Gastroenteritis in children is a lesion of the mucous membrane of the stomach and small intestine of an inflammatory nature, manifested by nausea, vomiting, abdominal pain, and frequent loose stools. The occurrence of gastroenteritis in children may be due to the action of various factors, but in pediatric practice, the infectious form of the disease is most often observed, most characteristic of children of early and preschool age.
Pathology is widespread, in the overall structure of the incidence it takes second place, second only to influenza and respiratory viral infections. In developing countries, it is the leading cause of infant mortality. Gastroenteritis in children can be both an independent disease and a syndrome that forms on the background of acute intestinal infections (salmonellosis, cholera).
Causes and risk factors
The development of gastroenteritis in children can be caused by exposure to infectious and non-infectious agents that irritate the mucous membrane of the digestive tract and disrupt their functions. These include:
- viruses (intestinal adenoviruses, caliciviruses, rotaviruses, coronaviruses, astroviruses),
- bacteria (E. coli, Salmonella, Shigella, Campylobacter),
- protozoa (cryptosporodia, dysenteric amoeba, intestinal Giardia),
- helminths (curved head),
- food allergens (crabs, strawberries, chicken eggs),
- poisonous mushrooms (false mushrooms, amanita),
- toxic fish products (mackerel caviar, liver burbot),
- some drugs (iodine and bromine preparations, sulfonamides, antibiotics, nonsteroidal anti-inflammatory drugs).
Bacteria, viruses, toxic substances or allergens, entering the gastrointestinal tract damage epithelial cells of the mucous membrane, thereby causing an inflammatory process. The resulting biologically active substances irritate the nerve endings, which causes abdominal pain, nausea, and vomiting. In addition, inflammation damages the villi of the small intestine. This disrupts the process of digestion, absorption of water, electrolytes and nutrients, leading to an increase in osmotic pressure in the lumen of the small intestine. As a result, diarrhea (frequent loose stools) occurs.
The occurrence of gastroenteritis in children may be due to the action of various factors, but in pediatric practice, the infectious form of the disease is most often observed, most characteristic of children of early and preschool age.
Viruses and bacteria in the process of vital activity synthesize toxins that are absorbed into the bloodstream and spread throughout the body, causing signs of general intoxication (fever, headache, lack of appetite) characteristic of acute gastroenteritis in children of infectious genesis.
Forms of the disease
Depending on the duration of the course, gastroenteritis in children is divided into acute and chronic forms. Acute gastroenteritis is characterized by rapidly expressed clinical symptoms and lasts 7–10 days. For the chronic form of the disease characteristic cyclical course in which remission are replaced by periods of exacerbation.
Depending on the etiological factor, the following forms of acute gastroenteritis in children are distinguished:
- viral - pathogens are viruses, the fecal-oral transmission mechanism. Outbreaks of the disease are mainly observed during the cold season. The incubation period is 1-3 days. The symptoms of gastroenteritis in children in this case are often combined with the symptoms of ARVI (sore throat, dry cough, runny nose),
- bacterial - caused by pathogenic bacteria. The incubation period is short, usually does not exceed 24 hours. Epidemiological outbreaks are more often recorded in the summer. The disease occurs with pronounced signs of general intoxication and damage to the gastrointestinal tract,
- toxic - provoked by ingestion of various toxic substances (salts of heavy metals, household chemicals, poisonous mushrooms, alcohol, and many others),
- helminthic - associated with parasitism of worms, which in the process of life damage the mucosa of the small intestine. The symptoms of gastroenteritis in children with this form are usually expressed erased, resembling a chronic form of pathology. The disease is recorded throughout the year,
- allergic (eosinophilic) - develops in case of hypersensitivity to certain foods, acting as allergens. Most often it is eggs, cereals, dairy products. Allergic reaction is accompanied by the migration of eosinophils into the mucous membrane of the intestine and stomach, which leads to its inflammation, the formation of infiltrates and dysfunction,
- alimentary - triggered by errors in nutrition, food consumption, inappropriate age. Lasts 1-2 days.
According to the features of the clinical course of acute gastroenteritis in children, there are three severity of the disease:
- Easy Body temperature is not increased, vomiting is absent or once, diarrhea no more than 3-5 times a day, there are no signs of dehydration.
- Average. The body temperature rises to 38-39 ° C, the child complains of abdominal pain. Repeated vomiting occurs, and the frequency of bowel movements can reach 10 times per day. The loss of electrolytes and water with fecal and vomit masses leads to the development of a slight degree of dehydration, which is manifested by a loss of up to 3% of body weight, tachycardia, decreased diuresis, dry mouth and an increased sense of thirst.
- Heavy Body temperature reaches 40-41 ° С, repeated vomiting with an admixture of bile, stool frequency 15–20 times a day. Severe dehydration develops - weight loss exceeds 4%, dry mucous membranes and skin, impaired consciousness, cyanosis, a significant decrease in the number of urination and the amount of urine secreted, convulsions.
In most cases, acute gastroenteritis in children ends with recovery within 7–10 days.
Symptoms of gastroenteritis in children
The clinical picture of chronic and acute gastroenteritis in children varies greatly depending on the form. Acute gastroenteritis occurs suddenly and rapidly develops. Its main symptoms are nausea, vomiting, abdominal pain and diarrhea. If the disease is caused by infectious agents, then the child's body temperature rises, a headache appears, and appetite decreases.
With vomitus and feces we lose water and electrolytes, which leads to dehydration of the body. The child experiences strong thirst, the amount of urine in him decreases, its color becomes saturated and dark.
Exacerbations of chronic gastroenteritis in children are provoked by an error in diet, stress, ARVI. Most often they occur in spring and autumn. During an exacerbation, a child has abdominal pain, nausea, flatulence, rumbling, polyfecalia (an abnormally large amount of feces) or diarrhea.
