Almost every child will experience diarrhea when growing up. Diarrhea is a medical disease, but every year during the peak season of rotavirus infection, our pediatric surgery will be busier.
One is that rotavirus infection will increase the risk of intussusception in children. In autumn, intussusception will also increase. In many cases, there are nearly 10 children treated by enema a day. If they cannot be irrigated, they have to undergo surgery.
The second is because rotavirus enteritis often has vomiting, abdominal distension and other symptoms, to the hospital, doctors in order to eliminate intestinal obstruction, will give children a film. However, many children with enteritis will have the performance of intestinal paralysis, and the film will have liquid and gas level.
As soon as the radiologist sees that the liquid and gas are flat, he will write a diagnosis report of “intestinal obstruction is not excluded” with the attitude of “would rather kill by mistake than let go”. As soon as the physician sees the word “intestinal obstruction”, he will be referred to the general surgery department.
Therefore, every year our pediatric surgeons have to follow suit to fight rotavirus.
What is rotavirus?
For diseases such as rotavirus, surgeons naturally have less experience in diagnosis and treatment than physicians, but due to the above reasons, we also have more contact, so we can still share some knowledge with you.
You may also have heard that rotavirus enteritis is a “self-limited disease”, that is to say, most of them will recover even if they are not treated. However, you may not know that until now, diarrhea is still the second leading cause of death in children under the age of 5.
It is estimated that in 2008, around 453,000 children under the age of five died of rotavirus infection globally, accounting for 37 percent of children who died from diarrhoea and 5 percent of children who died under the age of five.
Because rotavirus is highly infectious, It can survive for hours to months outside the body and even longer in low temperatures. In the stool of patients in acute phase, the number of viruses contained in every gram of stool exceeds 100 billion, and children can expel viruses before symptoms appear until 10 days after symptoms appear, so it is easy for families and kindergartens to spread to each other.
What happens if you are infected with rotavirus?
Children of different ages will have different manifestations after infection.
Newborns often have no symptoms or mild symptoms after infection because the antibodies they get from their mothers are still relatively high. However, premature infants are an exception because they do not get enough antibodies, and the risk of severe symptoms is higher than that of full-term infants.
Severe cases mainly occur in children between 3 and 24 months old, and only about 25% of severe cases occur after the age of 2. Most children suffer from multiple infections, but the symptoms of the first infection are often heavier than those of the subsequent infection, and the symptoms of the subsequent infection are relatively mild or even asymptomatic, probably because the first infection produces [immune protection].
Children infected with rotavirus do not show symptoms immediately. During the incubation period of the first 1-7 days, children may not show any symptoms.
As soon as the incubation period passes, symptoms appear.
The initial manifestations are usually fever and vomiting. About half of the children will have fever, but most of them have low fever, but about 1/3 of the children will have more than 39 degrees. 80%-90% of the children will have vomiting. After these symptoms last for 1-2 days, the children will start to pull water-like stool, which can be pulled 10-20 times a day, and diarrhea generally lasts for 3-8 days.
Panic-stricken parents
Most children infected with rotavirus have to go through such a process, which is enough to make many parents panic.
For example, the fever initially shown may be judged as a cold by parents when there are no other symptoms, and then the child will be given cold medicine. If vomiting occurs, you should worry about whether you have eaten something bad and start to give your children antiemetic drugs. Come again, the child began to have diarrhea, watching the child keep poop-poop, many parents began to feel upset again, and then began to smecta mommy love to eat together, even antibiotics also eat together.
It is true that all parents find it difficult to calm down in the face of their children’s illness. They wish all symptoms were far away from their children and let them stay away from all pain, but many things are not satisfactory.
Even in the United States, children under the age of 5 are basically infected by rotavirus, and 4/5 of them will suffer from rotavirus enteritis, so most children are hard to avoid rotavirus.
Moreover, there are no effective antiviral drugs at present. Like colds, they are mainly good on their own. No matter whether you are anxious or not, there are not many ways to shorten the process of illness.
As you may also notice, The symptoms of fever, vomiting and diarrhea shown by rotavirus enteritis are not what specific, and other enteritis may also have these symptoms. According to the course and season of onset, doctors may have a general judgment, but if relevant pathogen tests are not done, they cannot determine whether they are, let alone the parents themselves.
Treatment of Rotavirus Infection: Correcting Dehydration
Fortunately, the coping principles for all diarrhea are really the same.
For rotavirus enteritis, because there is no effective antiviral drug, the goal of treatment is not to cure it, but to help the child carry the process of illness and wait for him to get well. Just like the storm has come, you can’t stop it, all you can do is to keep your house from being blown down by the storm.
Because rotavirus enteritis can cause children to lose a large amount of water and electrolyte in a short period of time, ensuring that children are not dehydrated is the primary goal, while maintaining the balance of electrolyte and nutrition in children.
Children need more water and electrolytes per kilogram of body weight than adults, so children are also more prone to dehydration.
During mild to moderate dehydration, children may suffer from fatigue or dysphoria, thirst, dry lips, slight sunken eye sockets, inelastic skin, cold limbs and less urine.
When severe dehydration occurs, the child may suffer from apathy, coma, non-drinking water and deep eye socket, which is very dangerous.
