As a community health nurse, I’ve seen a lot of diarrhea cases especially among children. Sad to witness that some of the mothers brought their child to the health center when dehydration is evident. They live in far areas and monetary problem is one of the leading reasons why they don’t seek medical help immediately. In my assigned barangay, I conducted mother’s class regarding diarrhea in order to inform and educate them. They asked questions and clarifications at the end of the lecture and hopefully they can use the inputs I’ve shared in real life situation.
Try to identify diarrhea and its causes
The medical term for LBM (loose bowel movement) is diarrhea. It is the passage of loose or watery stools for at least three times in 24 hours. There are many causes of diarrhea, but most frequent in children are viruses from Rotavirus family. Diarrhea can also be caused by bacteria like enterotoxigenic E.coli or shigella or by amoeba infection. It is hard to distinguish one from the other although amoeba and shigella often present as bloody stools.
The main problem with diarrhea is that it can lead to dehydration from fluid and electrolyte loss, and malnutrition when the diarrhea is prolonged. If a big amount of fluid is lost, the brain becomes dehydrated, blood volume is decreased, and the kidney suffers leading to acute kidney failure. The loss of electrolytes (sodium, potassium chloride and bicarbonates) will lead to drowsiness and weakness. Persistent diarrhea, that lasts for 14 days or longer, can lead to malnutrition or serious infections extending beyond the intestine.
The early stages of dehydration usually have no signs and symptoms. As dehydration increases thirst, restlessness, irritable behavior, loose skin, sunken eyeballs and a sunken fontanel in infants will be observed. Dehydration is evident when the skin in the abdomen is loose when lifted. The hands will also be wrinkled known as washerwoman’s hands. In severe dehydration, the child can go into shock as shown by low or undetectable blood pressure, lack of urine output, diminished consciousness, rapid but weak pulse, and even cyanosis.
Red Lights in Diarrhea
(The child needs to be seen by a doctor or health worker)
- Frequent watery stools
- Repeated vomiting
- Becomes very thirsty
- Unable to eat or drink
- Develops a fever
- There is blood or mucus in the stool
- Does not get better in three days
As a general rule, fluid replacement has to be given continuously until the diarrhea stops. Water is not sufficient, so salt and sugar have to be added to it. Fluids that normally contain salt are oral rehydration solution (ORS), salted drinks like rice water and yoghurt drink; vegetable and chicken soups with salt. Rehydration can also be given by intravenous route. It is important to continue feeding the child if there is no vomiting to prevent malnutrition.
GOOD NEWS! The Department of Health (DOH) is giving free rotavirus vaccine to children from the poor sector, those who belong to the National Household Targeting System (NHTS). The said vaccine comes in a single-dose preparation which will be given orally in two doses.
Rotavirus vaccination schedule:
1st dose-infants aged 6 weeks to less than 15 weeks
2nd dose-infants aged 10 weeks to less than 32 weeks