With a long course of the inflammatory process, the villi of the small intestine are gradually affected. As a result, nutrient absorption deteriorates and a number of common symptoms develop:
- weight loss,
- trophic changes of the skin, hair, nails,
- increased fatigue
- sleep disorders.
In children with chronic gastroenteritis, the common symptoms also remain in the remission phase of the disease.
Diagnosis of acute gastroenteritis in children is carried out on the basis of the characteristic clinical picture of the disease and the results of laboratory studies:
Gastroenteritis in children can be both an independent disease and a syndrome that forms on the background of acute intestinal infections (salmonellosis, cholera).
If you suspect that chronic gastroenteritis is used not only laboratory, but also instrumental diagnostic methods:
- Ultrasound of the abdominal organs,
- intragastric pH-metry.
Treatment of gastroenteritis in children
Treatment of acute gastroenteritis in children begins with the appointment of a water-tea break for a period of 8-12 hours. At this time, the child is not fed, often given to him to drink warm liquid (unsweetened tea, Regidron or Peditral solution, mineral water without gas) 1-2 sips every 5–10 minutes. In the presence of indications carry out gastric lavage and put a cleansing enema. After the end of the water-tea break, the child is prescribed nutritional therapy (Pevzner's diet No. 4), the main purpose of which is mechanical, thermal and chemical sparing of the digestive system organs.
In severe forms of gastroenteritis in children, treatment is carried out in the hospital, since in this case dehydration quickly develops and it may be necessary to inject intravenous infusion of electrolyte and glucose solutions.
When bacterial gastroenteritis prescribed antibiotics.
In case of allergic etiology, it is necessary to exclude from the diet product that is an allergen. This is usually enough to quickly improve the condition of the child.
In chronic gastroenteritis, you must follow a diet. Drug treatment is carried out taking into account the etiology. So, if a child has an increased acidity of the stomach, proton pump inhibitors, antacids are prescribed, and if the inflammation of the mucous membrane of the stomach and intestines is caused by an infection, antibacterial therapy is indicated.
Possible consequences and complications
Acute gastroenteritis in children can lead to the development of serious complications:
Especially dangerous is acute gastroenteritis in children of the first years of life, as they quickly develop dehydration, a severe form of which can be fatal.
With timely treatment started, the prognosis is generally favorable. In most cases, acute gastroenteritis in children ends with recovery within 7–10 days.
With chronic gastroenteritis, proper nutrition and ongoing anti-relapse courses of therapy (autumn and spring) make it possible to achieve stable remission.
Prevention of gastroenteritis in children includes:
- thorough hand washing
- compliance with the technology of cooking and storage of dishes,
- use only drinking or bottled water for drinking and cooking,
- Isolation of patients with infectious forms of gastroenteritis and disinfecting measures at the source of infection.
Education: She graduated from the Tashkent State Medical Institute with a degree in medicine in 1991. Repeatedly took advanced training courses.
Work experience: anesthesiologist-resuscitator of the urban maternity complex, resuscitator of the hemodialysis department.
The information is generalized and is provided for informational purposes only. At the first signs of illness, consult a doctor. Self-treatment is dangerous for health!
What is gastroenteritis
This pathology is an inflammatory process that affects the mucous membrane of the stomach and small intestine. It happens that malaise is a consequence of allergies, the simultaneous consumption of non-compatible products (for example, fresh vegetables and milk), chemical poisoning or thermal damage to the stomach walls, the introduction of a new product into the infant’s diet or drastic changes in feeding habits of a nursing mother, side effects of drugs .
However, most often the disease is caused by bacteria or viruses (more often - rotaviruses), which enter the child’s body from the external environment or activate their activity as a result of a weakened immune system. The incubation period depends on the type of pathogen and lasts from several hours to several days.
Anatomy of the stomach and small intestine
Consider the sections of the digestive tract that are affected by gastroenteritis.
The stomach is a bag-like expansion in which food accumulates. In the stomach, it is treated with acidic gastric juice and acquires a liquid consistency. Here is the initial stage of digestion.
The wall of the stomach consists of three shells:
- Mucous membrane has three layers:
- the columnar glandular epithelium lines the inner surface of the stomach,
- own plate is represented by loose fibrous tissue located between the glands,
- Glands of the stomach produce components of the gastric juice. Types of glands: cardiac, fundal, pyloric, as well as mucous and endocrine cells.
- Muscular coat , providing mixing of food masses with gastric juice and the promotion of its contents into the intestines.
- Serous membrane performing a protective function.
Small intestine - the digestive system, located between the stomach and the colon. It provides the basic processes of digestion and assimilation of food. In its lumen, the food mass is processed by bile and digestive enzymes of the pancreas and small intestine. As a result, nutrients become suitable for absorption.
The small intestine consists of three sections:
The small intestine has the same membranes as the stomach:
- Mucous membrane lining the inner surface, covered with villi and has a folded surface. Its components are:
- circular folds - transverse folds on the mucosal surface,
- intestinal villi - fingerlike outgrowths of the mucous membrane,
- intestinal glands that produce components important for digestion (Brunner, Liberkunov).
- Muscular coat has 2 layers: longitudinal and circular. This structure allows the contents to move towards the colon,
- Serous membrane is an outer cover and provides a protective function.
The small intestine maintains neuro-reflex communication with the stomach. It is used to regulate the size of a portion of edible gruel that enters the intestine from the stomach, the acidity of the gastric juice, the amount of digestive enzymes, etc.
