Diarrhoea in infants and young children

Latest update: - Authors: Mieke Croughs, Ula Maniewski-Kelner

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.  Extra (purified) water can be given on a spoon in a hot climate.

Food and drink

The measures to ensure safe consumption of food and drinks will 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 
  • Bloody stools 
  • Persistent vomiting

Symptoms of dehydration include: 

  • Thirst 
  • A dry mouth 
  • Reduced urination 
  • Sunken eyes 
  • Crying without tears 
  • Apathy 

Treatment

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

1) Hydration: avoid deshydration 

  • Continue breastfeeding and give ORS between feeds (a mixture of salts and glucose (dextrose)) - at least 10 mL per kg for each bowel movement - and purified water on request. 
  • Adjust the dose of ORS according to the instructions on the packaging. 
  • Formula feeds should be replaced by sufficient ORS for the first six hours: 10 to 15 mL per kg per hour. Then switch back to normal feeds with the addition of 20% extra fluids. This can be achieved by adding water to the formula milk, or by giving water between the feeds. Give 10 mL per kg ORS solution after each bowel movement. 
  • If the quantities described above cannot be given, you can replace the formula feed with diluted formula. Add double the amount of water to the powder, until the diarrhoea improves and for a maximum of 24 hours. 
  • A child that is vomiting will often refuse to drink, but you can offer the feeds in very small quantities, for example using a teaspoon or a syringe. Older children sometimes prefer to drink through a straw. 
  • The ORS will not reduce the diarrhoea, but will prevent dehydration. 
  • Continue feeding the child, starting with foods that are easy to digest (boiled potatoes, rice, toast), but try to return to the normal feeding pattern as soon as possible. 

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

Racecadotril (Tiorfix®) can be given to reduce the diarrhea: 

  • 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 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.  

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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