When a person has loose or watery stools, he has diarrhea. If mucus and blood can be seen in the stools, he has dysentery.
Diarrhea can be mild or serious. It can be acute (sudden and severe) or chronic (lasting many days).
Diarrhea is more common and more dangerous in young children, especially those who are poorly nourished.
This child is well nourished. He is less likely to get diarrhea. If he gets it he usually will get well again quickly.
This child is poorly nourished. - He is more likely to get diarrhea - and there is a much greater chance he will die from it.
Diarrhea has many causes. Usually no medicines are needed, and the child gets well in a few days if you give him lots of Rehydration Drink and food. (If he does not eat much, give him a little food many times a day.) Occasionally, special treatment is needed. However, most diarrhea can be treated successfully in the home, even if you are not sure of the exact cause or causes.
THE MAIN CAUSES OF DIARRHEA:
poor nutrition. This weakens the child and makes diarrhea from other causes more frequent and worse.
shortage of water and unclean conditions (no latrines) spread the germs that cause diarrhea
virus infection or 'intestinal flu'
an infection of the gut caused by bacteria, amebas, or giardia
worm infections (most worm infections do not cause diarrhea)
infections outside the gut (ear infections; tonsillitis; measles; urinary infections)
malaria (falciparum type - in parts of Africa, Asia, and the Pacific)
food poisoning (spoiled food)
AIDS (long-lasting diarrhea may be an early sign)
inability to digest milk (mainly in severely malnourished children and certain adults)
difficulty babies have digesting foods that are new to them
allergies to certain foods (seafood, crayfish, etc.); occasionally babies are allergic to cow's milk or other milk
side effects produced by certain medicines, such as ampicillin or tetracycline
laxatives, purges, irritating or poisonous plants, certain poisons
eating too much unripe fruit or heavy, greasy foods
Although diarrhea has many different causes, the most common are infection and poor nutrition. With good hygiene and good food, most diarrhea could be prevented. And if treated correctly by giving lots of drink and food, fewer children who get diarrhea would die.
Children who are poorly nourished get diarrhea and die from it far more often than those who are well nourished. Yet diarrhea itself can be part of the cause of malnutrition. And if malnutrition already exists, diarrhea rapidly makes it worse.
Malnutrition causes diarrhea. Diarrhea causes malnutrition.
This results in a vicious circle, in which each makes the other worse. For this reason, good nutrition is important in both the prevention and treatment of diarrhea.
THE 'VICIOUS CIRCLE' OF MALNUTRITION AND DIARRHEA TAKES MANY CHILDREN'S LIVES.
Prevent diarrhea by preventing malnutrition. Prevent malnutrition by preventing diarrhea.
To learn about the kinds of foods that help the body resist or fight off different illnesses, including diarrhea, read Chapter 11.
The prevention of diarrhea depends both on good nutrition and cleanliness. Many suggestions for personal and public cleanliness are given in Chapter 12. These include the use of latrines, the importance of clean water, and the protection of foods from dirt and flies.
Here are some other important suggestions for preventing diarrhea in babies:
• Breast feed rather than bottle feed babies. Give only breast milk for the first 4 to 6 months. Breast milk helps babies resist the infections that cause diarrhea. If it is not possible to breast feed a baby, feed her with a cup and spoon. Do not use a baby bottle because it is harder to keep clean and more likely to cause an infection.
• When you begin to give the baby new or solid food, start by giving her just a little, mashing it well, and mixing it with a little breast milk. The baby has to learn how to digest new foods. If she starts with too much at one time, she may get diarrhea. Do not stop giving breast milk suddenly. Start with other foods while the baby is still breast feeding.
• Keep the baby clean - and in a clean place. Try to keep her from putting dirty things in her mouth.
• Do not give babies unnecessary medicines.
Treatment of diarrhea:
For most cases of diarrhea no medicine is needed. If the diarrhea is severe, the biggest danger is dehydration. If the diarrhea lasts a long time, the biggest danger is malnutrition. So the most important part of treatment has to do with giving enough liquids and enough food. No matter what the cause of diarrhea, always take care with the following:
1. PREVENT OR CONTROL DEHYDRATION. A person with diarrhea must drink a lot of liquids. If diarrhea is severe or there are signs of dehydration, give him Rehydration Drink. Even if he does not want to drink, gently insist that he do so. Have him take several swallows every few minutes.
2. MEET NUTRITIONAL NEEDS. A person with diarrhea needs food as soon as he will eat. This is especially important in small children or persons who are already poorly nourished. Also, when a person has diarrhea, food passes through the gut very quickly and is not all used. So give the person food many times a day - especially if he only takes a little at a time.
• A baby with diarrhea should go on breast feeding.