Drug treatment of viral gastroenteritis
|Group of drugs||The mechanism of therapeutic action||Representatives||Mode of application|
|Oral rehydrating agents||Preparations for the preparation of solutions intended to compensate for the loss of fluids and minerals. Solutions for drinking can fight dehydration and eliminate toxins. Additionally, they may contain antispasmodic, aseptic and anti-inflammatory components.||Touring||The contents of the 1st sachet are dissolved in 200 ml of boiled water and cooled.|
Take 500-1000 ml in the first 4 hours. Then 200 ml after each liquid stool.
|Orsol||Accepted at the rate of 10 mg per kilogram of body weight per hour|
|Antidiarrheal drugs||Reduce intestinal tone, slow down the rate of advancement of the food mass. Increase the tone of the anal sphincter||Loperamide||2 tablets after each liquid stool. But no more than 8 tablets per day.|
Do not take more than 2 days - severe constipation may develop
|Stoperan||2 capsules after each case of diarrhea. No more than 8 capsules per day|
|Antiviral drugs||Suppress the activity of the virus, reduce the symptoms of the disease||Arbidol||Is ingested 2 tablets half an hour before meals. Duration of treatment 3 days|
|Enzyme preparations||They contain enzymes that break down proteins, fats and carbohydrates. Provide food digestion with insufficient digestive glands||Creon||The drug is taken orally during each meal. The dosage is based on 10 thousand units of lipase per kilogram of body weight per day.|
|Pancreatin||Accepted with food, squeezed with plenty of liquid (juice, water).The average daily intake for adults 150 000 IU|
|Adsorbents||Adsorb (absorb) bacteria and toxins in the intestinal lumen||Smecta||The contents of the 1st sachet are dissolved in 100 ml of water. Take the 1st sachet 3 times a day|
|Activated carbon||Inside for an hour before meals 1 g (4 tab) 4-5 times a day|
|Antiemetics||Normalize the tone of the digestive system. They have an antiemetic effect, promote the movement of food from the stomach to the intestines.||Zeercal||At 10 mg (1 tab) 3-4 times a day. Take half an hour before meals|
|Probiotics||Restore the normal intestinal microflora, increase local immunity||Bifidumbacterin||Adults are taken orally on a package 3 times a day for 20-30 minutes before meals. Contents of 1 packet are dissolved in 2 teaspoons of hot water.|
|Bifikol||Is ingested in the form of diluted powder 2-3 bags 2 times a day, regardless of the meal. The course of treatment 3-5 days|
Drug treatment of bacterial gastroenteritis
|Group of drugs||The mechanism of therapeutic action||Representatives||Mode of application|
|Antibiotics||Antibiotics prevent the growth of bacteria by slowing down the synthesis of their RNA and destroy pathogens. Assign with bacterial diarrhea. Do not apply to viral forms of gastroenteritis||Alpha Normix|
acts in the intestinal lumen, almost not absorbed into the blood
|Inside 1-2 tablets every 8 hours. Duration of treatment 5-7 days|
|Polymyxin M sulfate||Inside 500 000-1000 000 IU 4 times a day. Course 5-10 days|
|Levomycetin||Inside 1 tablet 4 times a day. Take 30 minutes before eating. Duration of treatment is 5-15 days.|
|Nitrofuran derivatives||It has an antimicrobial effect: slows the growth of bacteria and causes the death of the causative agent||Nifuroxazide||2 tablets every 6 hours.|
Not absorbed from the intestines, can be used during pregnancy
|Enterosorbents||They have a detoxifying effect, neutralizing toxins. Drugs absorb them and remove them from the body during bowel movements. Also bind and remove microorganisms.||Enterosgel||Inside 3 times a day. Take 1 hour before meals or 2 hours after meals. Single dose of 15 g (1 tbsp. Spoon). The course of treatment is 5-14 days.|
|Polysorb||Is taken orally for 1 hour before meals or taking other drugs. 1.2 g of the drug (1 tbsp. Spoon) dissolved in a glass of boiled water. Daily dose of 12 g (10 tablespoons). 3-5 days course|
|Oral rehydrating agents||Restore water and electrolyte balance in the body. Reduce intoxication||Regidron||1 bag dissolved in 1 liter of water. With diarrhea and vomiting in small doses up to 3.5 liters per day|
|Antiemetics||Normalize contractions of the gastrointestinal tract and the passage of food into the small intestine||Motilium||Inside 20 mg (2 tab) 3-4 times a day|
|Enzyme preparations||Improve digestion and promote digestion||Festal||1-2 tablets with meals 3 times a day. The course lasts from several days to several months.|
|Mezim Forte||Inside 1-2 tablets before meals 2-4 times a day. The course of 2 days to several months|
|Probiotics||Restore normal intestinal microflora||Bifikol||Before use, 3-5 teaspoons of the drug diluted in the same amount of water. Take 3 times a day for 20-30 minutes before meals. Course 2-5 weeks|
With bacterial gastroenteritis do not prescribe antidiarrheal drugs. Natural cleansing of the intestine from the pathogen and toxins contributes to the speedy recovery. At the same time ensure that the patient does not develop dehydration. To do this, it must receive 2 times more fluid than it loses with diarrhea and vomiting.
To restore the mineral balance, you can use solutions for oral rehydration, sold in a pharmacy. You can prepare its analogue at home: in 1 liter of water dissolve 1 teaspoonful of baking soda and salt, and 1 tablespoon of granulated sugar.
Diet with gastroenteritis
Diet for gastroenteritis is the main focus of treatment. During the period of diarrhea patients recommended table number 4. Nutrition is chosen in such a way as to minimize irritation of the intestinal mucosa and eliminate fermentation processes. The diet contains a normal amount of protein - 90 g, a minimum of fat - 70 g, and carbohydrates - 250 g
Cooking method: Products are boiled in water or steamed, rubbed or crushed with a blender.
Diet: 5-6 times a day in small portions.
