HEALTH PROBLEMS: FIRST YEARS AT SCHOOL
DIARRHEA AND CONSTIPATION
Under the age of three we can speak of diarrhea if numerous discharges occur (more than six per day), generally accompanied by loss of appetite and vomiting. In fact, during the first three years, even if the child often has five or six discharges a day, he should not be treated with either diets or medicines.
After the age of three we can speak of diarrhea even if the discharges are less than five or six a day, but the stools must be watery and not just a little soft. The child who really has diarrhea often also has a fever and appears “sick”, that is, he loses his usual vitality. Whether the stool is yellow, green or brown is of little importance. The color, in fact, depends on the amount of bile that the stool contains and on how this is modified by intestinal bacteria, which normally varies for physiological reasons.
If someone in the family has vomiting or diarrhea, we tend to immediately attribute the blame to some “heavy” food, or to an intolerance. However, except for quite unusual cases, these two symptoms are caused by infections of the digestive system of viral or bacterial origin. These diseases are contracted by contagion, in various ways. The first is that of contamination of the environment with the feces of a sick individual. An adult or child who has a gastrointestinal infection and accidentally gets their hands dirty, even with a microscopic amount of feces, are perfect propagators of the germ. This happens, for example, in nursery schools where strict hygiene is not respected. For example, if a baby has gastroenteritis or even a healthy carrier, caregivers can easily contaminate their hands and pass the germ on to other babies if they don’t wash their hands thoroughly after diaper changes.
Another example is that of the sick child who first touches his bottom and then manipulates the toys that will later be placed in the mouth by other children. A common path of contagion is food contaminated with fecal germs. This can occur during the preparation of food by healthy carriers who do not respect the elementary rules of hygiene. Even drinking water, fortunately increasingly rarely, can be contaminated due to the infiltration of sewage sewage into the aqueducts.
And if the large sewer pipes lead to a stretch of sea near the coast and the purifiers that are supposed to destroy the “bad” bacteria do not work, bathing becomes a serious risk. Finally, seafood are excellent concentrates of water germs and, if eaten lightly cooked, they easily cause gastrointestinal infections, in addition to viral hepatitis.
As with respiratory tract infections, also for gastrointestinal infections, a distinction must be made between viral and bacterial infections.
Viruses of gastroenteritis
During the winter, viral gastroenteritis, commonly caused by so-called rotaviruses, are much more common. Like all members of this class of microorganisms, they are not sensitive to antibiotics or sulfonamides or other “intestinal disinfectants”, which are completely useless in fighting this type of infections. Viral gastroenteritis initially manifest itself with strong loss of appetite and repeated vomiting, which last for a few hours, up to a whole day. Then, within the first twenty-four hours, diarrhea occurs with frequent, watery discharges, rarely containing small amounts of blood. The fever can be high, but sometimes it doesn’t show up at all. After the first two days the diarrhea subsides a lot and disappears completely by the fourth, fifth day at the latest. While in the early stages of the disease the child tends to vomit everything he eats, in the second or at the latest on the third day he is able to resume eating everything. In the first two days, the inflamed intestine becomes unable to digest lactose.
Diseases of the gastrointestinal system i.e. the sugar naturally present in milk. Therefore the administration of cow’s milk in this phase can accentuate the diarrhea. Rotavirus infections can cause severe dehydration in infants and therefore a special vaccine is recommended today, which is administered orally from the first month of life.
The bacteria of gastroenteritis
Bacterial gastroenteritis is usually more serious than viral, depending on the germ that produces it. Indeed, even in these infections the main symptoms are vomiting and diarrhea, but the course is usually longer than for viral forms and the general condition of the child suffers more.
Salmonella, for example, a family of bacterial with varying degrees of danger, generally produces high fevers, blood in the stool and intense killing. Enteropathogenic Escherichia Coli, to be distinguished from Escherichia Coli normally present in the intestine, instead causes a very abundant watery diarrhea, but almost never fever or blood loss. Other less common or rare bacteria that cause gastroenteritis are Shigella, Campilobacter, Vibrione del Colera, Yersinia, Klebsiella, Criptosporodium, etc. In every country there is a prevalence of one or the other and, especially in hot places, there are numerous other germs that can cause this type of infection. Let’s say that in our country, Salmonella and Enteropathogenic Escherichia Coli are mainly found, but also Criptosporidium (which is resistant to chlorine in swimming pools!).
As we have learned from not too ancient chronicles, however, even germs theoretically disappeared in Italy, such as the vibrio of cholera, are not entirely unknown! Bacterial gastroenteritis is usually treatable with antibiotics, because bacteria, unlike viruses, are sensitive to these drugs.
In both forms of gastroenteritis, the greatest danger for children is dehydration. If they continue to vomit beyond the first day and lose plenty of fluids with diarrhea, after a couple of days the body may run into a deficit of essential fluids. In children, this risk is more likely than in adults, for some reasons.
The first is that the little ones need a greater amount of water as their body is made up of liquids in a 123 higher percentage than adults.
