Dear Doctor,

For a week now, my two-year-old has had a running stomach. She feeds well and I try to give her fruits after each meal. I don’t fry her food. Everything is boiled and with little to no salt.  I don’t know what is causing this. It is watery and seems to come more frequently than normal. What can I do to stop it?

Esther

Dear Esther,

The most common cause for recurrent running stomach in a child is infection of the gut. Toddlers are more susceptible to such infections than older children, due to multiple causes.  Unless parents are vigilant, a small child does not know how to handle food and hand hygiene. Eating with dirty hands, putting contaminated objects in the mouth, playing with one another with dirty hands, drinking dirty, contaminated water  using contaminated plates for eating or glasses for drinking,  are some of the causes of intestinal infections. Any surface or object touched by one having germs on his hands, can help in spread of infection to another person. Moreover, children of this age do not have sufficiently developed immune systems to fight off infections or contain them in the body.

Viral infections are the most frequent cause of gut infections in children. Rota virus and adenovirus are most commonly implicated. Bacteria like salmonella, campylobacter, Escerichia coli, etcetera, can enter body through contaminated food or water and cause diarrhoea, with or without vomiting in children. Protozoal infections like amoeba or giardiasis, worm infestations like ascaris, are also implicated in causing diarrhoea and vomiting in children.

Due to gut infection, a child can have liquid or semiliquid diarrhoea, vomiting, abdominal cramps, one or more of these symptoms. Fever can occur in case of bacterial infections. The severity of infection depends on the amount of microbes ingested and state of immune system of the child. It can range from mild diarrhoea to severe diarrhoea needing hospitalisation. Nothing needs to be done in cases of mild diarrhoea. It subsides by itself, more so in case of viral infections. Oral rehydration solutions help in correction of mild dehydration. However, in case of severe dehydration, a child would need intravenous fluids, which would be possible in a hospital setting. Signs of severe dehydration in a child are, irritability, crying with few tears, dry mouth and tongue, passing scanty urine. Presence of any one or more of these signs requires the child to be taken to a hospital. Persistent vomiting, severe diarrhoea, high fever 40 degrees or more, are yet other indicators for urgent medical treatment.

Prevention consists of improving the personal and food hygiene of a small child.

A child can also have a running stomach due to food allergy. Try removing one food item from his diet and reading after two to three days. This can help to identify the causative allergy causing substance. Most commonly implicated are milk products and protein containing products like nuts and eggs.

Antibiotics used for some other sickness can cause diarrhoea as adverse effect.

Dr Rachna is a specialist in internal medicine  at Ruhengeri Hospital

rachna212002@yahoo.co.uk