Infantile Diarrhea

　　Among the 12 million deaths of children under the age of 5 worldwide each year, up to 3 to 4 million die from infantile diarrhea, ranking second only to respiratory diseases. Infantile diarrhea is not an independent disease, but a common manifestation of many diseases. It can be accompanied by symptoms such as vomiting, fever, abdominal pain, bloating, mucous stools, and bloody stools.

　　From June to October each year, most babies aged 6 months to 3 years will face the fierce attack of 'summer diarrhea'. Some say, 'summer diarrhea' is more fierce than a tiger! With a high incidence rate, acute onset, strong persistence, dehydration, complications, and high mortality rate, we should take diarrhea seriously in order to prevent it in advance and treat it in a targeted manner in a timely manner.

　　Summer pediatric diarrhea is determined by the physiological characteristics of children. Firstly, due to the underdeveloped gastrointestinal tract, less gastric acid, and poor bactericidal ability, if children consume too much beverage in summer, it dilutes the gastric acid, making it easy for bacteria to pass through this barrier and enter the intestines, causing diarrhea. Secondly, children have fewer digestive enzymes in the gastrointestinal tract, which is not conducive to food digestion and easily causes indigestion. Thirdly, infants and young children grow rapidly and need sufficient nutrition. The burden on the child's gastrointestinal tract is relatively heavy, and it is easy to occur digestive dysfunction. In addition, high temperatures in summer are conducive to bacterial reproduction, which is also one of the reasons for increased infection.

　　1. Extra-intestinal infection: Extra-intestinal infection may be a cause of diarrhea, but it is also often infected due to low systemic resistance after diarrhea. Common ones include skin suppurative infection, urinary tract infection, otitis media, upper respiratory tract infection, bronchitis, pneumonia, phlebitis, and sepsis. Viral enteritis occasionally has concurrent myocarditis.

　　2. Thrush is more likely to occur in children with prolonged thrush or those with pre-existing malnutrition, especially after long-term use of broad-spectrum antibiotics. If medication is not stopped in time, fungi can invade the intestines, even causing systemic fungal disease.

　　3. During the course of toxic hepatitis, jaundice may occur, which is more common in children with pre-existing malnutrition. It may be caused by enteritis due to Escherichia coli, concurrent with septicemia caused by Escherichia coli, leading to toxic hepatitis. The condition worsens rapidly after diarrhea, and death may occur quickly after the appearance of jaundice. However, if polymyxin, ampicillin, or carbenicillin is injected promptly, most cases can be cured.

　　4. Prolonged diarrhea due to malnutrition and vitamin deficiency, or repeated fasting and long-term insufficient caloric intake, can easily lead to malnutrition, anemia, and vitamin A deficiency. Chronic diarrhea can damage liver function, reduce vitamin K absorption, and decrease prothrombin, leading to bleeding.

　　5. In severe cases of dehydration, acute renal failure may occur concurrently. In addition, there may be toxic intestinal paralysis, intestinal hemorrhage, intestinal perforation, intussusception, and gastric dilation. It can also cause acute heart failure, hypernatremia or hyponatremia, or hyperkalemia due to improper fluid administration. Negligent care of vomiting in infants can lead to asphyxia.

　　(I)Staging of diarrhea

　　1. Acute diarrhea with a course of less than 2 weeks.

　　2. Persistent diarrhea with a course lasting from 2 weeks to 2 months.

　　3. Chronic diarrhea with a course lasting more than 2 months.

　　(II)Classification of diarrhea

　　1. Diarrhea: classified into two types according to severity: mild (simple diarrhea) and severe (toxic diarrhea).

　　(1) Mild diarrhea: It is often caused by dietary factors or extraintestinal infection, or by viral or non-invasive bacteria in the intestines. The main symptoms are gastrointestinal, with more than 10 bowel movements per day, and a few cases may reach more than ten, with each bowel movement not much, thin or watery, yellow, with an acid taste, commonly with white or yellowish milk residue (soap block) and foam, which may contain a small amount of mucus. Generally without fever or low fever, accompanied by loss of appetite, occasional regurgitation or vomiting, without obvious systemic symptoms, in good spirits, without dehydration symptoms, and usually recover in a few days.