The second is that the body loses fluids more easily during early childhood than at later ages.
However, if the child cannot replace the fluids he loses during a gastroenteritis by drinking enough, at some point he will show the first symptoms of dehydration: he pees much less than usual and the mucous membrane of the mouth becomes dry, he no longer has saliva. If the vomiting stops at this point, it is still possible to treat him at home by having him drink fluids suitable for rehydration.
If, on the other hand, the vomiting and diarrhea continue, the blood volume decreases rapidly and the pressure begins to plummet. At this point, the kidney no longer produces urine, the eyes become sunken and the oral mucosa appears completely dry. Now the general conditions are really serious and at this stage, only the administration of fluids intravenously can reverse the trend and avoid circulatory collapse. In fact, the most serious danger consists in a sudden drop in blood pressure up to shock that can be fatal.
How to cure gastroenteritis
When diarrhea and vomiting arrive, whatever the cause, the first thing to do is to avoid excessive fluid loss. Thus, when the child vomits repeatedly, it is good to suspend the administration of any food and liquid (even water) and put the digestive system at rest for a few hours.
As soon as the little sick child stops vomiting, it is illogical and harmful to give him food immediately for fear that he will “weaken too much”. It is best to work to replace lost fluids quickly, starting at least a couple of hours after the last episode of vomiting with small sips of lightly sweetened water.
If the child is holding her back, we can offer him increasing quantities of a rehydration solution to buy at the pharmacy, containing not only sugar, but also salts. In fact, it must be remembered that in gastroenteritis, in addition to taking water, sodium and potassium are eliminated, essential elements for the body.
These solutions are especially necessary in the first months of life, when dehydration is much more likely. In children after the year, if vomiting and diarrhea are short-lived, lightly sweetened tea or chamomile tea is enough for this first procedure.
Assuming that the child has stopped vomiting and retains fluids well, when can you begin to feed him again, without the risk of a relapse? Diseases of the gastrointestinal system.
Did the diarrhea have completely disappeared before I gave him solids? What are the foods we can give first? As for infants who take only breast milk, once the vomiting has disappeared for at least three to four hours, they can be reattached to the breast, even if the diarrhea is intense.
However, it is good to continue to offer them a balanced solution of salts and sugars in the intervals between feedings.
For those who instead take formula milk and for the older ones, it is better to prolong the fasting of food for a few hours from the end of vomiting, by administering only the solution described. If all goes well, after this fast, infants are better off starting over with a lactose-free milk, such as a soy-based formula, to be administered within the next 24 hours.
For the older ones, already weaned, you can start over with tea and biscuits and, hopefully, you can continue with rice, meat or chicken, boiled eggs and fish. Naturally, after the first “home” surgery, it is better to contact the pediatrician to describe the situation.
A visit is essential for the little ones, but it is not in the case of a light viral infection in children beyond the first six months. If the infection is bacterial, an antibiotic or a sulfonamide can only be useful if the diarrhea is severe and is accompanied by fever and persistent general malaise, because even in this case the child usually heals spontaneously.
There are no “symptomatic” medicines that can calm diarrhea due to gastroenteritis. Drugs based on racecadotril have questionable effectiveness and, in my opinion, are not worth using them. On the other hand, medicines that are actually effective at masking the symptom of diarrhea, such as those based on diphenoxylate, work by paralyzing the muscles of the intestine and are very dangerous in children. In fact, they can cause acute dilation and even a rupture of the colon. The use of so-called “astringent” foods (ie rice, carrots, carob flour, etc.) which are traditionally recommended for diarrhea, does not change the substance of things. In the best of cases, they make the stools a little more compact, but do not shorten the course of gastroenteritis.
Early in my career as a medical writer, a few years after I returned from the United States, I began to answer letters sent to the magazine Io e il mio Bambino [My baby and me]. These letters were often written by despairing mothers asking for advice. After a couple of years doing this job, I analysed the hundreds of requests I had received by that time and realized that the great majority concerned one specific problem:
“My child won’t sleep”.
My second finding was that the period when all these children were unable to sleep was usually limited to the first two and a half years of life. I rarely received letters from the parents of older children with the same problem. My subsequent experience allowed me to get to the bottom of the statistics. I realized that 90 per cent of sleep disorders in younger children are linked to gastroesophageal reflux and the problem tails off after two years of age because the reflux also diminishes significantly at this age. However, a good proportion of children continue to exhibit reflux symptoms well beyond this limit and some are even destined to have the problem into adulthood. After the age of two, the situation nevertheless changes in such a way that the problem risks going undetected and untreated even though the circumstances mean it continues to cause great discomfort. Let’s look at why this happens.
Because reflux was little-known at the beginning of my career, I didn’t realize that my daughter’s bad breath was one of its most telling signs. So, I forced her to clean her teeth three times a day, but to little avail.