List of recommended products:
- White bread crackers, stale wheat bread,
- Mashed soups with croup (rice, semolina). In soups add dumplings, meatballs, egg flakes,
- Vegetables only in the form of decoctions in soups,
- Low-fat varieties of meat and poultry - veal, beef, chicken breast. Cutlets on the water, steam meatballs,
- Fish low-fat varieties, boiled in water or steamed. Products from minced fish or a piece,
- Eggs 1-2 per day in the form of a steam omelet or soft boiled,
- Freshly prepared calcined cottage cheese, grated unleavened cottage cheese,
- Porridge from cereals on the water - oatmeal, semolina, buckwheat,
- Butter in the first and second dishes,
- Fruit - grated fresh apples,
- Drinks - black or green tea, diluted fruit juices (except grape, plum and apricot). Compotes, jellies, decoctions of dried rosehips, black currants, blueberries.
- Any bakery products other than those listed above
- Vegetables and fruits in natural or boiled form,
- Spicy, fatty, fried and baked dishes,
- Cold dishes and drinks,
- Milk, kefir and fatty dairy products,
- Barley and pearl barley, millet, legumes,
- Cocoa with milk, sweet and soda.
Diet number 4 observe 3-5 days. Then go to diet number 2.
Table number 2 appointed in the period of recovery after acute gastroenteritis and in chronic form of the disease. The purpose of the diet is to normalize the work of the digestive organs and provide the patient with adequate nutrition.
Cooking method: boiled, steamed, baked and fried (without a crust) dishes.
In the diet, gradually increase the amount of carbohydrates to 400 g, and fat to 100 g (25% vegetable). Protein 90-100 g.
- Yesterday's or dried bread, rolls of baked goods. 2 times a week, cooled, lean pastries with cottage cheese, meat, jam,
- Soups on weak broth (meat, fish, mushroom) with finely chopped or pureed vegetables,
- Meat - low-fat varieties without fascia, tendons and skin: beef, veal, rabbit meat, chicken, turkey meat, boiled tongue, milk sausages. Pork and lamb in limited quantities,
- Fish - low-fat varieties. Chopped products or a whole piece,
- Milk - sour milk drinks, cottage cheese and products from it, cheese, sour cream for dressing dishes,
- Eggs - soft-boiled, in the form of an omelette, fried without a crust. Exclude hard boiled eggs,
- Vegetables - boiled, stewed and baked, in the form of casseroles, fried without a crust,
- Cereals - in the form of semi-liquid and crumbly cereals, casseroles, cutlets without a crust,
- Snacks - salads from boiled vegetables and fresh tomatoes with the addition of eggs, lean ham, meat and fish, low-fat aspic, liver pate.
- Drink only bottled water. Use the same for washing fruit.
- Wash your hands as often as possible.
- Use liquid soap, the usual contains a large number of microbes.
- After visiting public places, wipe your hands with wet wipes and treat with antiseptic.
- Avoid swimming in standing water where sewage could get into.
- Do not buy food on the streets. Choose dishes that have been heat treated and cooked with you.
- Refuse steaks with blood and other dishes from poorly roasted meat, fish and shellfish.
An oral vaccine has been developed for the prevention of rotavirus gastroenteritis - Rotarix. It is recommended to drip in the mouth to children of the first half of the year of life. The vaccine is a weakened rotavirus. Once in the body, they provoke the production of antibodies designed to protect the body from infection.
Scheme. The vaccine is administered twice:
- The first stage - at the age of 6-14 weeks,
- The second stage - in 4-10 weeks after the first at the age of 14-24 weeks.
The effectiveness of vaccination. If both stages of vaccination were made before the 1st year, then the efficiency exceeds 90%. If up to 2 years, the efficiency is 85%. Studies have shown that for 2 years the vaccine reliably protects children from the development of the disease. In older adults, they carry a mild rotavirus infection. They do not develop severe forms of the disease that require treatment in a hospital.
Side effects On the basis of a survey of 63,000 vaccinated children, it was established that the vaccine does not cause serious consequences and is safe to use.
Infectious gastroenteritis in children
From October to March, the most common cause of gastroenteritis in children is rotavirus. It causes about 60% of cases. It is possible to infect as airborne droplets, as well as through dirty hands and premeasures, which have particles of feces or vomiting.
In the summer months, gastroenteritis is more often associated with foodborne toxicoinfections associated with the consumption of a large number of opportunistic microorganisms in food. Especially dangerous products made from minced meat, pies, cakes and cream cakes, dairy products.
A child may become infected:
- From a sick person. The patient becomes infectious from the moment the first signs of the disease appear. With viral gastroenteritis, it remains infectious for 5-7 days, with bacterial - for several weeks or months. Therefore, if rotavirus gastroenteritis appeared in the garden, a large number of children in the group may become infected.
- From the carrier. A carrier is a person who is apparently healthy but releases viruses or bacteria. The most dangerous are carriers who are involved in cooking.
- From animals. Bacteria can enter the body with the meat and milk of sick animals. Gastroenteritis caused by salmonella develops after consuming eggs, especially waterfowl.
- Consumption of contaminated food and water:
- Insufficient heat treatment - dishes are poorly cooked, roasted.
- Bacteria from the patient or carrier got on the products after preparation. Such dishes become dangerous after they have stood without a refrigerator for 2 or more hours - a time sufficient for bacteria to multiply.
- Products that have expired. In this case, the number of bacteria increases dramatically, even if storage conditions were properly followed.
Non-infectious gastroenteritis in children
- Medicinal gastroenteritis. May develop against the background of ordinary SARS or influenza. In this case, the first symptoms will be fever, runny nose, sore throat and cough. Diarrhea and nausea appear 12-24 hours after taking antipyretics (Nurofen, Panadol) or antibiotics. These drugs irritate the mucous membranes, and drinking plenty of water makes the stool even more fluid. In this case, it is desirable to use antipyretic agents in the form of suppositories, and add sorbents to the ARVI treatment regimen.
- Alimentary gastroenteritis associated with overeating, consumption of too fat, spicy and coarse food, a large number of berries and fruits. The child does not produce enough digestive enzymes to assimilate such food. The intestine is trying to clear it from using increased motility.
