Acute Diarrhoea In Children

Acute diarrhoea is passage of three or more abnormally loose or watery stools in 24 hours, lasting less than 14 days. Infection is the dominant cause in children. Watery diarrhoea usually reflects viral or enterotoxin mediated disease, while blood and mucus suggest invasive intestinal inflammation.

The central management decision is classification into no dehydration, some dehydration, severe dehydration or hypovolaemic shock.

Watery diarrhoea may occur with vomiting, fever and abdominal cramps.

Some dehydration is suggested by combinations of:

• Restlessness or irritability
• Sunken eyes
• Increased thirst
• Reduced skin elasticity

Severe dehydration causes:

• Lethargy or reduced consciousness
• Inability to drink adequately
• Markedly sunken eyes
• Very slow skin pinch
• Oliguria
• Poor perfusion

Visible blood defines dysentery and requires a separate management pathway.

• No dehydration: continue feeding and breastfeeding; give ORS after each loose stool. A practical regimen is approximately 10 mL/kg after each loose stool.

• Some dehydration: give ORS 75 mL/kg over 4 hours, continue breastfeeding, then fully reassess and reclassify.

• Severe dehydration: commence structured IV rehydration as detailed in Severe Dehydration.

• Give zinc for 10 to 14 days, 10 mg/day if 6 months or younger and 20 mg/day if older than 6 months.

• Continue age appropriate feeding. Prolonged starvation worsens nutritional deterioration and intestinal recovery.

Acute Abdominal Pain In Children

Acute abdominal pain is a symptom rather than a single disease. Most episodes are benign, but the primary clinical task is rapid recognition of conditions requiring surgery or urgent resuscitation.

Important causes vary with age and include gastroenteritis, constipation, urinary infection, appendicitis, intussusception, intestinal obstruction, volvulus, incarcerated hernia, testicular torsion and diabetic ketoacidosis.

Red flags include:

• Bilious vomiting
• Guarding or rigidity
• Peritonism
• Significant abdominal distension
• Gastrointestinal bleeding
• Persistent focal pain
• Haemodynamic instability
• Absent bowel sounds with distension
• Palpable abdominal mass
• Severe testicular or groin pain

Young children often localize pain poorly. Extra abdominal disease such as pneumonia can present primarily as abdominal pain.

• Perform a complete abdominal examination including hernial orifices and, where appropriate, genital examination.

• Urinalysis is useful because UTI commonly mimics abdominal pathology.

• Pregnancy testing is essential in postmenarchal adolescents where pregnancy is possible.

• Ultrasound is preferred first line imaging for appendicitis, intussusception, gallbladder disease and many pelvic conditions.

• Plain abdominal radiography is reserved mainly for suspected obstruction, perforation or foreign body rather than nonspecific pain.

• CT should be reserved for situations where ultrasound and clinical assessment remain inconclusive and the result will change management.

• Stabilize first if shock, sepsis or major dehydration is present.

• Give appropriate analgesia. Analgesia does not need to be withheld while awaiting surgical assessment.

• Keep the child fasting when a surgical abdomen is suspected and establish IV fluids as required.

• Bilious vomiting, peritonism, suspected volvulus, testicular torsion, perforation or strangulated obstruction requires immediate surgical involvement.

• Reassessment is essential when the diagnosis remains uncertain because evolving appendicitis or obstruction may initially have subtle findings.

Acute Diarrhoea In Children

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management