Diarrhoea facts

Why it is important?

• Diarrhoea is the second most common cause of death in young children, after pneumonia. About 4 billion cases of diarrhoea are estimated to occur every year among children under 5. It kills more than 1.5 million children under 5 years of age every year, representing 17 per cent of all deaths in children under 5. Children are more likely than adults to die from diarrhoea because they become dehydrated and malnourished more quickly.
• Diarrhoea is caused by germs that are swallowed, especially germs from faeces. This happens most often where there is unsafe disposal of faeces, poor hygiene practices, lack of clean drinking water, or when infants are not breastfed.
• Infants who are exclusively breastfed in their first six months and who receive all their immunizations on time are less likely to get diarrhoea. Children with diarrhoea should be given lots of fluids and foods along with a special solution called oral rehydration salts (ORS) and zinc to help reduce the severity of the illness.
• Families and communities, with support from governments and non-governmental organizations (NGOs), can do much to raise awareness of 1) what causes diarrhoea, 2) why it is important to treat diarrhoea as soon as it starts, and 3) how to prevent the conditions that cause it.
• When everyone works together to reduce diarrhoea, children's right to life, survival, health and development can be better assured.

What every family and community has a right to know ?

1. Diarrhoea kills children by draining liquid from the body, which dehydrates the child. As soon as diarrhoea starts, it is essential to give the child extra fluids along with regular foods and fluids.
2. A child's life is in danger if she or he has several watery stools within an hour or if there is blood in the stool. Immediate help from a trained health worker is needed.
3. Exclusive breastfeeding for the first six months of life and continued breastfeeding after six months can reduce the risks associated with diarrhoea. Immunization against rotavirus (where recommended and available) reduces deaths from diarrhoea caused by this virus. Vitamin A and zinc supplementation can reduce the risk of diarrhoea.
4. A child with diarrhoea needs to continue eating regularly. While recovering, she or he needs to be offered more food than usual to replenish the energy and nourishment lost due to the illness.
5. A child with diarrhoea should receive oral rehydration salts (ORS) solution and a daily zinc supplement for 10–14 days. Diarrhoea medicines are generally ineffective and can be harmful.
6. To prevent diarrhoea, all faeces, including those of infants and young children, should be disposed of in a latrine or toilet or buried.
7. Good hygiene practices and use of safe drinking water protect against diarrhoea. Hands should be thoroughly washed with soap and water or a substitute, such as ash and water, after defecating and after contact with faeces, and before touching or preparing food or feeding children.

Supporting Information

Key messages - Diarrhoea kills children by draining liquid from the body, which dehydrates the child. As soon as diarrhoea starts, it is essential to give the child extra fluids along with regular foods and fluids.

A child has diarrhoea when she or he passes three or more watery stools a day. The more numerous the watery stools, the more dangerous the diarrhoea.

Some people think that drinking liquids makes diarrhoea worse. This is not true. A child with diarrhoea should be given drinks, including breast milk, as often as possible. Drinking lots of liquids helps to replace the fluids lost during diarrhoea.

Recommended drinks for a child with diarrhoea include:

• Breast milk (mothers should breastfeed more often than usual)
• Oral rehydration salts (ORS) mixed with the proper amount of clean water (refer to the box on ORS after Message 5)
• Soups
• Rice water
• Fresh fruit juices
• Coconut water
• Clean water from a safe source. If there is a possibility the water is not clean and safe to drink, it should be purified by boiling, filtering, adding chlorine or disinfecting with sunlight in accordance with information provided by a trained health worker or extension agent.

To avoid dehydration, breastfed children should breastfeed as often as possible. Children who are not breastfeeding should drink the following amounts of liquids every time a watery stool is passed:

• For a child under the age of 2 years: between 1/4 and 1/2 of a large (250-millilitre) cup
• For a child 2 years or older: between 1/2 and 1 whole large (250-millilitre) cup.

Drinks should be given from a clean cup. A feeding bottle should not be used. It is difficult to clean bottles completely, and unclean bottles can contain germs that cause diarrhoea.