- Allergic Gastroenteritis develops with the consumption of products to which the body has a hypersensitivity. In 0.6% of babies up to 4 months develop an allergy to cow's milk, which is part of the mixtures or used in its pure form. In children of preschool and school age allergens are: strawberries, chocolate, citrus fruits, kiwi, eggs, nuts.
What are the manifestations of gastroenteritis in children?
When gastroenteritis in children noted:
- temperature rise
- refusal to eat
- abdominal distention accompanied by rumbling
- tongue is coated with white bloom.
After a few hours or the next day, catarrhal symptoms (runny nose, sore throat, cough) may appear, indicating the rotavirus nature of the disease.
Acute gastroenteritis in children already for the first day leads to dehydration. His signs are:
- dry skin,
- sunken eyes,
- dry red chapped lips
- dry mouth mucous,
- strong thirst
- weight loss,
- rare scanty urination,
- increased heart rate and breathing
- sunken spring.
If you notice some of these symptoms, you should immediately call a doctor, and before his arrival, take steps to restore the normal amount of fluid in the body. To do this, the child should receive 20 ml of fluid per 1 kg of body weight per hour. So, a child of 15 kg should drink 15 x 20 = 300 ml every hour. The liquid should be warm and come in small portions of 5-20 ml every 5 minutes. Breastfed babies should be applied to the breast every 15-20 minutes.
When does a child need urgent medical care?
- there were signs of dehydration,
- diarrhea and vomiting continue for more than a day, despite the treatment,
- the temperature has risen above 39 degrees,
- during 4-5 hours the child’s condition worsens,
- mucus or blood is found in the feces
- there was a strong weakness, impaired consciousness.
1. Rehydrating solutions - to restore normal levels of fluid and salt. Promote the elimination of toxins. Used to prevent and treat dehydration.
- Humana electrolyte. The contents of 1 sachet dissolved in 1 cup of boiled water. Regimen: about 500 ml in the first 4 hours - every 5 minutes a teaspoonful. Further, 100-150 ml after each liquid stool.
- Regidron 1 bag dissolved in 1 liter of boiled water. The amount of solution depends on the degree of dehydration. For the first 6-10 hours, the child should receive a portion of Regidron, twice the loss of body weight caused by diarrhea and vomiting.
- Viferon rectal suppositories are injected into the rectum 2 times a day for 10 days. A single dose is calculated based on the area of the child’s body.
- Laferobion nasal solution (nasal drops or spray). The child is instilled into each nostril with 5 drops of the drug with an activity of 50–100 thousand IU every 2 hours.
- Nifuroksazid in the form of syrup is recommended for children up to 6 years. 2-6 months - 0.5 tsp. 2 times a day. 6 months-6 years old - 1 tsp. 3 times a day. Older than 6 years old - 1 tsp. 4 times a day.
- Zeercal. Allowed for children over 3 years. Assign a rate of 0.1 mg / kg body weight. The drug is prescribed in pills inside or in solution for injection.
- Smecta bag content is dissolved in 50 ml of water. Daily dose: children up to the year 1 sachet, 1-2 years - 2 sachets, children over 2 years old - 3 sachets per day. The dose is divided into several methods. It is allowed to mix in semi-liquid food - porridge, mashed potatoes.
- Polysorb The powder is diluted with water (50-100 ml) before the formation of a suspension. Powder dosage - for every 10 kg of body weight 1 measuring spoon without top. Apply an hour before meals. Suspension is prepared every time before use.
- Enterol 250. Children 1-3 years old on the 1st capsule 2 times a day.Older than 3 years - 1 capsule 3 times per day. If necessary, the capsule can be opened and diluted its contents in water (50 ml). Take 1 hour before meals.
Diet with gastroenteritis - The most important component of treatment. Practice has shown that fasting is not the best way.
Children are recommended:
- unlimited breast milk. Cow, goat milk and dairy products from them completely exclude
- rice water and sticky rice porridge,
- protein steamed omelette.
More detailed nutritional guidelines are described above.
Treatment of chronic gastroenteritis
|Group of drugs||The mechanism of therapeutic action||Representatives||Mode of application|
|Vitamin preparations||Normalize metabolic processes and improve the nutrition of the tissues of the stomach and intestinal walls. Strengthen the immune system and the general condition of the patient.||Pangeksavit||1 tablet 3 times a day, a course of 30 days.|
|Undevit||Inside after eating 2 drops 3 times a day. Duration is 20-30 days.|
|Antimicrobial agents||Cause the death of bacteria and protozoa.||Enteroseptol||Inside 1-2 tablets after meals, a course of 10-12 days.|
|Intestopan||Inside 1-2 tablets 3 times a day, a course of 2 weeks. Tablets crushed and washed down with water.|
|Astringents||On the damaged mucous membrane form a film that protects against irritating substances.||Tealbin (tanalbin)||Inside 1 tab. (0.3-0.5 g) 3-4 times a day.|
During treatment, you must follow a diet 4 (4-a, b) and completely eliminate alcohol.
As a binder and anti-inflammatory agent used decoctions of medicinal plants:
- Broth oak bark. 2 tbsp. bark poured a glass of boiling water and heated for half an hour in a water bath. Cool, squeeze, bring to 200 ml with boiled water. Take 1/4 cup 4 times a day on an empty stomach.
- Infusion of cherry fruit. 2 tbsp. dried berries poured a glass of boiling water. Let it brew for 20 minutes. Accepted by the same scheme.
- The infusion of blueberries. 2 tsp. dry or 4 tsp. Fresh berries are poured with a glass of cold water and left overnight. Take during the day 2 tablespoons.
Gastroenteritis treatmentmineral waters of low and medium mineralization. The mechanism of action of mineral waters is not fully understood. As a result of treatment, the production of gastric juice and digestive enzymes normalizes, inflammation decreases.