　　(2) Severe diarrhea is often caused by intestinal infection

　　1) Gastrointestinal symptoms: Frequent diarrhea, more than 10-30 times a day, with more water and less fecal matter, or watery stools mixed with mucus. At the same time, there may be abdominal distension and vomiting.

　　2) Dehydration: The degree of dehydration is divided into mild, moderate, and severe. The nature of dehydration is divided into isotonic, hypotonic, and hypertonic three types.

　　Pay attention to dietary hygiene: Strengthen health education, strictly manage the hygiene of water sources and food. Food should be fresh and clean, and any deteriorated food should not be fed to children. Utensils must also be disinfected.

　　Advocate breastfeedingIs the most suitable food for infants under six months old, and it should be strongly advocated that infants be fed on demand. Breast milk contains IgA, which can neutralize enterotoxins produced by Escherichia coli, and has the effect of preventing infection with Escherichia coli.

　　Add complementary foods on time: When adding complementary foods, children must pay attention to adding from small to large, gradually increasing, so that the baby has an adaptation process; from thin to thick, start with rice gruel, and gradually transition to congee and soft rice; from fine to coarse, such as when adding fruit, start with fruit juice, and then eat fruit puree. Try adding egg yolk, fish puree, and soft tofu at five months; after seven months, you can add nutritious and suitable foods for digestion and absorption, such as fish, minced meat, green vegetables, crackers, etc., and gradually prepare for weaning, but avoid weaning in summer.

　　When gradually adding foodWhen adding food gradually, it is best to get accustomed to one food before adding another, and do not add several types at the same time. If the child falls ill, temporarily do not add another food. It is not advisable to force feeding when there is a loss of appetite.

　　Enhance physical fitness: In daily life, strengthen outdoor activities, improve the ability to adapt to the natural environment, pay attention to physical exercise for children, enhance physical fitness, improve the body's resistance, and avoid various diseases.

　　Avoid adverse stimuli: In daily life, children should prevent overfatigue, fright, or excessive mental tension.

　　Strengthen the care of weak infants and young children: Children with malnutrition, rickets, and weakened physical condition after illness should strengthen nursing care, pay attention to dietary hygiene, and avoid various infections. Treat mild diarrhea promptly to prevent it from developing into severe diarrhea.

　　Avoid cross-infection: Infectious diarrhea is prone to epidemic outbreaks, and neonates, nurseries, and hospitals should pay attention to disinfection and isolation. Isolate and treat diarrhea patients and carriers, and disinfect feces.

　　Rational use of antibiotics: Avoid long-term abuse of broad-spectrum antibiotics to prevent dysbiosis of intestinal flora, leading to the proliferation of drug-resistant bacteria and causing enteritis.

　　Examination items needed for pediatric diarrhea: stool routine, colonoscopy, fecal occult blood test (OBT), fecal bacterial culture, fecal microscopic examination, blood routine, six-item blood biochemical examination, electrocardiogram, enzyme-linked immunosorbent assay, electronic colonoscopy

　　1. Stool Routine Examination: Microscopic examination of stool, pay attention to the presence of pus cells, white blood cells, red blood cells, and phagocytes. Also, pay attention to the presence of eggs, parasites, fungal spores, and hyphae. Sometimes it needs to be repeated several times to be meaningful, which helps in the etiology and etiological diagnosis of diarrhea.

　　2. Stool Culture: Stool culture is of great significance for determining the etiology of diarrhea. The positive rate of a single stool culture is low, and it needs to be done multiple times. Fresh specimens can be immediately cultured to increase the positive detection rate.

　　3. Stool Latex Agglutination Test: It has diagnostic value for some viral enteritis, such as rotavirus, enteric adenovirus, etc., with good sensitivity and specificity, and is helpful for the diagnosis of Campylobacter jejuni enteritis.

　　4. Enzyme-Linked Immunosorbent Assay (ELISA): It has high sensitivity and specificity for rotavirus, which is helpful for the diagnosis of rotavirus enteritis and other viral enteritis.

　　5. Polyacrylamide Gel (PAGE) Electrophoresis Test: This method can detect rotavirus subgroups and different electrophoretic types, which is helpful for rotavirus classification and research.

　　6. Stool Reducing Sugar Test: When there is malabsorption of disaccharides, the stool reducing sugar is positive, and the pH value

　　7. Stool Electron Microscopy: It has diagnostic value for some viral enteritis, such as rotavirus enteritis, Norwalk virus enteritis, etc.