The judgment of dehydration signs has certain subjectivity, and inexperienced doctors will not be allowed to judge. The advantage of parents is that they spend more time with their children, observe more and more for a long time, and know more about their children’s normal conditions than doctors, so they can make better comparisons when they are ill.
However, it is still very difficult to rely on parents to accurately judge the degree of dehydration. Moreover, dehydration may progress quickly. If the child’s mental reaction is wrong, and there is little urine or other psychological uncertainty, he must go to the hospital in time so as not to delay the illness.
Mild to moderate dehydration can be rehydrated by oral administration, and oral rehydration salt can be mixed with water for children to drink, which can not only supplement water, but also supplement electrolyte.
The third generation of rehydration salt, also known as [low osmotic rehydration salt], is currently recommended by WHO and is very cheap and safe.
Note: It is not recommended to mix salt water for children at home.
Severe dehydration should be prevented as much as possible, and you must go to the hospital as soon as possible once it occurs.
Do you want to continue feeding?
Vomiting is usually infrequent, Children who can take oral rehydration can also eat normally. Long-term diarrhea may affect intestinal villi, but the intestines still have absorption function. Once the rehydration is almost corrected, they can continue to feed breast milk or formula milk without dilution. They can eat rice, bread, lean meat, yogurt and fruits and vegetables at ordinary times.
However, attention should be paid to avoid eating foods high in fat and sugar, so as not to aggravate diarrhea. However, for children who are lactose intolerant, yogurt can be considered instead of milk.
Do you want to use other drugs?
Children with diarrhea in China generally take montmorillonite powder. This drug is mainly used in Europe, Asia and Africa. Some studies also believe that it can reduce stool quantity and shorten diarrhea process, but the World Health Organization believes that it has no effect. The American Academy of Pediatrics also recommends not to use [antidiarrheal] drugs on its own.
Another medicine commonly used in diarrhea is probiotics. Some studies suggest that probiotics, including lactobacillus, bifidobacterium and yeast, can help restore intestinal microecology and improve immune protection. However, the current evidence is not so sufficient, and Nielsen Pediatrics believes that they cannot be routinely recommended for diarrhea in children.
Contrary to montmorillonite and probiotics with insufficient clinical evidence, some drugs have sufficient effective evidence but are not widely used.
For example, zinc supplement, current research shows that it can significantly reduce the degree of diarrhea in children in developing countries, shorten the time of diarrhea, reduce the proportion of serious cases, and may also reduce the chance of recurrence of diarrhea. It is also recommended by the World Health Organization and the United Nations Children’s Fund, but it is rarely used in China.
Therefore, if the child has diarrhea or after diarrhea, the child can be given zinc for 10-14 days, 10 mg/day for children under 6 months old, 20 mg/day for children over 6 months old, zinc sulfate, zinc acetate and zinc gluconate.
Of course, not all children with diarrhea are caused by rotavirus infection. Even rotavirus infection, some children are critically ill and even have neurological symptoms. Even in the medically developed United States, children die from rotavirus infection. Therefore, not all children are suitable for observation and treatment at home.
What conditions accompanying diarrhea in children should parents be on guard against?
In addition to observing the dehydration mentioned earlier, we should also pay attention to other conditions, such as continuous frequent vomiting, especially when spitting out yellow and green things, we should be alert to intestinal obstruction.
When the stool is bloody, we should also be alert to intussusception, bacterial enteritis, etc.
When children suffer from diarrhea, they should also consider bacterial enteritis. Whether to use antibiotics or not should follow the doctor’s advice.
When diarrhea occurs, due to abnormal intestinal peristalsis, Also often accompanied by abdominal pain, but most of them are not serious. If abdominal pain persists, especially there are fixed tenderness areas, you should also be alert to other infections in the abdominal cavity, such as appendicitis. This is because the appendicitis of infants may be very atypical, sometimes even manifested as diarrhea, which need to be identified by doctors in the hospital.
Popular science is only the transmission of knowledge and can never replace doctors’ face-to-face diagnosis and treatment. Parents should find some places to go to the hospital when they encounter things that they are not sure about.
Is there any way to prevent rotavirus?
Rotavirus was once called [democratic virus], because whether you were born in a poor or rich country, or whether you were born in a temperate or tropical region, you will basically be infected for several years after birth. It is democratic and fair to every child.
However, since the rotavirus vaccine was available, the outcome of children in poor countries is very different from that of children in rich countries. Because severe cases are basically primary infection, vaccination does not mean that they will not be infected again, but it is equivalent to completing the primary infection, producing protective antibodies, reinfection, and symptoms are very mild or even asymptomatic.
Rotavirus is transmitted through the faecal-oral route, because it is highly infectious, and it is difficult to completely prevent infection through measures such as paying attention to sanitary conditions. However, children in developing countries with relatively poor sanitary conditions are still infected earlier than children in developed countries.
In addition, most other children’s diarrhea is also related to diet and hygiene conditions, which is why most of the children killed by diarrhea are in Africa and South Asia.
In addition to rotavirus vaccination, breast-feeding, maintaining children’s nutritional balance, food hygiene and frequent hand washing are also the main methods to prevent children’s diarrhea. Parents should not wait for their children to feel overwhelmed when they have diarrhea, but should give them prevention at ordinary times.
The article was reprinted by Clove Garden authorized by the author.