For chronic gastroenteritis, it is recommended:
- Essentuki №4,
Mineral water is taken 20-30 minutes before meals in small sips 3-4 times a day, 100-150 ml. The course of treatment is 30-45 days. Treatment can take place at a spa or at home.
Physiotherapygastroenteritis improves blood circulation and trophism in the tissues of the stomach and small intestine. During treatment, the innervation and functioning of the digestive organs normalize:
- inductometry is shown with reduced acidity of gastric juice,
- decimeter therapy for gastritis with increased secretion,
- galvanization and electrophoresis with antispasmodics,
- exposure to diadynamic currents,
- ultrasound therapy
- paraffin and ozocerite applications,
- heating pads on the area of the stomach and small intestine.
The treatment is carried out in courses of 10-15 procedures with a frequency of 1 every six months.
Does immunity develop after gastroenteritis?
Immunity after gastroenteritis is not persistent and not long lasting. The same pathogen can cause recurrent disease after a short period of time.
After rotavirus gastroenteritis, antibodies remain in the blood of people, which provide an easier course of the disease in adults.
Causative factors of infectious gastroenteritis
- enteropathogenic Escherichia coli,
- staphylococcus and others.
- cytomegalovirus and others.
- balantides if
- dysentery amoeba, etc.
Alimentary gastroenteritis often develops after the simultaneous consumption of dairy products and fresh vegetables (for example, cow's milk and green cucumbers). The disease occurs when the individual intolerance of certain foods (for example, fatty meats, fish). Alimentary gastroenteritis does not require special treatment and does not cause significant harm to the child’s body. But the problem of infectious gastroenteritis should be covered more fully.
- inadequate personal hygiene. The child has not developed the habit of washing hands after using the toilet, after walking, before eating,
- early age. In children under one year there is a functional immaturity of the digestive system. The development of IgA, which plays a major role in the development of local immunity, is not fully performed in infants,
- insufficient heat treatment of meat, fish, eggs in the process of their preparation,
- poor processing of fresh fruits and vegetables before eating them,
- contact with patients with acute intestinal infection (children with vomiting, loose stools, fever),
- inadequate hygiene by adults caring for a young child. It is important that parents always wash their hands after changing the diaper to the baby. A lactating woman should have a breast hygiene each time before feeding. Great attention to the artificial character of feeding should be given to clean nipples and bottles. Toys with which the child is engaged must also undergo the necessary, regular processing.
The route of transmission is predominantly fecal-oral. The spread of the pathogen is promoted by mechanical carriers (flies, cockroaches, rodents). An infectious agent that has entered the child’s body begins to undergo a reproduction cycle there. It inhibits the normal microflora, contributes to the death of beneficial intestinal bacteria (bifidobacteria, lactobacilli). Microbes violate the absorbability of nutrients, impair the movement of the food lump in the gastrointestinal tract.
- abdominal pains (often do not have a clear localization, are non-permanent, pulling character. Children, explaining exactly where they feel pain, often indicate the umbilical region),
- loose stools (the stool consistency may be mushy with a mild degree of illness and in the initial stages of inflammation. Later the stool becomes abundant and watery),
- vomiting (at first it looks like undigested food lumps, then vomit becomes watery or even takes on a characteristic bile appearance),
- flatulence (increased flatulence), rumbling in the stomach,
- temperature increase (in rare cases, the temperature remains normal, but more often it is observed to increase within 37.5-39.5 degrees),
- symptoms of general intoxication (lethargy, irritability, moodiness, decrease in playing activity, headache),
- signs of dehydration (pale, gray-tinged skin, skin fold easily collected and poorly straightened, tongue dry, covered with thick white or brown patina).
The severity of gastroenteritis. Determination of the degree of dehydration
The severity of gastroenteritis is estimated by the multiplicity of occurrence of the leading symptom. If the frequency of vomiting is higher than the frequency of liquid stool, then the severity of the inflammatory process is assessed by the number of episodes. If the child is more worried about loose stools, then it is worth focusing on him.
- Mild gastroenteritis is exposed at a frequency of the leading symptom up to 3 times,
- Medium degree - up to 10 times
- Heavy degree - more than 10 times.
With emetic masses, with liquid stool, at elevated body temperature, the child's body loses water and the trace elements necessary for its normal functioning (potassium and sodium).
There is dehydration of all tissues, including brain tissue. Therefore, it is important to correctly assess the degree of fluid loss and take all possible measures to eliminate this process.
Evaluation of dehydration is carried out by percentage weight loss relative to the initial weight of the child.
If the weight loss is 3-5%, the first degree of dehydration is diagnosed, 5-10% is the second degree, more than 10% is the third degree.
Mild to moderate gastroenteritis therapy can be performed at home under the mandatory supervision of a local pediatrician. Treatment of a severe form of the disease is carried out exclusively in an infectious diseases hospital.
Important components of the integrated treatment of infectious gastroenteritis are:
- Diet. For the first day, the patient was recommended hunger. From the second day, the child begins to receive food, taking into account his usual diet. If the patient was breastfed before the illness, doctors are allowed to put the baby on the mother's breast. Feeding should be more frequent, but shorter.
If the child received an adapted milk formula, then fractional feedings are prescribed by the usual milk replacer with a decrease in a single portion volume. Sour milk formula is recommended for consumption.
On the second day of treatment, children who receive a common table usually get lean chicken broth, boiled vegetables, porridge cooked in water. Further, the patient's diet is gradually expanding: the one-time amount of food eaten increases, new foods are added. Drinking mode. For a speedy recovery and in order to eliminate dehydration, it is important to properly otpaivat child. The amount of fluid needed must be calculated for the first six hours of therapy and for the remaining time of day.
