Gastroenteritis in children

Gastroenteritis - inflammation of the mucosa, which, starting with the stomach, descends into the small intestine. The causes of pathology are different, but in terms of the frequency of spread among the child population, acute infectious gastroenteritis is second only to respiratory diseases and influenza.

Timely treatment of gastroenteritis in children is carried out purposefully against the pathogen of infection, requires strict adherence to diet, compensation of enzymatic activity of digestive organs, restoration of water and electrolyte balance, intestinal microflora. Shortcomings in therapy, after a few years, will lead the child to a chronic lesion of the gastrointestinal tract.

What changes occur in the stomach and intestines of the child?

The inflammatory process is accompanied by a lesion of the mucous membrane. In the stomach among the epithelial cells are the secretory glands producing hormone-like substances and hydrochloric acid.

When gastritis under the influence of the damaging factor, they are subjected to dystrophy, stop working. Violation of the regulation of acidity, motility of the pyloric sphincter. Sour contents are thrown into the intestines along with pathogenic microorganisms.

Pancreas and gallbladder in children are not able to quickly adapt to new conditions and dramatically reduce the secretion for the cleavage of nutrients. Dystrophic changes in the intestine occur under the influence of toxic for him untreated in the stomach contents, the products of the decomposition of pathogenic microorganisms, allergic reaction.

Disturbances in the intake of food substances are disrupted, they are removed from the body with diarrhea and vomiting, while water and electrolytes are lost (dehydration process). The organism of young children under 1 year is especially difficult to tolerate dehydration. Quickly reacts to the cardiovascular system, arrhythmias occur, and blood pressure drops.

Types of gastroenteritis

Depending on the cause, gastroenteritis is distinguished:

• alimentary- in young children is caused by non-observance of the feeding regime, early transfer to nutritional mixtures, at the older age - by the use of the child of "adult" food, roasted meat, fats, spicy sauces and spices, carbonated water, overeating;
• infectious- caused by pathogenic viruses, bacteria, parasites, infection often occurs in children's groups (school, kindergarten, summer camp), this variant of gastroenteritis in children causes group outbreaks, one-stage disease, many patients need treatment and prophylaxis at once;
• allergic- is caused by increased sensitivity to certain foods, medicines, chemicals;
• toxic- accompanies the general poisoning of children with poor quality products, animal or vegetable toxins, medicinal products, household detergents and cleaning agents.

Admission of a large number of medications can trigger the development of a pathological process

What pathogenic microorganisms cause infectious gastroenteritis?

Infectious gastroenteritis in children can occur when infected with viruses, bacteria or protozoa. Of the viruses, the most common pathology: rotavirus, adenovirus, astroviral, coronavirus. Rarely cause reovirus and cytomegalovirus. Increasingly causes intestinal manifestations of influenza.

Among the pathogenic bacteria, the danger for the intestine is:

• salmonella;
• shigella;
• pathogenic strain of Escherichia coli;
• staphylococcus aureus;
• clostridia;
• Proteus;
• Campylobacter;
• iersinia.

Bacterial infections are much more severe than viral infections. Shigella (causative agents of dysentery) cause gastroenterocolitis, to the defeat of the stomach and small intestine inflammation of the sigmoid colon is added.

In children, microorganisms from the species of the "simplest" can be found in the intestine: lamblia, cryptosporidia, dysentery amoeba. Cases of defeat by parasites are more rare.

Ways of transmission of infection

In infectious gastroenteritis, most often the child becomes infected through dirty hands, food, contact with contaminated feces of the patient or carrier infection toys, bedding, towels, pots. This path is called fecal-oral.

It is characteristic for infection with protozoa and parasites. Viral infection spreads quickly from a sick person both at home and in a children's institution. For her typical airborne transmission with a cough, sneezing.

In most cases of viral gastroenteritis, the disease begins with signs of respiratory inflammation (runny nose, redness of the throat)

What contributes to infection with intestinal infection?

