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      Diarrhoea in infants and young children

      Latest update: - Authors: Mieke Croughs, Ula Maniewski, Nele Alders

      Diarrhoea in tropical countries is usually caused by eating or drinking food or water that has been contaminated with bacteria. Children under the age of two years have a higher risk of severe diarrhoea resulting in dehydration.

      Prevention

      Breastfeeding

      Breastfeeding offers the best protection. It is best to feed your baby on demand; in hot climates, babies may need to be breastfed more often. Make sure you drink enough water yourself.

      Food and drink

      In hot climates, extra fluids may be necessary. A baby younger than 6 months is best fed extra breast milk or formula. For children older than 6 months, pure water can also be given with a spoon or cup.
      Measures for safe eating and drinking reduce the risk of diarrhoea.

      Vaccine

      There is no suitable vaccine for traveller’s diarrhoea yet.

      Diarrhoea

      Is your child suffering from diarrhoea?  

      Symptoms of severe diarrhoea include:  

      • watery stools three or more times within eight hours 
      • diarrhoea with fever 
      • blood or mucus in stool 
      • severe cramping
      • or persistent vomiting

      Symptoms of dehydration include: 

      • thirst 
      • less or no urination
      • a dry mouth 
      • sunken eyes 
      • crying without tears 
      • irritable or apathetic
      • or a skin that no longer automatically  returns to normal after being pulled up for a few seconds 

      Treatment

      Seek medical assistance immediately in case of severe diarrhoea or dehydration:

      1) Hydration: avoid dehydration

      • When breastfeeding:
        Breastfeed as frequently as possible. In case of persistent vomiting or frequent diarrhoea, give ORS between meals: at least 10 ml per kg for each stool produced.

      • When bottle feeding:
        In case of persistent vomiting, bottle feeding can be temporarily replaced by sufficient ORS for the first six hours: 10 to 15 ml per kg per hour. 
        Switch back to usual bottle feeding as soon as possible and give 20% extra fluids, this can be ORS, bottle feeding or extra water if your child is over 6 months. 
        For each stool made, give an additional 10 ml per kg of ORS solution.
      • Oral rehydration solution (ORS)
        • ORS is a mixture of salts and sugar dissolved in water sold under various brand names at pharmacies. 
        • ORS does not reduce diarrhoea but prevents dehydration. 
        • Follow the instructions on the package for compounding.
        • If vomiting occurs, the child sometimes refuses to eat or drink. You can administer ORS in very small amounts, for example a teaspoon or syringe without a needle every one to two minutes. Older children sometimes prefer to drink with a straw. 
        • If vomiting occurs, wait five to ten minutes and start giving ORS again but more slowly, for example a teaspoon every two to three minutes
        • Vomiting usually occurs in the first two hours of treatment, especially if the ORS is given too quickly, however, this does not hinder successful rehydration as most of it is absorbed. 
      • Restart feeding as soon as possible, first with easily digestible foods (such as boiled potatoes, rice, toast) but switch back to the usual diet as soon as possible. Frequent small feedings are often better tolerated than large feedings. 
      • Sugar-sweetened drinks such as soft drinks, fruit juices or caffeinated drinks such as coffee, cola and some teas can potentially worsen diarrhoea.

      2) In case of mild diarrhoea, treating the symptoms is sufficient

      Sufficient fluid intake remains the most important, in addition Racecadotril (Tiorfix®) may be given to reduce diarrhoea:

      • Tiorfix® Baby 10 mg : from three months to 9 kg: one sachet three times per day, 9 -13 kg: two sachets three times per day.
      • Tiorfix® Junior 30 mg: 13-27 kg, one sachet three times per day, > 27 kg: two sachets three times per day.
      • Tiorfix® caps. 100 mg: adult: 1 capsule three times per day.

      Loperamide (Imodium®) can be given to children above the age of six years. Give one capsule after each bowel movement, but not maximum four capsules a day.

      3) Antibiotics

      In case of severe diarrhoea and if medical assistance is not immediately available:

      • Do not give loperamide or Tiorfix®.
      • Start azithromycin (e.g. Zitromax® Syrup or pills), 10 mg per kg per day for three days, whilst waiting for medical assistance.  
      • Continue to seek medical assistance..

      Call the travel assistance insurance during your trip for advice on reliable medical facilities. You can contact your general practitioner or a specialised clinic after returning home.

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