If the child vomits, the caregiver should wait 10 minutes and then begin again to give the drink to the child slowly, small sips at a time.

The child should be given extra liquids in addition to regular foods and drinks until the diarrhoea has stopped.

Diarrhoea usually stops after three or four days. If it lasts longer, parents or other caregivers should seek help from a trained health worker.

Key messages - A child's life is in danger if she or he has several watery stools within an hour or if there is blood in the stool. Immediate help from a trained health worker is needed.

Parents should immediately seek help from a trained health worker if the child:

• Passes several watery stools in an hour
• Passes blood in the stool
• Vomits frequently
• Has a fever
• Is extremely thirsty
• Does not want to drink
• Refuses to eat
• Has sunken eyes
• Looks weak or is lethargic
• Has had diarrhoea for several days.

If the child has any of these signs, help from a trained health worker is needed urgently. In the meantime, the child should be given ORS solution and/or other liquids, plus zinc.

If the child passes several watery stools in one hour and vomits, there is cause for alarm – these are possible signs of cholera. Cholera can kill children in a matter of hours. Medical help should be sought immediately and the child should continue to receive ORS solution and zinc.

• Cholera can spread throughout the community quickly through contaminated water or food. Cholera usually occurs in situations where there is poor sanitation and overcrowding.
• There are four steps to take to limit the spread of cholera or diarrhoea:

1. Always wash hands with soap and water or a substitute, such as ash and water, after defecation, after contact with faeces, before touching or preparing food, before eating and before feeding children.
2. Dispose of all faeces, including those of infants and young children, in a latrine or toilet, or bury them. Disinfect the places touched by the faeces.
3. Use safe drinking water.
4. Wash, peel or cook all foods.

Trained health workers and health centres should provide families and communities with clear information on the risks of diarrhoea and cholera and what steps to take when either one occurs.

Key messages - Exclusive breastfeeding for the first six months of life and continued breastfeeding after six months can reduce the risks associated with diarrhoea. Immunization against rotavirus (where recommended and available) reduces deaths from diarrhoea caused by this virus. Vitamin A and zinc supplementation can reduce the risk of diarrhoea.

• Breast milk is the best source of liquid and food for a young child with diarrhoea. It is nutritious and clean and helps fight illness and infections. An infant who is fed only breast milk in her or his first six months of life is less likely to get diarrhoea during this time.
• Breast milk prevents dehydration and malnutrition and helps replace lost fluids. Mothers are sometimes advised to give less breast milk if a child has diarrhoea. This advice is wrong. Mothers should breastfeed more often than usual when the child has diarrhoea. Fathers should support mothers who are breastfeeding by caring for the sick child and other children in the family, and by helping with household tasks.
• Rotavirus causes diarrhoea. Children should be immunized against rotavirus in countries that offer this vaccination.
• Vitamin A supplementation, particularly in areas deficient in vitamin A, is an important measure to reduce the risk of diarrhoea. Foods that contain vitamin A include breast milk, liver, fish, dairy products, orange or yellow fruits and vegetables, and green leafy vegetables.
• Including zinc as part of the treatment for diarrhoea for 10–14 days helps to reduce its severity and duration, and also protects the child from future diarrhoea episodes for up to two months. Children over 6 months of age can take 20 milligrams per day of zinc (tablet or syrup). For children under 6 months, 10 milligrams per day (tablet or syrup) is an appropriate amount.
• The trained health worker should show the mother, father or other caregiver how to give the child a zinc tablet by dissolving it in a small amount of expressed breast milk, ORS or clean water in a small cup or spoon. If the child is too young for a tablet, zinc syrup can be used.

Key messages - A child with diarrhoea needs to continue eating regularly. While recovering, she or he needs to be offered more food than usual to replenish the energy and nourishment lost due to the illness.

