Diarrhea is a digestive tract syndrome caused by various pathogens and factors, characterized by increased stool frequency and changes in stool characteristics.
There are about 2 billion cases of diarrhea in the world every year. The annual incidence rate of diarrhea among children in China is 1.9 times/person/year, which is the main cause of malnutrition among children under 5 years old and the second leading cause of death among children under 5 years old.
When the baby has diarrhea, the loss of body fluids due to vomiting and diarrhea, coupled with insufficient intake of liquid, reduce the total amount of body fluids, which can lead to dehydration to different degrees. If dehydration is not relieved in time, serious consequences will occur.
Therefore, the most important thing for babies with diarrhea is to evaluate the severity of dehydration, which is directly related to whether the baby is suitable for family treatment.
Pay attention to the dehydration of the baby,
Typical characteristics of infant dehydration include: skin mucosa dryness, skin elasticity, anterior fontanelle socket depression, peripheral circulation such as heart rate, blood pressure, pulse, limb temperature, body temperature, urine volume, etc.
Among them, the most accurate way to evaluate the severity of dehydration is to calculate the percentage of the total weight before dehydration according to the weight loss. If conditions permit, you can weigh yourself (net weight) at the beginning of diarrhea. The clinical manifestations and detection of dehydration in children are often inaccurate, so comprehensive evaluation can improve the accuracy of diagnosis more than single factor evaluation.
Diarrhea babies without dehydration and mild or moderate dehydration can be treated at home, but please adhere to the following principles.
From the beginning of your baby’s diarrhea, you can take enough suitable fluids orally to prevent dehydration. You can start using oral rehydration fluids as soon as diarrhea is found, and you don’t have to wait until dehydration symptoms occur. In any case, home rehydration should include at least one saline liquid.
Breastfed babies should continue to breastfeed, And increase the frequency of feeding and prolong the time of single feeding. Mixed feeding of babies, Oral rehydration salts (ORS, preferred) or other clean drinking water should be given on the basis of breast feeding. Artificially fed babies choose ORS or food-based rehydration, such as soup, rice soup, noodle soup, sugar saline (close to the salinity of tear water), sugar-free fresh fruit juice, yogurt drink or clean drinking water, with various soups as the first choice.
It is suggested to supplement a certain amount of liquid after each loose stool (50 ml for those < 6 months; 6 months to 2 years old, 100 ml; 150ml for 2-10 years old; Children over the age of 10 can drink as much as they can until diarrhea stops).
It should be noted that water, fruit juice, refreshing drinks, sports drinks and soft drinks generally contain low sodium and potassium but high sugar content, so the effect is not as good as ORS in supplementing water and electrolyte lost by dehydrated children.
Oral rehydration was used to relieve dehydration in time, ORS was applied, total dosage (ml) = body weight (kg) × (50 ~ 75 ~ 100), and oral administration was completed in 4 hours.
Weigh the child and make a fluid replacement balance plan.
Oral rehydration of 10 ~ 20 ml/kg bw/h was given at the first hour and 5 ml/kg bw/h was given every 15 minutes. Cups, bottles, spoons, drippers, syringes, etc. were used according to the wishes of the children. If oral rehydration can be tolerated, oral rehydration of 10 ~ 20 ml/kg bw/h is continued for 3 hours.
- Persistent, frequent and massive diarrhea > 10 ~ 20 ml/kg body weight/hour; The dosage of ORS solution is insufficient. Frequent and severe vomiting; If the baby still has dehydration within 4 hours, the fluid infusion plan should be adjusted. If the baby suffers from persistent vomiting or aggravation of dehydration, it is recommended to see a doctor and infusion therapy can be considered.
Supplement of zinc
Babies with acute diarrhea should be treated with zinc supplement immediately after eating. Babies over 6 months old should be supplemented with 20 mg of elemental zinc every day, while babies under 6 months old should be supplemented with 10 mg of elemental zinc every day for 10-14 days. 20 mg of elemental zinc is equivalent to 100 mg of zinc sulfate, 140 mg of zinc gluconate and 200 mg of zinc licorice.
If you only buy zinc gluconate oral liquid (one 10 ml containing 3.53 mg of elemental zinc), you need 3 less (less than 6 months old) or 6 less (7 months old to 5 years old) per day according to the recommended dose. If you buy zinc gluconate tablets (one 10 mg elemental zinc tablet), you only need one or two tablets a day, both of which are taken 2-3 times and continuously for 10-14 days.
Supplement zinc in case of diarrhea, It is considered that zinc plays a central role in cell growth and immune function. Supplementing zinc, It can shorten the course of diarrhea, reduce the severity of diarrhea and reduce the risk of dehydration. Continuous zinc supplement for 10-14 days, Can completely supplement the zinc lost during diarrhea, And reduce the risk of recurrent diarrhea in children within the next 2-3 months. The benefits of zinc supplement go far beyond reducing the morbidity and mortality of diarrhea in children, but also reducing the irrational use of antibiotics. In developing countries, excessive use of antibiotics for diarrhea is the main reason for increasing drug resistance.
Different zinc preparations such as zinc sulfate, zinc acetate or zinc gluconate have the same curative effect.
