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Dr. Himanshu Joshi's Profile
Diarrhoeal Illness in Children
Diarrhea management in children
Passage of 3 or more loose stools in 24 hours period is considered diarrhea. A change in consistency and frequency of stool pattern is noticed by parents. It is estimated that on average a child under 5 years of age will have approximately 3.2 episodes of diarrhea per year. The loss of liquids caused by diarrhea can lead to dehydration and disturbances in body electrolytes which may require medical treatment.
What causes diarrhea in children?
Gastrointestinal tract infections – Mostly Viral, also bacterial and protozoal are the cause of diarrhea. Many a times there may be a non-infectious cause of diarrhea (antibiotic induced, lactose intolerance, etc.)
Additional complaints
Child having diarrhea can also have Vomiting, Fever, Abdominal Pain and Decreased Appetite.
What can parents do at home?
ORS (Oral rehydration solution) should be started for child having loose motions. Parents can also start with home available fluids like dal water, sugar-salt solution (Half teaspoon salt+ 8 teaspoon sugar added to a liter of clean 1 liter water). Parents should consult doctor urgently if:
1. Child is becoming very sleepy or irritable
2. Child is having multiple vomiting and is not able to drink ORS
3. Eyes of child look sunken into the orbit.
4. Child is passing blood in stools
Medical management of diarrhea:
World Health Organization emphasizes on 3 points in management of any acute childhood diarrhea. These are ORS, Feeding and Zinc supplementation. Since most of diarrhea episodes are due to viral infections most children recover with ORS and Zinc therapy. Feeding should not be stopped during diarrhea. Doctor examines the child to look for any dehydration (decrease in body water), rule out possible bacterial cause of diarrhea (which might require antibiotics), other causes of loose motions (transitional stooling in newborns, increased gastro colic reflex, toddlers diarrhea etc.). Antibiotics are not required for every case of diarrhea. Stool or blood tests are not required usually but doctor may decide to perform some tests if diarrhea gets prolonged to more than 2 weeks and in some other conditions.
How to Prevent Diarrhea:
1. Hand washing - after playing outdoors, after going to toilets, before having meals.
2. Prevent eating out at places that seem to have doubtful hygiene standards.
3. Exclusive breast feeding for first 6 months of life prevents diarrhoea episodes in young infants; Bottle feeds can prolong a diarrhoea episode and can be a cause of recurrent loose motions in a child
4. Vaccine: Vaccine to prevent diarrhea caused by Rotavirus is available.

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Cold And Cough in Children
Cold and Cough in Children – The common facts
Most of the hospital visits by parents of children, especially younger ones, are for complaints of cold and cough. Parents are usually concerned because of accompanying fever in most of cases. Majority of these episodes of illness are VIRAL in origin and as such medical treatment is symptomatic and no antibiotic is required.
Cold is a VIRAL illness in which symptoms of running nose and blocked nose are common. The first symptom is often sore or scratchy throat, followed by blocked nose and finally runny nose. Around 1/3 cases of cold are associated with cough. Other complaints like fever, headache, body ache and tiredness can also occur. Usually episode of cold and cough lasts about 1 week and 10% cases may last for 2 weeks. Colds occur year –round , but more common in August- October and April- May due to increased activity of RHINOVIRUS. Other viruses like RSV can cause cold between December to April.
Young children (up to 3-4 years of life) have average of 6-8 colds per year and 15% children have at up to 12 cold episodes per year i.e. one per month. The cold episodes decrease with age and by adulthood average of 2-3 episodes per year are reported. Parents should seek medical opinion early if following complaints occur:
1. Child refuses to drink anything for long period of time.
2. Change in behavior of child- either very sleepy or very irritable.
3. Difficulty in breathing.
Antibiotics are not effective in treating colds. They may be necessary if the cold is complicated by a bacterial infection, like an ear infection, pneumonia, or sinusitis. Inappropriate use of antibiotics can lead to the development of antibiotic resistance, and can possibly lead to side effects, such as an allergic reaction.
Simple hygiene measures can help to prevent infection with the viruses that cause colds. Hand washing prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. It may be difficult or impossible to completely avoid people who are ill, although parents should try to limit direct contact.
Some parents ascribe cause of cold to food items like curd, fruits and rice. These are food myths and have no scientific rationale. As previously mentioned young children can have one episode of cold every 1 to 1 ½ months in first few years of life and they are not related to weak immunity. Children who are bottle fed have more chances of getting colds, ear infections and diarrhea episodes. Exclusive breast feeding in first 6 months of life protects little ones from catching frequent infections.

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