Children more often than adults are at risk of contracting an infection that causes gastroenteritis. Predisposing factors are:

• functional inferiority of the digestive system, restriction of the production of enzymes, juice;
• a lack of immunoglobulins that provide local protection, infants do not receive the necessary immunity from their mother, while their own is reduced;
• lack of personal hygiene skills, the child tends to touch everything, but to wash hands after playing games, walking, toilet is not used.

How does gastroenteritis manifest in children?

Symptoms of gastroenteritis in children are manifested in foodborne lesions in a few hours or immediately after meals. When infected, the incubation period takes place, which is necessary for the propagation of the pathogen and the manifestation of aggressive properties. At this time the child is already sick, but there are no signs of inflammation of the intestine and stomach yet.

The most characteristic are:

• diarrhea (diarrhea) - a loose stool that looks like a foamy, watery, reminiscent of a "rice broth", color from yellow to greenish brown, the frequency is associated with the degree of damage, the intestine with diarrhea removes undigested food, slags from the life of pathogens, a chair is possible more than ten times per day;
• intestinal pains (colic) - cramping pains of a spastic nature, localized around the navel and in the epigastric region, impermanent, caused by a violation of the innervation of the intestinal wall, small children are unable to accurately show where it hurts;
• nausea and vomiting - with repetitions, the contents are acidic, if there is an admixture of bile, then with bitterness, indicates increased acidity;
• when connected to inflammation of the large intestine (gastroenterocolitis), there are tenesmus - ineffectual painful urge to defecate (typical for dysentery), spittle from mucus with blood veins is allocated from the rectum;
• the temperature rises to high figures when the infection works, it is possible to moderate with alimentary gastroenteritis, a decrease of up to 35 degrees indicates dehydration of the child.

The appearance of bitterness in vomiting indicates the attachment of dyskinesia bile ducts

The manifestations of general intoxication include: weakness, lack of desire to move, headache, insomnia, increased tearfulness, irritability. Signs of gastroenteritis worsen during dehydration of the patient due to loss of fluid and electrolytes with multiple vomiting and diarrhea.

The child becomes pale, the skin loses elasticity, dry. There may be convulsions, a violation of consciousness. The lack of compensation leads to serious consequences for the child's health. Upon examination, the pediatrician discovers a dry tongue with a thick white or yellowish coating. The cardiovascular system reacts with a decrease in blood pressure, tachycardia, arrhythmias.

How to determine the severity?

To determine how best to treat a child, selecting the right drugs, determining the dosage, the doctor needs to determine the severity of the disease. Usually, the frequency of manifestations of the leading symptom of gastroenteritis is calculated for this: if it is diarrhea, then how many times the child had a stool, if vomiting, then a more frequent symptom is taken.

An easy degree is the frequency of the main manifestation up to three times a day. Average - up to 10 times. Heavy - with repetitions more than 10 times. To determine the amount of fluid loss, establish the degree of dehydration by the proportion of the lost weight to the initial body weight: I degree - within 3-5%, II - 5-10%, III - more than 10%.

How is diagnostics performed?

To correctly diagnose, the doctor learns in detail from the parents under what circumstances the child is ill, the order of the symptomatology. Significance is associated with other similar cases of gastroenteritis in children of one group of kindergarten or class, contact of the child with patients in the last week.

In the analysis of the patient's blood, leukocytosis is observed with a shift of the formula to the left for bacterial infection and leukopenia for viral infection. According to biochemical tests, it is possible to judge nonspecific inflammation - the growth of C-reactive protein, the predominance of gamma globulins over alpha globulins.

In severe cases, the growth of enzymes of alkaline phosphatase, aldolase. They indicate the intervention of the pancreas. In general, stool analysis reveals mucus, leukocytes, a lot of fiber, starch, undigested food residues. When the vessels are damaged, red blood cells can be detected.

Bacteriological study of feces allows us to identify a specific causative agent of gastroenteritis, to establish its sensitivity to antibacterial drugs. It takes at least five days to carry out a full-fledged analysis.