Therefore, it is not necessary to struggle with what zinc agent to supplement it, but only to pay attention to whether the element zinc content in it meets the standard.
Keep feeding your baby
Food should be arranged individually according to the baby’s age, preferences and eating habits before illness.
(1) Babies with severe vomiting can temporarily fast for 4-6 hours (unable to help water). After 4-6 hours, the principle of “from less to more, from thin to thick” should be followed to restore as soon as possible the normal diet (including breast milk) that babies have been eating before diarrhea.
Breastfed babies should continue to breastfeed, but they should pay attention to the diet of lactating mothers, try to avoid greasy, high-fat, high-sugar diets and foods that are easy to cause sensitization, breast-feed as needed, and increase the number of times and time of each breast-feed.
- Breastfeeding should be increased for mixed feeding babies < 6 months old.
- Artificially fed babies < 6 months old can continue to be fed formula milk at least once every 3 hours. The so-called special formula milk powder for diarrhea babies should not be used routinely.
- > 6-month-old babies can continue to eat daily foods they have become accustomed to, such as porridge, noodles, porridge, eggs, minced fish, minced meat, fresh coconut juice rich in potassium and fresh fruit juice.
(2) Encourage your baby to eat as much as possible. If you eat less, you can increase the number of feeding meals, and you can arrange to eat once every 3-4 hours, because your baby’s tolerance to feeding a small amount of times is better than that of feeding a large amount of times.
(3) For children with lactose intolerance after infection secondary to acute diarrhea, breast-feeding providers should continue breast-feeding, unless formula milk providers with hip epidermis peeling off or unable to maintain weight gain should use lactose-free formula milk for 3-4 weeks before transitioning to ordinary formula milk.
Viral enteritis (such as autumn diarrhea) often suffers from secondary disaccharidase (mainly lactase) deficiency. Suspected enteritis can be temporarily fed with soy milk, starch food, or low (or de-lactose) formula milk powder for 1-2 weeks. After diarrhea improves, the original feeding method will be changed.
(4) Avoid feeding babies vegetables and fruits containing crude fiber and high-sugar foods or high-fat diets, and avoid giving sugary drinks (including general commercial fruit juice, sweet tea, soda, cola, etc.), sports drinks, undiluted fruit juice or refreshing drinks, and some irritating, diuretic or laxative liquids such as coffee, some medicinal tea or granules, etc.
The main raw material of soft drinks is drinking water or mineral water, Juice, vegetable juice or extracts of plant roots, stems, leaves, flowers and fruits. According to raw materials and processing technology, it can be divided into 8 categories: carbonated beverages, fruit juice and its beverages, vegetable juice and its beverages, vegetable protein beverages, plant extract beverages, lactic acid beverages, mineral water and solid beverages. However, in the United States, Britain and other countries, soft drinks do not include fruit juice and vegetable juice.
(5) After diarrhea stops, gradually restore nutritious food and eat once a day for at least 2 weeks. If the baby is malnourished, you should always give extra meals before the baby’s weight returns to normal.
(6) Allergic diarrhea: Milk allergy is more common. This kind of children should avoid eating allergic foods or adopt oral desensitization feeding method, without limiting the foods they have already tolerated. Infants can usually tolerate deeply hydrolyzed casein formula. If they still do not tolerate, they can adopt amino acid-based formula or all-factor diet.
Essential diet, It is the most ideal food when intestinal mucosa is damaged. Composed of amino acids, monosaccharides, fatty acids, vitamins, minerals and trace elements, Compared with non-essential diet, essential diet has poor taste and higher osmotic pressure, but its nutrients are uniform in variety, sufficient in quantity and reasonable in proportion, which can meet nutritional needs and is suitable for patients with chronic diarrhea, intestinal mucosal injury and malabsorption syndrome.
What situations do you go to see a doctor?
If the baby’s condition does not improve or any of the following symptoms occur, he must be sent to the hospital in time:
- Severe diarrhea, frequent stool or large amount of diarrhea. Can’t eat normally. Frequent vomiting, can’t take orally. Fever: The body temperature of the baby < 3 months old > 38 ℃, The body temperature of 3 ~ 36 months old baby is > 39 ℃. Obviously thirsty, Found signs of dehydration, Such as sunken eye socket, few tears, dry mucous membrane or reduced urine volume, Change of mind, Such as irritability, apathy, lethargy, etc. Feces are bloody. Age < 6 months (complicated with water, electrolyte disorders and acid-base imbalance, Minerals, vitamins and trace elements deficiency, etc.), premature infants, have a history of chronic diseases or complications (such as pneumonia, septicemia, urinary tract infection and otitis media, etc.). All severely dehydrated babies and moderately dehydrated babies who still refuse oral rehydration after one hour of trial should be sent to hospital.
How to prevent diarrhea?
- Develop good hygiene habits, pay attention to food hygiene and environmental hygiene. Feed reasonably, advocate breast-feeding and add supplementary foods reasonably. Actively prevent and treat malnutrition, supplement vitamins A and D reasonably. Reasonable use of antibiotics and adrenocortical hormones to avoid long-term abuse. Vaccination is currently considered to be rotavirus vaccine that may be effective.
Responsible Editor: Ji Lingyan