Diarrhea and Vomitting

In developing countries like India babies less then 1 year of age experience on an average 5-6 episodes of diarrhea / year and in children above 1 year of age experience about 2-3 episodes of diarrhea /year.

How does acute gastroenteritis present in children

Diarrhea is the passage of loose, watery stools that occur more frequently than the usual (about 3-4 times in a day). Diarrhea in children is usually caused by infection (bacteria, viruses or parasites) through contaminated food or drinking water.Acute Gastroenteritis usually present in children with diarrhea and vomiting. In Some cases they can also present with fever.

The most common complication of acute diarrhea is dehydration, which can be prevented easily if treatment is started early. Severe diarrhea can lead to significant fluid loss and may be life threatening if not treated properly.

What Causes acute gastroenteritis(AGE)
The most common cause of diarrhea is infection including bacterial, viral, and parasitic organisms. Among these the most common ones in India are Rotavirus (virus) and E. coli (bacterial) infections, giardia or amoeba infection.

How can we prevent/minimise AGE

Maintain good sanitation and personal hygiene
Use only safe drinking water
Wash your hands after using toilet and before handling food.

Educate yourself and your child (If old enough) about how infections spread
Vaccinate your baby with Rotavirus and typhoid vaccines

Try top avoid unhygienic or improperly cooked food from outside eg., Restaurants.

 What happens in diarhea

As your child vomits and passes loose stools they loose excess water from their body. They get dehydrated (less water in the body) when the fluid lost in vomiting and diarrhea are not replaced.The severity of dehydration varies as below

Mild dehydration

Slightly dry mouth, increased thirst and decreased urine output.
Moderate dehydration

Above signs plus

 Irritability and restlessness

 Decreased skin elasticity

 Sunken eyes

Severe dehydration:

Above signs plus reduced consciousness, cool and moist extremities, feeble pulse and low BP. Very often in case of severe dehydration they may contain high/low sodium levels in their blood(Hyper/Hyponatremia) and they may present in kidney failure.


Treatment depends on the clinical condition and the extent of dehydration of the child. Treatment primarily involves correcting dehydration and treating other associated problems.

Replacing the fluid:

For mild or moderate dehydration, oral rehydration salts solution (ORS) can be used to replace the lost fluid and also the ongoing loss. ORS packets are easily available and are very safe to give, as long as it is mixed with water in right proportions. ORS is absorbed in the gut and it replaces the water and electrolytes, which is lost in the stool.Readymade ORS solutions are available in different flavours-Apple , orange.

How much ORS to give?
If there is moderate or severe dehydration start giving ORS and take to the doctor immediately.

  1. Mild dehydration:
  2. <10 kg body wt: 60-120 ml ORS foreach diarrheal stool or vomiting
  3. >10 kg body wt: 120-240ml ORS for each diarrheal stool or vomiting.
  4. Moderate dehydration:50-100ml of ORS/kg body weight -over 3-4 hrs then follow that for mild dehydration.
    3. Severe dehydration:IV fluids till the child regain consciousness and the circulation improves.It is important to recognise and treat other associated complications

In addition to replacing fluid other measures involve

  • Nutritious food: Continue breastfeeding or resume age appropriate food after replacing the lost fluid.
  • Zinc Supplements:Giving Zinc supplements have shown to reduce the duration of diarrheal episodes and volume of the stool.
  • Probiotics:These are healthy bacteria that might help competitively replace the bad once in the gut. They help to reduce the duration of diarrhea.
  • There is not of much use in giving antibiotics except in specific circumstances.

Children with prolonged diarhea might have secondary lactose intolerance and your doctor may recommend lactose free milk for a few days.

Author: Dr. S. Boopathi