March 1, 2001

Dehydration can be a problem for kids

By Dr. Diana Curran
Guest Columnist
February 27, 2001

When a child gets sick with vomiting or diarrhea, the body fluids they lose can lead to dehydration. Although most children with diarrhea do not get dehydrated, those that do have a very serious condition that could lead to death if not treated properly. Parents can prevent these complications if they recognize the signs of dehydration early and know how to treat it at home.

Diarrhea that comes on rapidly is also called acute gastroenteritis. It may be associated with nausea, vomiting, fever, or abdominal pain. Gastroenteritis is very common. In the United States, children under 3 years old get sick with diarrhea 1.3 to 2.3 times a year on average. Each year 220,000 children under age 5 years require hospitalization for treatment of gastroenteritis, and 300 will die due to dehydration.

Symptoms of gastroenteritis typically last from 24 hours to a week, and may be associated with other illnesses including colds. The cause can be viral or bacterial. All forms of diarrhea are contagious, and children should remain home until the diarrhea stops. Children under 5 years old in day care or pre-school programs are more likely to catch these illnesses from other children. In these settings, especially, we may need to know the cause in order to prevent spread. The stool culture is the test of choice.

In recent years, our region has experienced outbreaks of both Campylobacter and Shigella infections. To prevent spread, health department nurses investigate the cases, like detectives, so they can find the source and contain it. They also educate the public in order to notify those at risk to watch for symptoms and get treatment if necessary.

Treatment is supportive. Over the counter medicine should be avoided in children. It is best to let the illness run its course. Pepto-bismol contains an aspirin-like substance that should not be given to children. Anti-diarrhea medication such as Immodium can prevent clearing of the infection and prolong the illness, and may lead to serious intestinal complications in children. Even with bacterial causes of diarrhea, antibiotics should not be given to children due to severe complications that can arise from certain types of bacterial gastroenteritis. The only effective treatment is supportive rehydration with salt-containing fluid solutions.

Rehydration replaces the important salts lost by the body in diarrhea such as sodium, potassium, and chloride. This can be accomplished by giving an oral solution if it contains these salts and some sugars. Sodas like ginger ale or Sprite have often been used by parents, but they do not contain enough salts to replace what is lost, and may worsen diarrhea. Homemade solutions with salt can have too much salt and may also worsen the condition. Some parents use Pedialyte solution which is available at drug stores. However, this can be expensive.

To make it easier for parents, AccessCare recently provided oral rehydration packets to the Health Department and Hendersonville Pediatrics to give to their parents. These packets are mixed with one liter of water to make the perfect balance of salt and sugar to effectively rehydrate children. AccessCare also provided these offices with educational pamphlets for parents with all the specific instructions about how to recognize the signs of dehydration, what other treatments to try or to avoid, when and how to reintroduce food and when to call the doctor.

In general, give fluids soon and often, and offer the child her usual diet right away.

Dr. Diana Curran is medical director of the Henderson County Department of Public Health.

Copyright 2001 Times-News