Helicobacter pylori infection is diagnosed by urease respiratory test, it is performed simply, children understand how to blow into the tube

Immunoenzymatic analysis does not help much in diagnosis, because antibodies in the blood of a child are formed only by the fifth day of the disease, and treatment is required immediately. The method is useful for resolving the issue of final recovery.

It is impossible to detect and type a virus in a conventional laboratory. This requires special conditions, equipment. The most significant is the method of polymerase chain reaction (PCR). It allows you to accurately detect the presence of the virus genome in the body, even with its insignificant amount in the patient's blood.

How to cure a child with gastroenteritis?

The scheme of therapy of children with gastroenteritis includes the obligatory directions:

• gentle nutrition;
• compensation of fluid and electrolyte losses;
• with bacterial damage, antibiotics;
• normalization of acidity of gastric juice and enzymatic insufficiency;
• restoration of the correct balance of microflora in the intestine;
• support of immunity and general metabolic processes.

If the severity corresponds to the light or medium course, then, in the presence of good conditions, the doctor allows the child to be treated at home. Observation is carried out by visits of a doctor and a nurse. In cases of severe illness, the child is hospitalized in the infectious disease department along with one of the parents.

The first day of illness the patient will starve, it is allowed to drink only boiled water. From the second day, the menu is assigned to the usual age ration. Breasts are allowed to feed on mother's milk. Feedings are recommended to be shortened in duration, but increase in frequency. Artificial animals are more shown during this period of milk-milk mixtures for children.

The older children on the second day can eat chicken broth, porridges cooked on the water. Every day the diet expands, the number of single meals increases. The volume of liquid for drinking is calculated by special formulas for the body weight of the baby, depending on the degree of dehydration.

Antibiotics of cephalosporins and aminoglycosides, antibacterial preparations (Enterofuril, Furazolidon, Polymyxin) are used to counteract pathological bacteria. The need for intramuscular injection or the ability to give a pill depends on the severity of the disease.

If you suspect a viral nature prescribe children Anaferon, Ergoferon, Kagocel, as with the flu

Reception of sorbents helps to remove from the intestines the products of the decomposition of microorganisms, to remove intoxication. For children recommended Smecta, Polysorb MP, Enterosgel. Treatment with pre- and probiotics is necessary to restore the amount of useful microflora and the overall balance. With gastroenteritis apply Bifidumbacterin, Hilak-Forte, Lactobacterin, Bifiform, Lineks.

To support the processes of digestion briefly assign courses of enzyme preparations (Mezim, Creon). During the recovery period, you can not immediately decide to eat a lot of fruits, fatty dairy products, sweets. The need for vitamins is temporarily compensated by vitamin complexes.

Prevention

To prevent gastroenteritis in children, you should eliminate the causes of the disease, depending on adults:

• when caring for a child of younger age, you need to wash your hands with soap more often, especially after changing diapers, visiting your toilet, cleaning the room;
• breastfeeding mother is obliged to regularly wash the breasts before feeding;
• artificial babies need to carefully select the mixture according to age and tolerance, do not enter into food products ahead of time, handle special brushes and boiling water from inside the nipples and feeding bottles;
• toys, to which the child touched, should be washed with soap daily;
• During cooking for children and adults, it is necessary to ensure sufficient thermal processing of meat products, fish, eggs;
• it is recommended to wash fresh vegetables and fruits under the stream of water, places contaminated with earth, wipe with a brush;
• You can not allow a child to eat chips, drink soda water, uncontrollably eat sweets, chocolate;
• medicines and toxic substances should be stored in a place inaccessible to the child;
• it is necessary to stop on time any contact with sick children and adults (with vomiting, diarrhea, fever).

Although gastroenteritis in children is very common, parents can limit the infection of their child with skillful care, patient training in hygiene. When the initial symptoms appear, you should immediately consult a doctor.