• A child with diarrhoea loses weight and can quickly become malnourished. A child with diarrhoea needs all the foods and fluids, including breast milk, she or he can take. Nutritious foods will help the child recover more quickly.
• A child with diarrhoea may not want to eat or may vomit, so feeding can be difficult. Breastfeeding should be more frequent. If the child is 6 months of age or older, parents and other caregivers should encourage the child to eat as often as possible, offering small amounts of soft, mashed foods or foods the child likes. These foods should contain a small amount of salt. Soft foods are easier to eat and contain more fluid than hard foods.
• Recommended foods for a child with diarrhoea are well-mashed mixes of cereals and beans, fish, well-cooked meat, yogurt and fruits. A little oil can be added to cereal and vegetables, about 1 or 2 teaspoons. Foods should be freshly prepared and given to the child five or six times a day.
• After the diarrhoea stops, extra feeding is vital for a full recovery. At this time, the child needs to be given more food than usual, including breast milk, to help replenish the energy and nourishment lost due to the diarrhoea.
• A child is not fully recovered from diarrhoea until she or he is at least the same weight as when the illness began.

Key messages - A child with diarrhoea should receive oral rehydration salts (ORS) solution and a daily zinc supplement for 10–14 days. Diarrhoea medicines are generally ineffective and can be harmful.

Diarrhoea usually cures itself in three to four days with rehydration (drinking a lot of liquids). The real danger is the loss of liquid and nutrients from the child's body, which can cause dehydration and malnutrition.

A child with diarrhoea should never be given any tablets, antibiotics or other medicines unless prescribed by a trained health worker.

The best treatment for diarrhoea is to (1) drink lots of liquids and oral rehydration salts (ORS), properly mixed with clean water from a safe source, and (2) take zinc tablets or syrup for 10–14 days.

Diarrhoea usually stops in three or four days.

If it does not stop, consult a trained health worker.

Key messages - To prevent diarrhoea, all faeces, including those of infants and young children, should be disposed of in a latrine or toilet or buried.

• Children and adults can swallow germs that cause diarrhoea if faeces come in contact with drinking water, food, hands, utensils or food preparation surfaces.
• Flies that settle on faeces and then on food also transmit the germs that cause diarrhoea. To keep away flies and prevent the spread of germs, (1) dispose of faeces safely in a latrine or toilet, (2) keep the latrine or toilet clean, and (3) cover food and drinking water.
• All faeces, even those of infants and young children, carry germs and are dangerous. If children defecate without using the latrine or toilet, their faeces should be cleaned up immediately and disposed of in the latrine or toilet or buried. Afterwards, hands should always be washed with soap and water. If soap is not available, ash and water can be used as a substitute. Men and boys can help women and girls in disposing of the faeces.
• If there is no toilet or latrine, adults and children should defecate away from houses, paths, water supplies and places where children play. Faeces should then be buried under a layer of soil. Human and animal faeces should be kept away from water sources.
• In communities without toilets or latrines, the community should consider joining together to build such facilities. Households can be encouraged to build their own.

Key messages - Good hygiene practices and use of safe drinking water protect against diarrhoea. Hands should be thoroughly washed with soap and water or a substitute, such as ash and water, after defecating and after contact with faeces, and before touching or preparing food or feeding children.

Hands should always be washed with soap and water or a substitute, such as ash and water, after defecating, after helping children use the toilet or latrine, after cleaning the baby's bottom, after disposing of refuse, and immediately before feeding children, handling food or eating.

Young children frequently put their hands in their mouths. So it is important to keep the household area clean and to teach children to wash their hands properly and frequently, especially after defecating and before eating.

Using safe drinking water and keeping it clean and free of germs helps to reduce diarrhoea.

Other hygiene measures that can help to prevent diarrhoea include:

• Peel fruit and vegetables or wash them thoroughly with clean water, especially if young children eat them raw
• Prepare and thoroughly cook food just before eating (Food left standing can collect germs that can cause diarrhoea. After two hours, cooked foods are not safe unless they are kept very hot or very cold.)
• Bury burn or safely dispose of all food refuse to stop flies from spreading disease.

Source: UNICEF