Overview of diarrhoea in children


Alternative names: Diarrhoea, diarrhoeal disease, “the runs”, loose stools, runny stools, dysentery

Worldwide, diarrhoea is a leading cause of death among children under five years of age.

According to UNICEF.org, diarrhoeal disease was responsible for at least 480,000 deaths globally in children in 2016. This has decreased from 670,000 deaths in 2010 and 1,240,000 deaths in 2000. The 2016 stat for the death rate of diarrhoeal disease in children under five in South Africa was about 4,200.

Diarrhoeal disease can last for several days. As a result, a child’s body may become dehydrated due to a loss of fluids. Electrolyte imbalances (i.e. imbalances in salts such as sodium, chloride, potassium and bicarbonate) are also common. Both dehydration and electrolyte imbalances may result in death if not addressed in time.

While western medicine is now more readily available, and education around diarrhoeal disease has improved, a common cause of death is still sepsis from bacterial or viral infection. Sepsis can occur when the child’s immune system responds to an infection by attacking the body’s own organs and tissues.

Children who are most at risk of dying due to diarrhoeal disease are those with a weakened immune system – for example children living with HIV, children who haven’t been vaccinated, and those who are undernourished.

Diarrhoeal disease doesn’t only affect the digestive (intestinal) tract, but also a child’s ability to grow and develop.

Studies have shown that children who have suffered from prolonged diarrhoea, or even frequent diarrhoeal infections, are more likely to be undernourished. This can turn into a viscous cycle, as undernourished children are more likely to fall ill, further affecting their ability to grow and develop.

What, exactly, is diarrhoea?

The World Health Organization (WHO) defines diarrhoea as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools isn’t diarrhoea, nor is the passing of loose, “pasty” stools by breastfed babies.

Diarrhoea is often a symptom of an infection in the digestive tract. Infections can be caused by a variety of bacterial or viral organisms as well as parasites.

Children may become infected when they consume contaminated food or water, or as a result of poor hygiene. They may also infect one another (i.e. through person-to-person contact). This is often the case when sick children are sent to crèche, where they pass on the “bug” to other children when playing or interacting. 

There are three clinical types of diarrhoea:

  • Acute, watery diarrhoea that lasts several hours or days. This includes cholera.
  • Acute, bloody diarrhoea (also called dysentery).
  • Persistent diarrhoea that lasts 14 days or longer.

In terms of the course of the disease, diarrhoea can be split into two categories:

  • Acute (short-term) diarrhoea, which may last for several hours or even days
  • Chronic (persistent) diarrhoea, which may last for 14 days or longer

Acute diarrhoeal disease isn’t likely to affect a child’s growth and cognitive development. However, once the child is feeling better, weight gain is important if weight loss occurred.

Persistent diarrhoeal disease, and even frequent acute diarrhoeal disease (3-4 infections per year), can impact a child’s growth and cognitive development.

Children with HIV/AIDS, and even those who have just been exposed to HIV, are at higher risk of contracting a diarrhoeal infection. The death rate for these children is 11 times higher than the rate for children without HIV. Children with a poor nutritional status are also more likely to be affected.

Importantly, children with diarrhoea or vomiting should stay away from crèche or school for two days after their symptoms have disappeared.

Reviewed by Kim Hofmann, registered dietitian, BSc Medical (Honours) Nutrition and Dietetics, BSc (Honours) Psychology. August 2018.

Image credit: Unsplash.com

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