At 1 tbsp. dehydration fluid volume for the first 6 hours is calculated using the formula 50ml * body weight in kg. The resulting amount of ml is divided equally by 6 hours and is drunk to a child from a teaspoon or a tablespoon, depending on age.
At 2 tbsp. dehydration to calculate the required fluid in the first 6 hours you need 80 ml * body weight in kg.
The volume of water for further watering is calculated as 80 ml * body weight in kg. The resulting volume is divided by the number of remaining hours (at 18) and is uniformly evaporated to the child.
It is important to alternate the intake of salt solutions with ordinary water or sweet tea. For example, every 1 tsp. Rehydron (pharmacological saline) alternate with 1 tsp. sweet tea. Antibiotics. Of the antibacterial drugs recommended for oral administration, children often use Enterofuril, Polymyxin, Furazolidone, etc.
Cephalosporins (for example, Ceftriaxone), aminoglycosides (Amikacin, Gentamicin) and others are prescribed from injectable forms.
Gastroenteritis is a common disease. According to the frequency of its occurrence, it ranks second after SARS in children. With timely treatment to the doctor and properly prescribed treatment, the disease is successfully treated. The prognosis for the life and health of the child after a postponed intestinal infection is usually favorable.
How does the infection occur?
The causes of infectious and viral gastroenteritis in children are:
- eating poor quality, expired or insufficiently processed foods (undercooked meat, fish, eggs of infected poultry, etc.),
- ingestion of infected water
- interaction with a sick person (an infection is transmitted by airborne droplets),
- the use of poorly washed dishes (for example, in places of public catering),
- non-compliance with hygiene standards. Since childhood, it is necessary to teach the child to wash their hands after walking on the street and before eating. Parents should also monitor the cleanliness of dishes, baby bottles and nipples, which each time it is desirable to disinfect (even ordinary boiling water will do). A nursing mother should be aware of breast care.
Signs of gastroenteritis in children
The first symptoms of infection of the child are:
- Pain in the abdomen, usually in the area around the navel, but sometimes the child is not able to clearly indicate exactly where it hurts. The pain appears unexpectedly and may even disappear by itself.
- Progressive diarrhea. At first, the stool softens, but within a day it becomes watery, and visits to the toilet are on the increase.
- Nausea and vomiting. Sometimes, along with undigested food, vomit contains particles of blood.
- Rumbling in abdomen. Fingers gropes in the area of the cecum. The child is tormented by flatulence.
- Gastroenteritis can sometimes be confused with poisoning: there is a weakness, dizziness and headaches, the child quickly gets tired, irritated and naughty. Body temperature rises to 38-39 degrees.
- Pallor, tongue, loss of appetite.
Prolonged observation of these symptoms indicates an acute infectious gastroenteritis in a child. Vomiting and diarrhea are very dangerous, which not only exhaust the weakened organism, but also lead to dehydration and disturbances in the functioning of the digestive organs. In infants with the impossibility of immediate hospitalization increases the risk of death!
In older children, signs of severe fluid loss are: grayish skin, dry mouth, dizziness and fainting, muscle cramps, coma.
If allergic pathology or food abuse is easily eliminated by changes in nutrition, then acute or chronic gastroenteritis in children should never be treated on their own!
Folk remedies and grandmothers infusions are not able to cope with the infection.
Complications caused by an illness without proper medical therapy represent a serious risk to life:
- Dehydration is the most common cause of impaired normal functioning of the body,
- Violation of water-salt balance, which leads to a decrease in the volume of blood circulating through the body (hypovolemic shock),
- Ultimate thinning of the mucous membrane of the small intestine up to the complete impossibility of coping with the incoming food,
- Gastroenterocolitis - inflammation of the lower intestine,
- Negative changes in intestinal microflora (dysbacteriosis),
- Complications to other internal organs (heart, kidney),
- Blood poisoning,
Treatment of the disease
If a child is diagnosed with mild gastroenteritis, therapy will consist mainly in dieting and consuming large amounts of fluid.
- On the first day of illness, it is better to refuse food. It is necessary to feed the baby to the breast with care, in small portions.
- On the 2nd day, frequent but small in volume feedings are recommended: chicken broth or vegetable soup, porridge on water.
- Steamed lean meat can be given on day 3.
- By the 4th day, you can include unsweetened, oven-dried white bread, boiled eggs, and steamed fish in the diet.
- On the 5th day, as a rule, it is possible to return to the usual way of eating, but milk and dairy products remain banned.
- At the stage of recovery, you will have to abandon sweets and flour products, carbonated drinks, as well as any coarse and spicy foods.
- In order to prevent dehydration, the child must be given clean water: a few sips every quarter of an hour,
- The salted solution, which is prepared on the basis of the medications prescribed by the doctor, is usually Citroglukosolan, Regidron, Pedialyte.
- Well restore water balance broth hips, cranberries, mint.
To combat infectious or viral gastroenteritis, as well as to prevent complications, children are prescribed:
- Antibiotics, the choice of which depends on the specific infectious agent
- Antivirals, if the viral basis of the disease is confirmed,
- Preparations that remove toxins from the intestines (sorbents such as Activated carbon, Smecta, Polysorb),
- Enzyme medications that help the digestive system (CREON, Pancreatin),
- Probiotics, stimulating the restoration of intestinal microflora (Bifiform, Linex),
- As a rule, antidiarrheal drugs are not prescribed, because with diarrhea the body is cleansed of bacteria and toxins,
- Also, do not take antipyretic drugs and other drugs not prescribed by a doctor. Such autonomy can lead to deterioration.
Treatment can take place both at home and in the hospital if the child needs constant monitoring during a dangerous course of the disease.
With proper treatment, the recovery period does not last so long: only about a week. However, it should be remembered that during therapy and after its termination the child needs rest, during illness and the first time after it will be lethargic and tired.
