Gastroenteritis and your baby

ONE of the most common illnesses seen in children under age five who turn up at hospital emergency rooms across the world is the diarrhoeal disease acute gastroenteritis.

“Gastroenteritis is historically a major cause of death and disability in children, accounting for approximately 15 per cent of deaths in children around the world, with higher numbers in developing and underdeveloped countries. It remains a very big economic burden of care, capturing worldwide attention and affecting international health policy,” said paediatrician Dr Anona Griffith.

She noted that the condition is often accompanied by vomiting, nausea, fever, as well as a runny nose, abdominal pains and sometimes blood in the stool, especially where the illness is caused by bacteria. She said that gastroenteritis should always be considered in every patient who presents with diarrhoea or vomiting, or both.

“It occurs most commonly as a result of infection of the intestines and stomach along with inflammation resulting in decreased ability of the organs to perform their function of digestion and absorption of foods and fluids from digested foods back into the body; hence there is an increase in frequency of and watery consistency of stools, as well as vomiting,” Dr Griffith explained.

The most common agents that cause gastro are viruses, but there are other known culprits as well.

“Viruses such as rotavirus and norovirus have been associated with the epidemic and many deaths, especially in children. However, bacteria such as salmonella and shigella have been identified as causative agents, and parasites and worms have also been implicated as well. Additionally, some antibiotics have been associated with a form of gastroenteritis,” Dr Griffith underscored.

She explained that gastroenteritis is common in developing and underdeveloped countries because conditions exist in these countries which facilitate the condition. These include:

•Poor water quality and inadequate supply.

•Poor nutrition.

•Poor hygiene practices.

•Overcrowding of individuals with inadequate waste disposal, including human waste.

According to Dr Griffith, while the condition may be life-threatening in some children, it is often self-limiting and mild and can be managed at home if there is an adequate replacement of fluids lost with appropriate fluids. However, it can become complicated very easily and even fatal, once there is an imbalance between supply and deficit.

Below are cases where Dr Griffith said urgent medical care is required:

•Where children are showing signs of dehydration such as dry lips, as children tend to lose water quickly.

•When there is decreased saliva, tears, urine, sunken eyes, decreased activity and droopiness.

•When the skin is slow to return to regular position when pinched.

“To address this, medical personnel will provide ideal fluids for rehydration containing an ideal mix of glucose and electrolytes. ORS — oral rehydration salts — are highly recommended by the WHO, and other fluids such as coconut water or commercially prepared electrolyte solutions can be used for breastfed babies. Breastfeeding is encouraged,” she added. “Fluids must be administered frequently and in small graduated amounts. In severe cases, fluids may have to be given intravenously.”

In complicated cases, especially those caused by bacteria, antibiotics may be required to treat the underlying infection.

Development of a rotavirus vaccine has dramatically reduced the severity of the disease caused by the rotavirus. It is available if desired, and is given along with the primary series of vaccines up to six months.

Prevention of gastroenteritis is a public health as well as a personal issue, and may be achieved with access to adequate resources as well as by following the guidelines below:

•Have a clean water supply.

•Boil water if cleanliness is questionable.

•Hand washing.

•Proper garbage and waste disposal.

•Population control and prevention of overcrowding.