• An underweight child should get plenty of energy foods and some body-building foods (proteins) all the time he has diarrhea - and extra when he gets well. If he stops eating because he feels too sick or is vomiting, he should eat again as soon as he can. Giving Rehydration Drink will help the child be able to eat. Although giving food may cause more frequent stools at first, it can save his life.
• If a child who is underweight has diarrhea that lasts for many days or keeps coming back, give him more food more often - at least 5 or 6 meals each day. Often no other treatment is needed.
FOODS FOR A PERSON WITH DIARRHEA
When the person is vomiting or feels too sick to eat, he should drink:
As soon as the person is able to eat, in addition to giving the drinks listed at the left, he should eat a balanced selection of the following foods or similar ones:
watery mush or broth of rice, maize powder, or potato
rice water (with some mashed rice)
chicken, meat, egg, or bean broth
Kool-Aid or similar sweetened drinks
ripe or cooked bananas crackers
rice, oatmeal, or other well-cooked grain
fresh maize (well cooked and mashed)
(It helps to add a little sugar or vegetable oil to the cereal foods.)
chicken (boiled or roasted)
meat (well cooked, without much fat or grease)
beans, lentils, or peas (well cooked and mashed)
fish (well cooked)
milk (sometimes this causes problems)
fatty or greasy foods most raw fruits
DO NOT EAT OR DRINK
any kind of laxative or purge
highly seasoned food alcoholic drinks
Diarrhea and milk:
Breast milk is the best food for babies. It helps prevent and combat diarrhea. Keep giving breast milk when the baby has diarrhea.
Cow's milk, powdered milk, or canned milk can be good sources of energy and protein. Keep on giving them to a child with diarrhea. In a very few children these milks may cause more diarrhea. If this happens, try giving less milk and mixing it with other foods. But remember: a poorly nourished child with diarrhea must have enough energy foods and protein. If less milk is given, well-cooked and mashed foods such as chicken, egg yolk, meat, fish, or beans should be added. Beans are easier to digest if their skins have been taken off and they are boiled and mashed.
As the child gets better, he will usually be able to drink more milk without getting diarrhea.
Medicines for diarrhea:
For most cases of diarrhea no medicines are needed. But in certain cases, using the right medicine can be important. However, many of the medicines commonly used for diarrhea do little or no good. Some are actually harmful:
GENERALLY IT IS BETTER NOT TO USE THE FOLLOWING MEDICINES IN THE TREATMENT OF DIARRHEA:
'Anti-diarrhea' medicines with kaolin and pectin (such as Kaopectate) make diarrhea thicker and less frequent. But they do not correct dehydration or control infection. Some anti-diarrhea medicines, like loperamide (Imodium) or diphenoxylate (Lomotil) may even cause harm or make infections last longer.
'ANTI-DIARRHEA MEDICINES' ACT LIKE PLUGS. THEY KEEP IN THE INFECTED MATERIAL THAT NEEDS TO COME OUT.
'Anti-diarrhea' mixtures containing neomycin or streptomycin should not be used. They irritate the gut and often do more harm than good.
Antibiotics like ampicillin and tetracycline are useful only in some cases of diarrhea. But they themselves sometimes cause diarrhea, especially in small children. If, after taking these antibiotics for more than 2 or 3 days, diarrhea gets worse rather than better, stop taking them - the antibiotics may be the cause.
Chloramphenicol has certain dangers in its use and should never be used for mild diarrhea or given to babies less than 1 month old.
Laxatives and purges should never be given to persons with diarrhea. They will make it worse and increase the danger of dehydration.
Special treatment in different cases of diarrhea:
While most cases of diarrhea are best treated by giving plenty of liquids and food, and no medicine, sometimes special treatment is needed.
In considering treatment, keep in mind that some cases of diarrhea, especially in small children, are caused by infections outside the gut. Always check for infections of the ears, the throat, and the urinary system. If found, these infections should be treated. Also look for signs of measles.
If the child has mild diarrhea together with signs of a cold, the diarrhea is probably caused by a virus, or 'intestinal flu', and no special treatment is called for. Give lots of liquids and all the food the child will accept.
In certain difficult cases of diarrhea, analysis of the stools or other tests may be needed to know how to treat it correctly. But usually you can learn enough from asking specific questions, seeing the stools, and looking for certain signs. Here are some guidelines for treatment according to signs.
1. Sudden, mild diarrhea. No fever. (Upset stomach? 'Intestinal flu'?)
• Drink lots of liquids. Usually no special treatment is needed. It is usually best not to use 'diarrhea plug' medicines such as kaolin with pectin (Kaopectate) or diphenoxylate (Lomotil). They are never necessary and do not help either to correct dehydration or get rid of infection - so why waste money buying them? Never give them to persons who are very ill, or to small children.
