Diarrhea's No Joke Although Children May Sing About It

My children find something very funny about diarrhea. They even know a diarrhea song. When one of them develops the condition, they are prompt to point it out to the others.

Ever since I heard a report from UNICEF (United Nations Children's Fund) about diarrheal diseases in developing countries I get sober when I think of diarrhea. About 30,000 children around the world die every day due to diarrhea or the malnutrition it causes. Fortunately, this rarely occurs in this country, but it is still an unpleasant disease.

Many cases of diarrhea each winter are caused by a virus called rotavirus which peaks each winter. Despite many attempts, there is no medicine to treat it and no vaccine yet to prevent it.

There are two important concepts in treating children with diarrhea:

-- Most medicine is not recommended for use in children. Medicines have potentially dangerous side effects, or may cause the illness to last longer. I recommend avoiding them without specific advice from a doctor.

-- Children can often be treated with oral rehydration fluids. This may avoid hospitalization and intravenous fluids.

The World Health Organization has developed cheap simple mixtures of sugar, salt and water to compensate for what is lost in the diarrhea. In the U.S. there are convenient commercial liquids such as "Pedialyte" which serve the same function, but are more expensive.

Infants and young children should be given these rehydration fluids because they contain salt. Plain Koolaid or water will dilute the minerals in the body because some are lost in the diarrhea. This can have serious effects on a young baby.

The latest breakthrough is that rehydration liquids, such as Ricelyte, contain rice or other proteins and are easier to absorb.

A "clear liquid diet" is often prescribed for diarrhea. Sometimes parents do not understand, and they continue to feed their child clear liquids until the diarrhea stops.

The problem is, sometimes it doesn't stop . . . for weeks. We now know that children can develop diarrhea from starvation. Children remain in better nutritional shape and don't lose as much weight when feeding is continued.

Sometimes children lose their appetite, but it is best if feeding is not stopped for longer than 24 hours.

It is better to keep feeding your child, even though it appears most of it comes out the other end. Breastfed infants should continue to nurse.

However, if a child is vomiting, it does little good to keep pushing anything. It will just keep coming out until the stomach settles down. Try waiting 30 minutes after a vomiting spell before giving anything by mouth.

I know, your child will be thirsty and will want a drink, but the body doesn't understand what is happening. Try to distract your child with stories, music, or TV.

When you do give liquids again, try just one or two ounces. If vomiting occurs, stop and wait a little longer.

During rotavirus infection there is often one to three days of vomiting before the diarrhea starts. This is a difficult period.

Will your child get too dry before the vomiting stops? Wait and watch closely for signs of dehydration:

Are there tears? Are the tongue and mouth dry? Are the eyeballs or soft spot sunken? Has there been no urine output, or wet diaper for over 12 hours? If you have concerns, it's time to have your doctor check.

There is no need to wait for dehydration before starting the oral fluid therapy. If it is begun early in the course, dehydration can be prevented.

(Jeffrey A. Wright is chief of general pediatrics services at Children's Hospital Medical Center in Seattle and acting assistant professor of pediatrics at the University of Washington. His column appears periodically on Scene's Family Talk page. You can write to him c/o Scene, The Seattle Times, P.O. Box 70, Seattle, Wa. 98111.)