There is no freedom of choice for humans,
if it has been taken away from them at the beginning.
Breast-feeding is not a choice,
but an obligation to the choice.
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Wednesday, July 26, 2006

aduhaiii...toddler diarrhea.

Gundah gulana....Sekarang stok EBM Alhamdulillah tgh bnyk ada about 30 X 4oz i guess...Ini membuatkan hati ini gundah gulana...takut power tripping lagi....dah fobia ngan peristiwa lalu...kalau nak keluar rumah asyik check pintu freezer aja rapat ke tak..balik terus gi buka freezer tgk ebm ok ke tak..adeiii..ponatlah kalau gini ada susu bnyk pun susah hati tak bnyk lg susah baby sekarang ni kena toddler diarrhea.

Toddler diarrhea is a common pediatric condition. In infants it is referred to as chronic diarrhea of infancy and in older children as irritable bowel syndrome. Common clinical characteristics include:

Age between 6-30 months. Most are better by 4 years of age
2-6 watery stools per day. There can be periods of days without stools. Many stools contain undigested material and may drip down the child's leg from the diaper.
Normal weight, height, and head circumference growth curves without falling off
No evidence of infection
Stools are hematest negative
The child looks well and there is no evidence of malnutrition and no history of abdominal pain
Growth may be compromised if the diet manipulations that have been tried to control the diarrhea have not been enough calories.
There is often a history of colic, gastroesophogeal reflux, and family history of irritable bowel syndrome.

Differential Diagnosis
Malabsorption secondary to pancreatic insufficiency or intestinal mucosal injury
Children are frequently irritable and have loss of appetite
Stools are foul smelling and greasy
Poor weight gain and abdominal distention.
The child is often weak and displays decreased activity.
Anemia, hypoproteinemia, vitamin deficiencies.
Allergies to Food
Vomiting, diarrhea, and blood in stool
+ family history of atopy
Failure to gain and grow
History of eczema, reactive airway disease, urticaria, and allergic rhinitis
Loss of protein in the gut may lead to hypoproteinemia and edema
Lactose Intolerance
Genetic lactase deficiency is rare in young children and will manifest later on in life
Secondary lactase deficiency following gastroenteritis is usually transient and is improvedwithin 2 weeks
Giardia Infection
Foul smelling watery stools
Gassy and abdominal distention
Can develop into chronic condition and diagnosed by inspecting stool or duodenal fluid for cysts.
Usually waterborne but can be from person to person transmission
Watery, foul smelling stools that may be mucousy.
Crampy abdominal pain
+ oocysts in stool specimen
Waterborne or animal or person to person transmission.
Increased colonic transit time and decreased inhibition of post-prandial transit time
Decreased fat in diet because of diarrhea that is needed to decrease transit time
Fluid load is increased because of fear of dehydration and this aggravates the condition
Increase sugar in diet that acts as an osmotic diuretic and causes more water in the gut.
Increase fat in the diet
Decrease fluid in the diet
Avoid fructose and sorbitol- decrease fruit juices
Increase dietary fiber
Normal diet for age
Reassurance- this is difficult because parents have been to many physicians and are convinced that their child has a serious illness. It is important after making your recommendations to follow-up soon to reassure again and watch weight and height gains.
There is no role for medications.
The parents should be told that there is no serious sequelae and this is not a precursor to inflammatory bowel disease, chronic diarrhea as adults, or cancer
Most children are better by 4 years of age, and are better by the time they become potty trained.

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