2. Diarrhea with vomiting. (Many causes)
• If a person with diarrhea is also vomiting, the danger of dehydration is greater, especially in small children. It is very important to give the Rehydration Drink, tea, soup, or whatever liquids he will take. Keep giving the Drink, even if the person vomits it out again. Some will stay inside. Give sips every 5 to 10 minutes. If vomiting does not stop soon, you can use medicines like promethazine or phenobarbital.
• If you cannot control the vomiting or if the dehydration gets worse, seek medical help fast.
3. Diarrhea with mucus and blood. Often chronic. No fever. There may be diarrhea some days and constipation other days. (Possibly amebic dysentery.)
• Use metronidazole or diloxanide furoate. Take the medicine according to the recommended dose. If the diarrhea continues after treatment, seek medical advice.
4. Severe diarrhea with blood, with fever. (Bacterial dysentery - caused by Shigella?)
• Give co-trimoxazole or ampicillin. Shigella is now often resistant to ampicillin, and sometimes to co-trimoxazole. If the first medicine you try does not bring improvement within 2 days, try another or seek medical help.
5. Severe diarrhea with fever, usually no blood.
• Fever may be partly caused by dehydration. Give-lots of Rehydration Drink. If the person is very ill and does not improve within 6 hours after beginning Rehydration Drink, seek medical help.
• Check for signs of typhoid fever. If present, treat for typhoid.
• In areas where falciparum malaria is common, it is a good idea to treat persons with diarrhea and fever for malaria, especially if they have a large spleen.
6. Yellow, bad-smelling diarrhea with bubbles or froth, without blood or mucus. Often a lot of gas in the belly, and burps that taste bad, like sulfur. (Giardia?)
• This may be caused by microscopic parasites called giardia or perhaps by malnutrition. In either case, plenty of liquid, nutritious food, and rest are often the only treatment needed. Severe giardia infections can be treated with metronidazole. Quinacrine (Atabrine) is cheaper, but has worse side effects.
7. Chronic diarrhea (diarrhea that lasts a long time or keeps coming back).
• This can be in part caused by malnutrition, or by a chronic infection such as that caused by amebas or giardia. See that the child eats more nutritious food more times a day. If the diarrhea still continues, seek medical help.
8. Diarrhea like rice water. (Cholera?)
• 'Rice water' stools in very large quantities may be a sign of cholera. In countries where this dangerous disease occurs, cholera often comes in epidemics (striking many people at once) and is usually worse in older children and adults. Severe dehydration can develop quickly, especially if there is vomiting also. Treat the dehydration continuously, and give tetracycline, co-trimoxazole, or chloramphenicol. Cholera should be reported to the health authorities. Seek medical help.
A 'cholera bed' like this can he made for persons with very severe diarrhea. Watch how much liquid the person is losing and be sure he drinks larger amounts of Rehydration Drink. Give him the Drink almost continuously, and have him drink as much as he can.
Care of Babies with Diarrhea
Diarrhea is especially dangerous in babies and small children. Often no medicine is needed, but special care must be taken because a baby can die very quickly of dehydration.
• Continue breast feeding and also give sips of Rehydration Drink made with water, sugar and salt only.
• If vomiting is a problem, give breast milk often, but only a little at a time, Also give Rehydration Drink in small sips every 5 to 10 minutes (see Vomiting).
• If there is no breast milk, try giving frequent small feedings of some other milk or milk substitute (like milk made from soybeans) mixed to half normal strength with boiled water. If milk seems to make the diarrhea worse, give some other protein (mashed chicken, eggs, lean meat, or skinned mashed beans, mixed with sugar or well-cooked rice or another carbohydrate, and boiled water).
• If the child is younger than 1 month, try to find a health worker before giving any medicine. If there is no health worker and the child is very sick, give him an 'infant syrup' that contains ampicillin: half a teaspoon 4 times daily. It is better not to use other antibiotics.
GIVE HIM BREAST MILK
AND ALSO REHYDRATION DRINK
When to Seek Medical Help in Cases of Diarrhea
Diarrhea and dysentery can be very dangerous - especially in small children. In the following situations you should get medical help:
• if diarrhea lasts more than 4 days and is not getting better - or more than 1 day in a small child with severe diarrhea
• if the person shows signs of dehydration and is getting worse
• if the child vomits everything he drinks, or drinks nothing, or if frequent vomiting continues for more than 3 hours after beginning Rehydration Drink
• if the child begins to have fits, or if the feet and face swell
• if the person was very sick, weak, or malnourished before the diarrhea began (especially a little child or a very old person)
• if there is much blood in the stools. This can be dangerous even if there is only very little diarrhea (see gut obstruction).