In the majority of cases it is due to viral infection of the intestines. Benign and self-limiting, it again doesn’t require anything else but electral or ORS solution to make up for the fluid losses in diarrhea stools (i.e. to prevent the child from going into dehydration). Most of the diarrheas will correct themselves spontaneously in 2-3 days and in fact giving “over vigorous” therapy like antibiotics etc. may worsen the diarrhea because the antibiotics kill the “good” bacteria in the intestines.
These “good” bacteria prevent the “bad” bacteria from colonising the gut and so are beneficial in warding off infections. That’s why there is an entity called “antibiotic induced diarrhea”. Of course if there is clinical or laboratory evidence to suggest that the diarrhea is due to a bacterial infection, antibiotics are justified but to prescribe antibiotics for each and every case of diarrhea and that too multiple drugs is not justified.
Anti-motility drugs (drugs which reduce the motility of the intestines by reducing the muscle contractions) like Ridol, Imodium etc. are contraindicated in childhood diarrheas. Giving antibiotic injections and that too costly ones (in a bid to impress the parents) to a child for a simple case of diarrhea is even more difficult to justify, except when the child is having a serious systemic infection with diarrhea as one of its features (which is rare).
ORS therapy: It is a universally accepted treatment for diarrheas. It replaces the fluid and electrolyte losses that accompany the loose stools. There are many ORS powders available in the market, which have to be reconstituted by adding water. Ready made ORS in liquid form is also available as 200 ml bottles (often prescribed by the doctors costing about Rs 20/- for 200ml or Rs. 100/- for 1 litre) and is mentioned only to be condemned as the cost is prohibitive and it has no advantage over the freshly prepared ORS at home (which is practically free).
To charge Rs 100/- for a litre of salt and sugar water is really swindling the patients. The instructions for reconstitution with water are written on the packet and should be strictly followed. Usually, one packet of ORS is dissolved in one 1 litre of boiled and cooled water. Babies don’t like the taste of ORS much, as it is too salty (sodium is 90 Meq/L), particularly the WHO recommended ones. In such cases one can try ORS with a less salt content (i.e. 50 Meq/L).
I personally prefer ORS with 50 Meq/L sodium in the usual cases of diarrhea; and give ORS containing 90 Meq/L of sodium only if the stools are cholera like i.e. profuse and watery with a high frequency. Anyhow WHO recommends that 2 parts of its ORS should be offered with 1 part of ordinary water/ breast-feed as a supplement in between. This effectively reduces the sodium load to 60 Meq/L, the only difference being that in this particular approach, you are giving concentrated WHO ORS separately first and then offering plain water to the baby, so that they mix together in the stomach! Mothers should not make the ORS concentrated by adding less water than recommended to the powder.
Dangerous incidents of salt “poisoning” have been documented by doing so. Sometimes a child will not take ORS, how much you try In that case there is no alternative but to prepare it indigenously at home by adding 5 tsp of sugar and 1 tsp of table salt to 1 litre of boiled and cooled water along with some fresh lemon juice to make it tasty. In case the child rejects even this, one can go for rice water with salt to taste added to it. Coconut water, weak tea and barley water are also appropriate if the child doesn’t accept any of the above liquids. ORS therapy should be abandoned if there is persistent vomiting, the child refuses to accept, there is no urine output for 8 hours or the child is becoming more dehydrated. All such children will usually require intravenous fluid therapy.
Many types of diarrhea are blamed on an entity called “lactose intolerance”. It means that the child will have diarrhea if lactose (i.e. milk sugar) is offered to him. There are many lactose free tinned powders available in the market, which are given by doctors from day 2-3 of diarrhea at the expense of breast milk, cow’s milk or milk tins. There is no justification in such a step unless lactose intolerance has been documented by lab testing of the stools. So don’t “abandon” milk (particularly breast milk) if the diarrhea is not all right in 2-3 days.
Another treatment forwarded by the doctors is dietary restrictions and to give Vi diluted milk during episodes of diarrhea. There is no logic in this. The food that we eat is not causing diarrhea, otherwise one should have diarrhea daily whenever he/she takes full strength milk i.e. not 1/2 diluted. To say that during diarrhea, the digestive capacity is reduced and therefore diluted milk is required is also not correct as the body’s digestive capabilities remain the same during diarrhea also.
Similarly partial starvation/ fasting etc. are not good. In fact during diarrhea, there should not be any restriction on the diet of the child and he should be allowed to eat whatever he feels like. Remember, good nutrition is important in any disease including diarrhea and not starvation which will make the child even weaker and delay the recovery.
There is another entity called “toddler’s diarrhea.” In this, the child passes loose stools frequently but surprisingly the child suffers from no adverse effects. Thus the child for all practical purposes is a healthy one, gaining weight adequately and not going into dehydration. His appetite is not curtailed and he is active and playful. Routine stool examination doesn’t show pus cells or blood.
Such benign diarrheas do not require any treatment and the child outgrows it with time. Unfortunately this is the diarrhea, which is most commonly treated the wrong way. The parents run from pillar to post, get all sorts of tests done and are prescribed all sorts of medicines, particularly shot-gun types, with no relief or only transient relief. If the parents are aware of this entity, and it is not rare, a lot of their anxiety will be relieved plus they won’t go in quest of a cure where none is actually required.