Do not forget about a sufficient amount of fluid and a balanced diet, because this week your baby’s body has lost a lot of water and beneficial trace elements.
Do not let the child overeat after the illness retreats: a weakened digestive system does not immediately cope with the usual, and even more so, the amount of food that has been exceeded.
During the fight against the disease, your child needs special care and attention. Be patient when unexpected bouts of vomiting or diarrhea begin.
Give liquid or food not immediately after the attack, but after 15-20 minutes. Let your baby's stomach rest from a spasm.
Keep the child's hygiene, wash things that come in contact with the baby, and wash the dishes well, from which he eats. Even a recovered person is a carrier of infection for a few more days if the cause of the infection was a virus.
Symptoms and signs of the disease
Symptoms and signs of gastroenteritis in children usually combine:
- diarrhea (diarrhea),
- stomach cramps,
- temperature rise,
- loss of appetite
Regardless of the reasons, the most frequent manifestations of gastroenteritis are vomiting and diarrhea, however:
- Infectious gastroenteritis causes fever. Often characterized by abdominal pain.
- In viral etiology, the stool is watery, rarely contains mucus or blood.
- Rotavirus causes infections up to 5-7 days in infants and young children. In most cases, it is also accompanied by vomiting and fever.
- Norovirus causes more vomiting than diarrhea and lasts 1-3 days.
- Adenoviruses cause weak vomiting, 1-2 days after the onset of diarrhea. Diarrhea lasts 1-2 weeks.
- Astroviral symptoms resemble those of rotavirus infection.
- Bacterial infections often cause fever as well as diarrhea with blood.
- Gastroenteritis of parasitic etiology is characterized by a long course of diarrhea, which can pass and return again. Blood does not usually contain. Children may look very tired and exhausted with prolonged diarrhea caused by parasites.
Effective treatment of the disease
Treatment of gastroenteritis in children consists of two stages: rehydration and maintenance. In the rehydration phase, fluid deficiency is quickly replenished (for example, within 3-4 hours), achieving clinical hydration. In the maintenance phase provide the necessary amount of calories and fluids.
Rapid replenishment of nutrition should follow rapid hydration for the patient to return to a normal diet as soon as possible, according to age. Do not give peace to the intestines. Breastfeeding is continued throughout all stages, even during the initial rehydration.
To replenish calories during an acute illness, you must give children food if they are able to tolerate it. During both phases, the replacement of fluids is carried out simultaneously with the loss of diarrhea and vomiting.
Severe dehydration is an emergency and requires immediate intravenous rehydration.
Nonspecific antidiarrheal drugs (eg Kaolin / pectin), drugs that reduce intestinal mobility (eg loperamide), antisecretory and binding toxins (eg cholestyramine) are widely used for treatment, but information about their effectiveness is not enough.
A small zinc deficiency may be associated with the development of childhood diarrhea, which is why the use of zinc supplements is beneficial for improving the outcomes of mild and chronic diarrhea, as well as for its prevention.
Probiotics, or live microorganisms, are drugs that can improve the balance in the intestinal microflora. Studies confirm their use to prevent or reduce the severity or frequency of diarrhea among children, including diarrhea caused by rotaviruses and antibiotics.
Bacterial - staphylococcal species
Bacterial infection can be gastroenteritis when used:
- Contaminated food, in particular raw and poorly roasted meat products, eggs.
- Infected seafood.
- Unpasteurized milk or juice.
- Water from wells, springs and pools.
Bacteria can germinate in many products left outside the refrigerator. Staphylococcus in food secretes a toxin, causing sudden vomiting and diarrhea. Gastroenteritis, which has developed after eating foods containing microorganisms or their toxins, is sometimes called food poisoning.
Enterovirus - a common form
Enteroviruses are a large family of viruses responsible for many infections in humans. These viruses live in the gastrointestinal tract, but can cause many diseases. Very often enterovirus infections appear in homes where there are children, as well as in summer camps and kindergartens. Can be transmitted at any time of the year, but most often in summer and autumn
Effective drugs - the best antibiotic
Due to the fact that viruses (eg Rotavirus, Astrovirus, Entero-Adenovirus, Noravirus and Sapovirus) are the predominant cause of acute diarrhea in developed countries, the routine use of antibacterial drugs for the treatment of diarrhea is a waste of resources and can lead to an increase in bacterial resistance.
Even if a bacterial infection is suspected, they do not prescribe an antibiotic on an outpatient basis to children, due to the fact that most cases of diarrhea go away without their use. The exceptions are persons with weakened immune status, premature babies and the presence of associated pathologies.
How much does the temperature during gastroenteritis
As a rule, in mild gastroenteritis, symptoms usually last from two to three days. However, even after all the symptoms have passed, rare stool disorders can occur during the week.
How much the temperature is maintained is also affected by the method of treatment used. Ask for help if your child is older than 2 years and the temperature lasts more than three days, or if he is younger than 2 years old and the temperature lasts more than a day.
Proper and necessary prevention
A meta-analysis of 30 studies found that improved hand hygiene reduced the incidence of gastrointestinal infections by 31%. The most favorable was the use of ordinary soap. Antibacterial soap was slightly more effective. Another study found that good baby hand hygiene reduced the incidence of gastroenteritis in general, but had little effect on the transmission of rotaviruses.
Rotavirus vaccine is a live oral vaccine. Routine vaccination at two, four and six months is recommended - this is the main prevention.
There are special guidelines for premature babies and children who missed the first vaccine.
- vaccine hypersensitivity,
- congenital anomalies of the gastrointestinal tract,
- severe combined immunodeficiency.
At the moment there are two vaccines - Rotarix (monovalent human vaccine) and Rotatec (pentavalent, containing five live bovine and human reassortant strains). These vaccines were not observed side effects in the form of intestinal obstruction.
Both vaccines are safe, based on extensive randomized clinical trials.