　　8. Blood White Cell Count and Classification: In viral enteritis, the total white blood cell count generally does not increase. In bacterial enteritis, the total white blood cell count may increase or not increase, and more than half of the children have an increase in杆状核, with杆状核 greater than 10%, which helps in the diagnosis of bacterial infection.

　　9. Blood Culture: Blood culture is diagnostic for bacterial dysentery, Escherichia coli, Salmonella, and other bacterial enteritis. Positive blood culture helps in diagnosis.

　　10. Blood Biochemical Examination: For children with severe diarrhea, it is necessary to check blood pH, carbon dioxide binding power, bicarbonate, blood sodium, blood potassium, blood chloride, and blood osmotic pressure in a timely manner, which is of great significance for diagnosis and treatment.

　　11. Others: For patients with protracted and chronic diarrhea, lactose, sucrose, or glucose tolerance tests may be necessary when required, as well as breath hydrogen tests (a quantitative non-invasive method for determining malabsorption of carbohydrates, which can be applied if conditions permit), and also fiberoptic colonoscopy can be performed.

　　Patients with hypokalemia should undergo an electrocardiogram; patients with prolonged course, nutritional disorders, and severe infection poisoning symptoms should undergo X-ray and ultrasound examinations. Electrocardiograms of patients with hypokalemia show flat T waves, biphasic or inverted waves, and the appearance of u waves.

　　1. Boiled Apple: Boiled apples have astringent effects. Eating one apple per day can help alleviate the baby's diarrhea. When boiling apples, it is best to do so over boiling water, or add some rock sugar, as this is more appealing to the baby.

　　2. Yolk Diet: After boiling the egg, remove the shell and white, and use the yolk to simmer in a pot over low heat to extract the oil. Infants under 1 year old should take one yolk oil per day, divided into 2-3 doses, for a course of 3 days. It is used to treat diarrhea and has the effects of benefiting the spleen and stomach to stop diarrhea.

　　3. Roasted Rice Water: First grind rice flour or porridge into powder, fry it until it turns yellow, then add an appropriate amount of water and sugar, and then cook it into a paste. After adding water to the rice flour, heat it again, and its carbonized structure has a good adsorption and astringent effect.

　　4. Carrot Soup: Carrots are alkaline foods, and the pectin contained in them can promote the formation of stool, adsorb bacteria and toxins on the intestinal mucosa, and is a good astringent food.

　　5. Chestnut Paste: Use 3-5 chestnuts, peel and crush them, boil them with water into a paste, add sugar for seasoning, and eat it 2-3 times a day. It has a warming and止泻 effect. In addition, orange dates tea, carrot soup, and other foods also have a spleen and diarrhea-inhibiting effect.

　　6. Congee. When a baby has diarrhea, give the baby more congee, which is easy to digest and nutritious. Do not eat hard food when the baby has diarrhea. It is better to cook the congee until it is very soft.

　　7. Soft Noodles. When the baby's diarrhea situation improves, you can cook some soft noodles for the baby, add some green vegetables, which can further supplement the baby's nutrition and make it easier for the baby to digest.

　　8. Drink Ginger Tea. When a baby has diarrhea due to abdominal cold, you can brew some ginger tea for the baby. Cut the ginger into fine pieces, put it in boiling water, then add a small amount of cooked tea, and give the baby some every day to alleviate the symptoms of diarrhea.

　　9. Hawthorn Malt Water. When a baby has diarrhea due to poor digestion, you can brew some Hawthorn Malt Water for the baby to drink, which is quite effective. Choose roasted malt, and 3-5 Hawthorn fruits are enough. Adding some brown sugar is even better.

　　The Ministry of Health of China draws on the research results of the WHO, combines the experience of preventing and treating diarrhea in China over the years, and in light of the current prevention and treatment situation, clearly stipulates the following measures as the focus of future diarrhea prevention work in the national diarrhea control plan, namely, to increase the rate of exclusive breastfeeding for infants under 4 months old; improve personal hygiene habits; wash hands before and after meals; properly handle children's feces; use sufficient clean water; harmless treatment of feces; apply safe and hygienic methods to prepare family food, especially to add complementary foods in a hygienic manner; strengthen hygiene management and supervision in the production, transportation, and sales processes of food. By doing the above points meticulously, the incidence and mortality rate of diarrhea can be reduced.