethylsiloxane polyhydrate, diosmectite, and probiotics such as lactobacilli, saccharomyces boulardii are mainly recommended in children.
Enterosgel-polymethylsiloxane polyhydrate is an intestinal adsorbent suitable for the treatment of diarrhea in children. ENTEROSGEL® is a medical device, based on organic silicon, which binds toxins and various other harmful substances in the intestine. It is not self-absorbed and does not irritate the intestinal mucosa.
ENTEROSGEL® has no taste or odour, no additives or preservatives, and is non-allergenic. It is taken as a gel to be dissolved in water and then drunk, which is why it is also easy to use in children.
Most adsorbents and other drug therapies are only suitable for use from the age of 2-3 years or for older children. ENTEROSGEL® is recommended for use in children from the first year of life.
As the prevention of acute diarrhoeal diseases, hygiene is the main thing. Vaccination for intestinal infections is severely limited. There are vaccines against rotavirus, typhoid fever, and cholera.
Resources:
Guarino, Alfredo, et al. "European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014." Journal of pediatric gastroenterology and nutrition 59.1 (2014): 132-152.
Ambrožová H. "Akutní průjmy u dětí." Pediatrie pro praxi 16.2 (2015): 82-85.
Fleisher, Gary R., et al. "Patient education: Acute diarrhea in children (Beyond the Basics)."