After two years of age, children begin to be able to describe the pain they experience from time to time as “stomach-ache”. They touch themselves in the epigastric area, immediately below the ribs. The pain mainly makes itself felt early in the morning or a couple of hours after breakfast and then comes and goes without following any particular pattern.
Refusal to eat breakfast
This habit is due to nausea and a sensation that the stomach entrance is closed. This is linked to the fact that reflux gets worse at night when gastric acid can come back up more easily due to lying horizontally.
I have found that poor appetite coincides with periods when the condition is more active. A word of caution: this will not cause malnutrition or stunted growth because children always make up for it on days (or at the times of day) when they feel better.
Vagal hyperstimulation episodes
These are spells when the child almost seems to faint. They occur in direct proportion to the number of episodes experienced previously. One day, a five-year old patient of mine named Pietro scared his parents so much with one of these near-fainting episodes that he ended up in hospital and underwent a round of testing by cardiologists and neurologists, who found nothing abnormal. In this case too, as I regularly see happen, his parents had underestimated his reflux and stopped treating him for a few months, thinking (or hoping) that the condition had permanently cleared up.
Cough and laryngospasm and/or bronchospasm
Remember that, as with younger children, once children have passed their second birthday, there is a close relationship between coughing caused by respiratory infections and exacerbation of the reflux. Many children with reflux may experience episodes of bronchospasm, when they struggle to breath and make a wheezy sound on the out-breath as though they were having an asthma attack, or laryngospasm, when their cough sounds like a seal bark and their breathing is very raucous.
Vomiting with blood.
If the esophagitis has been neglected for a long time, ulceration may develop. This may bleed and cause vomiting with blood. Fortunately, the symptom is so rare in children that I’ve never even seen one case.
The problem of constipation culminates at around the age of two and often leads children to retain their stools to avoid the pain of straining. Children can go for several days without going to the toilet and from time to time they twist around trying as best they can to resist the stimulus for fear of causing the pain they felt while moving their bowels. The anus may be affected by small tears known as fissures due to passing hard, bulky stools and these only add to the problem. The resulting vicious cycle risks going on indefinitely. As I already explained in the case of younger children, effective treatment of reflux usually puts paid to this problem as well. Otherwise, I advise administering lactulose or macrogol (two or three desertspoonfuls daily) for a few months. These substances soften the stools and make them much easier to pass. As time goes on, the vicious cycle described is permanently broken.
Quality of sleep and dreams
The most evident sleep disturbances, when children wake up crying and calling for their parents to pick them up and comfort them, tend to disappear at this stage. However, if the child still has significant reflux after this age, bedtime may be somewhat disturbed by acid coming up and interrupting sleep patterns.
Example: at about three years of age, my daughter began to experience episodes when she sat up in bed, often with her eyes open, but in a state of sleeping wakefulness during which it was clear that she was in the grip of a nightmare. She sometimes even sleepwalked. All these effects are referred to as parasomnias and attributed to psychological disorders that are not properly identified. In my experience, these very distressing experiences are usually linked with the sensation of choking caused by acid coming back up. Children who experience such nightmares frequently are often scared of going to bed in the evening and suffer from anxiety and melancholia.
This video will help you understand the meaning of the baby’s symptoms and reactions
One of the phenomena that can worry parents a lot are the senseless movements of the arms, the face or the whole trunk, which many children aged 2-3 years and over, make and which are called NERVOUS TIC.
They are very different from other phenomena which are instead accompanied by total loss of consciousness or by movements of the whole body which are CONVULSIONS.
Convulsions occur instead with a shaking of the whole body of a completely unconscious person who unknowingly falls to the ground.
If your child has symptoms of a seizure, you should immediately take him for a visit to the neurologist
There are several nervous tics that differ in that they are single jerking movements of the hands, arm, head, eyes or mouth made by the child who is completely awake (even if distracted), but which have no justification. logic.
These movements have no consequences and do not cause any harm to children, they are just strange, unexpected movements that seem meaningless and that worry parents because they may seem like symptoms of a neurological problem.
This is the reason why these problems are brought to the attention of a pediatrician.
Nervous tics are not a neurological disease, as they do not originate from damage to the nervous system, they are movements that have no pathological significance but are instead of temperamental origin. They come from the more excitable, more tense, more nervous temperament of children.
They can be more or less unsightly and cause children to deride and therefore strike parents who are terrified of the idea that they are caused by damage to the child’s nervous system and therefore tend to try to block them, to ask the child not to get them and persecute them. The child who has no desire to make these movements initially does them unconsciously, but not unconsciously.
At some point the child becomes aware of these shots as it is the parents who point it out to him. However, the child has neither the desire nor an overly effective motivation to stop doing them and therefore there is no quick way and way to convince him to stop.
Unfortunately, all of this becomes a psychosocial problem and embarrasses the parents, and whatever effort they make does not have an immediate effect on the children. It is easier for the child as he grows up, in an absolutely unpredictable period of time, which can range from 1 year, 3 years and even 10 years, suddenly stops doing it. The more the tic is evident, the more the child will motivate himself more and more to stop doing it.