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Introducing Let's Talk Health, an initiative from Apollo Hospitals, where our endeavor is to share knowledge which you can use to keep yourself and your family fit & healthy.

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in Health & Happiness

Diarrhoea: When To Worry?


Diarrhoea refers to loose, watery, frequent bowel motions (stools, poop, poo). Diarrhoea that lasts more than two weeks is considered chronic diarrhoea. There are different causes for acute and chronic diarrhoea, as described below.

The most common cause of acute diarrhoea in an infant or a child is an infection. The most common virus-causing diarrhoea in children is rotavirus, but other viruses can also cause diarrhoea. Bacteria enter the body when they are ingested with contaminated food or water. Some common bacteria that cause diarrhoea are salmonella, shigella, campylobacter and various forms of Escherichia coli. Parasites that we might ingest similarly, like giardia, cryptosporidium and entamoeba, are also the culprits at times. When the child has infection, causing diarrhoea, it is called gastroenteritis.

Allergies to common foodstuffs can also cause diarrhoea. Usually it is common with milk and soya. Celiac disease (wheat allergy) is now being increasingly recognised as an important cause of chronic diarrhoea, especially in the wheat eating populations of northern India.

Another common cause is ‘toddler’s Diarrhoea can lead to dehydration, and this is a serious concern particularly so for young children and infants, cautions Dr Vidyut Bhatia diarrhoea’. This is a result of drinking too much juice or other sugary drinks.

The child’s digestive system becomes overwhelmed by all the fluid and sugar, resulting in diarrhoea. Limiting the amount of juice and other sugary drinks that the child consumes can easily prevent this.

Other conditions that may cause diarrhoea are diseases like ulcerative colitis, Crohn’s disease, and as a side effect of antibiotics.

Why is diarrhoea so dangerous?
Diarrhoea usually settles with time and most children will not require any medications other than medicines for vomiting and fluid therapy. However, diarrhoea can lead to dehydration, and this is a serious concern particularly so for young children and infants. Infants can become dangerously dehydrated very quickly. Moreover, the body of an infant or a toddler is still not ready to defend itself against an infection.

When should you start worrying?
It is important to be vigilant towards developing dehydration in the child. The onset of dehydration may be gradual if the child is passing stools of low volume and infrequently; but if the volume of stools is very high (for e.g. in some infections like cholera), the child might become dehydrated within a few hours. Prolongation of diarrhoea beyond a period of 14 days is also a matter of concern and should be investigated.

Symptoms and signs of dehydration
As the fluid content of the body decreases, the child becomes very thirsty. If they are able to speak, they may ask for fluids. When offered any fluids, the child drinks it readily. The child may also complain of a dry mouth. The following are signs of dehydration in an infant or child. The ones at the top are first to appear:

  • The child has dry mouth and lips.
  • The skin appears less elastic; it doesn’t spring back into place when pinched! The best place to check for this is on the abdomen of the child.
  • The eyes of the child appear sunken.
  • The soft spot (fontanelle) on the baby’s head is depressed.
  • There are no tears while crying.
  • Child has not passed urine for over 12 hours.
  • The child is not active; is looking listless and lethargic.
  • The hands and feet of the child feel cold to touch. This generally means that there isn’t enough fluid in the body and therefore the circulation has become sluggish.

Another way of checking for sluggish circulation is to press the thumb over the breastbone for a few seconds until the skin goes white. Then, take the thumb off and count in seconds until the normal skin colour returns. (1000-1, 1000-2, 1000- 3 etc.). If the colour has not returned within three seconds (1000-3), then the child needs urgent medical attention.

One should see a doctor if the child is lethargic or listless or has not passed urine for six hours or seems generally unwell; if diarrhoea occurs in a newborn baby; if one notices bloody or black stools; if the child is still vomiting after four to six hours; if he/she has a fever higher than 101.50 F.

What can you do?
When the child has acute diarrhoea, the important thing is to keep her fluids up and ensure he/she doesn’t get dehydrated. Continue to give the baby breast milk or milk in any other form that he/she was taking.

Homemade solutions
Make sure the baby has enough fluids and if necessary give extra fluids. If giving extra fluids, it is best to give an oral rehydration solution (ORS). ORS is a special mix of water, glucose (or sugar) and electrolytes like salt. It is specially formulated to help dehydration in infants and toddlers. One can buy ORS at the local chemist.

Making your own ORS
At times it may not be feasible to get hold of a rehydrating solution from the chemist (e.g. on a vacation). It is very easy to make your own ORS solution as given below: Mix the following together until the salt and sugar are dissolved and then keep in the fridge:

  • 1 litre of water (boiled and cooled)
  • 1/2 teaspoon of salt
  • 6 teaspoons of sugar
  • The taste of the solution should be similar to tears

Hygiene measures
Since diarrhoeal microbes spread from child to child very easily, it is important that parents and children wash their hands carefully after every diaper change and after using the toilet and before preparing and eating food.

Two oral vaccines have been developed and are available worldwide (RotaTeq, Rotarix) against rotavirus. Both vaccines have good (85 to 90 per cent) efficacy against severe rotavirus disease.

What not to do
Do not stop milk. One should not use fluids like juices or cola to rehydrate the child for any length of time. No medicine for stopping diarrhoea should be given since it can be fatal in children, and lastly, antibiotics should not be started without expert advice.

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