DIARRHEA-VOMITING IN CHILDREN
PROLIV I POVRAĆANJE KOD DJECE
Vomiting is the expulsion of stomach contents and is usually preceded by nausea. Vomiting usually starts suddenly and stops after 24 to 48 hours. Other signs of acute intestinal virus include nausea, diarrhea, fever, and abdominal pain. Vomiting in children is a very important and delicate sign, especially in the period of newborns, infants and young children. It can be an isolated sign, and it can be associated with diarrhea, when it leads to faster loss of fluid-dehydration, which can endanger small children, regardless of the cause of vomiting and diarrhea. It is important to note that water circulation in infants and young children is very intense. Infants renew 15-20% of their body water per day, which if compared to an adult of 80 kg, is approximately when an adult would ingest about 10 liters of fluid per day. This is a good illustration of how important it is for an infant and young child to maintain fluid level stability. The return of food immediately after a so-called meal should be distinguished from vomiting. "Spitting". Vomiting is most common in healthy, strong, voracious infants in the first months of life, who are progressing well. When vomiting occurs immediately after a meal, only a small portion of undigested food is vomited, usually with a loud burp.
Da bismo pravilno procijenili ozbiljnost povraćanja bitno je dobiti pouzdane podatke na sljedeća pitanja:
-da li dijete povraća odmah poslije obroka ili kasnije?
-koliko puta u toku dana povraća?
– koliko je povraćena masa obilna?
-Da li je povraćanje praćeno naporom ili je „bez muke“?
-Kakva je boja povraćenog sadržaja, da li je zgrušana i sl.?-Kakav je apetit djeteta , kako napreduje i kakvog je opšteg stanja?
Ukoliko je povraćanje praćeno gubitkom u tjelesnoj tezini, ako ima krvi u povraćenom sadržaju, ako je povraćena masa neugodnog mirisa, ako je povraćanje u mlazu, ako je praćeno kašljem i promjenom boje kože tj. da dijete pomodri prilikom povraćanja, takvo dijete mora biti shvaćeno kao ozbiljan bolesniki mora se uputiti u bolnicu.
Povraćanje kod dojenčeta i malog djeteta mogu izazvati brojne akutne infekcije organa za varenje, izazvanih bakterijama ili virusima( rotavirus, norovirus i adenovirus), ali mogu biti i posljedica trovanja hranom ili neprilagođene ishrane.Kod infektivnih uzroka , najčešće je povraćanje udruženo sa prolivom , pa je zbog te udruženosti i potencijalno opasnije i brze se razvija dehidracija.
Najtipičnije oboljenje infektivne prirode koje je praćeno povraćanjemi prolivom je rotavirusni infektivni gastroenteritis. Povraćanje obično prethodi profuznom prolivu i pogađa najčešće uzrast od 6 mjeseci do 2 godine.Najčešce su to kratkotrajni simptomi virusne infekcije i većina djece se spontano i brzo oporavi.
Diarrhea is more frequent bowel movements (more than 3 times a day) with large amounts of liquid stool accompanied by fever or vomiting, or without fever or vomiting. Children normally eliminate about 5 - 10 g / kg per day of stool under the age of 5, and an increase over 10 g / kg is referred to as Diarrhea. The main culprits are viruses, bacteria, antibiotic treatment, allergies, and less often they are parasitic infections or other. In order to properly approach the treatment of diarrhea, given the great variety of causes, it is very practical to divide it into acute and chronic diarrhea. Acute diarrhea usually lasts up to 7 days and is most often caused by viral agents.
What to do in case of diarrhea and / or vomiting
-Osnova njege kod djece sa akutnim prolivom/i povracanjem je nadoknada tečnosti ( sa odgovarajućim udiom elektrolita i glukoze) radi sprečavanja dehidracije, a prvog dana pošteda unosa hrane. Najvaznije je da prepoznate ukoliko je vase dijete dehidrirano. Dehidracija može biti : blaga ( gubitak 1- 2 % ukupne tjelesne tekućine), umjerena ( gubitak 5%) i teška ( gubitak 10 % tekućine). Znakovi blage dehidracije su suhe usnice i žeđ. U umjerenoj do teškoj dehidraciji prisutni su podočnjaci, suh i obložen jezik, oskudno mokrenje( pelena je suha ili je mokraca gusta i intenzivne žute boje) , manjak suza kod plača, ubrzan puls, pospanost. Neliječena teska dehidracija, iako se viđa rijetko , moze dovesti do šoka , zatajenja bubrega i letalnog ishoda.
Cilj je dati što više tečnosti, ali ako je prisutno povraćanje, tečnost se mora davati sporije.Ako nakon unosa tekučine dijete povrati , potrebno je napraviti pauzu od 20 do 30 minuta i potom nasaviti sa postepenim unosom tekucine. Obustavlja se peoralni unos hrane, ako je u pitanju malo dijete koje doji , obavezno nastavite dojenje.
Savjetuje se nadoknađivanje tečnosti pomoću oralnih rehidracijskih otopina ( ORS). Oralne rehidrac.otopine posebno su pripremljeni prašci koji su dostupni u apotekama te sadrže odgovarajući udio elektrolita i glukoze( Rehidromix,Nelit, Hipp ors…). 1 kesicu rastvoriti u odgovarajućem omjeru vode i davati prvih 4 sata brže do 30-50 ml na kg težine djeteta (ukoliko dijete povraća davati kašičicom na svakih 5 minuta da se ne ponovi povraćanje. ). Izbjegavati treba vrlo slatka pića-voćne sokove , energetske napitke ili Coca Colu.
Tab.1 prikaz potrebnog unosa tekućine kod blage dehidracije:
After the initial fluid replacement, you can breastfeed or feed your baby. The first two days of diarrhea are advised a lighter diet that includes soups, banana, baked apple, rice with carrots cooked in soup, pieces of boiled potatoes, bread. The child is given smaller and more frequent meals, approximately every two hours, between which it is mandatory to replace the fluid with oral rehydration solution.
If the child tolerates everything well, introduce a normal diet after 3 days.
If diarrhea is a prolonged course, introduce Soy formula (AMF-lactose-free) to younger children for 2-3 weeks. Do not give cow's milk to children over 1 year of age for several days.
In acute diarrhea, it is recommended to take proven effective probiotic cultures that reduce the duration and intensity of symptoms and lead to stabilization of the physiological intestinal flora (Prolife, Waya gtt, Bulardi junior caps). There are combinations of ORS solutions and probiotics on the market (Diarino ORS, Normia ORS). Medications that soothe nausea and vomiting in children are not recommended!
When to see a doctor:
-If it is an infant up to 3 months of age, it is obligatory to contact the competent pediatrician
-if the child suffers from a severe underlying disease (diabetes, autoimmune diseases, etc.)
-in case of constant vomiting
-in the case of frequent profuse diarrhea (more than 8 times a day),
-appearance of severe abdominal pain
-appearance of signs of moderate and severe dehydration (dry mouth and tongue, eye inflammation, little urine or lack of urine, crying with few or no tears, eye inflammation, dizziness, loss of consciousness, severe drowsiness, weight loss).
-in case of black stools ("like tar") - is a sign of bleeding in the digestive system and requires urgent medical examination
Dr.Aida Mehić-Ahmic
Specialist pediatrician