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Suggest treatment for viral diarrhea in children

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Posted on Wed, 11 May 2016
Question: My daughter is 16 months old. Her weight is 11 kgs. She refuses to eat solid foods and is very irritable if she is given any solid food. However, she always wants to feed on breast milk. She had viral gastritis in December 2015 and the paediatrician gave her Esmoac 10 granules and Syrup Rinifall Z. She improved in 3-4 days. Now she again had vomitting since 25th January 2016 after which the paediatrician again diagnosed it as Viral Gastritis. She is again taking the same medicines. Although vomitting has stopped, loose motions continue. She had a very foul smelling greasy whitish motion on 26th XXXXXXX and after that it has been semi watery yellow motion till today. Her refusal to eat at all is becoming a great concern for me. At times she refuses to drink water also. Am worried if it is only gastritis or something more serious. To add to this, she has a lot of stranger anxiety too and cries a lot on seeing anyone new. It is even difficult to take her to a doctor and she keeps on crying continuously.
doctor
Answered by Dr. Sumanth Amperayani (38 minutes later)
Brief Answer:
Looks like viral diarrhea - don't worry - food refusal is common in this age

Detailed Answer:
Hi....It seems your kid is having viral diarrhoea. Once it starts it will take 5-7 days to completely get better.

Unless the kid's having low urine output or very dull or excessively sleepy or blood in motion or green bilious vomiting...you need not worry.

I suggest you use zinc supplements (Z&D drops 1ml once daily for 14 days) & ORS (Each small packet mixed in 200ml of potable water and keep giving sip by sip) as hydration is very important and crucial part of treatment. If there is vomiting you can use Syrup Ondansetron (as prescribed by your paediatrician).

Regarding diet - You can use cerelac...any flavour will do. Avoid fruit juices as they might aggravate diarrhea. You can give zinc supplements & ORS apart from normal vegetarian porridges & soups.

Avoidance of solid food is quite common in this age group. Even the nausea and diarrhea will worsen the same.

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health.
Dr. Sumanth MBBS., DCH., DNB (Paed).,
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sumanth Amperayani (34 minutes later)
Thank you doctor. This was reassuring. My worry is how she will get her nutritional requirements without solid foods. Will her development not be affected if she does not eat solids normally. She also refuses milk completely and wants to breastfeed only.

I am also worried about her stranger anxiety. How do we reduce her fear of strangers? My wife does not work and is with my daughter at all times. We do take her out to play but she seems to enjoy alone and does not get alongwith other children much.
doctor
Answered by Dr. Sumanth Amperayani (4 hours later)
Brief Answer:
Addressed concerns on solid feeds/ stranger anxiety

Detailed Answer:
Hi....I take this opportunity to tell you certain scientific facts and relieve your distress -

1. An active is a well kid even if she/ he is not eating well.

2. Development of a kid is as important as or I would say even more important than growth alone.

3. As the kids grow their interest in food decreases and interest in play activities increases so that they eat small quantity and run away to play. As parents we need to be more patient and feed than less quantity but more aliquots per day.

4. This age rather than the quantity of the food I suggest you concentrate more on the number of times you feed her and also make whatever you feed her calorie dense by adding good amount of ghee to it.

5. I suggest you not to use appetite stimulants on long run as they may cause drowsiness

Regarding stranger anxiety - even this behaviour is normal at this age group. But I appreciate that you are taking her out and trying to mingle with other kids.

But in my experience I have seen many kids like this getting on very well after they go to the play school. Meanwhile what you can do is trying to bring some friend's kids to your home and asking her to mingle with or making her mingle with the other kids like sharing of toys or sharing the play etc.

Stranger anxiety needs to be medically addressed only if the the kid is showing extreme signs like vomiting or panic reaction. Otherwise this might settle by itself.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Sumanth Amperayani (15 hours later)
Thank you doctor. Am waiting patiently for her viral gastritis to subside. Yesterday she vomited twice and had loose watery motions 3 times. Am continuing with the the medicines given by the paediatrician (prescription attached). Just praying it settles down in 2-3 days as it is almost 4 days that she is suffering. On the diet part, she has been having a lot of gas even at normal times which makes her very uncomfortable. I wonder if it is due to some food item as we give her rice, dal, vegetables, ragi and fruit juice (orange) and sometimes add apple to her food. She takes water through spoon and we are trying to get her used to drink from a small glass. The gas at times bloats her stomach and she appears uncomfortable. Even before this episode of viral gastritis, she had lot of gas towards the evening and her tummy was bloated. Kindly advise.
doctor
Answered by Dr. Sumanth Amperayani (1 hour later)
Brief Answer:
Its recovering viral diarrhea - don't worry

Detailed Answer:
Hi...It is recovering viral diarrhea - do not worry. Once it starts it will take 5-7 days to completely get better.

It will settle in a couple of days.

Regarding gaseous distension of abdomen - This happens when the baby sucks at the breast or drinks or eats very fast and in eagerness to drink milk will gulp in air too.

Unless the air comes out like burping or flatus this discomfort will be there and next time check if the baby is sucking too fast and gulping in air too. You will be more convinced. Usually I don't advice any medicines for this as they give only temporary relief.

The two best ways to relieve this distress is -

1. Do not put the baby in lying position after feeding till the baby burps out the swallowed air.

2. If still crying - put the baby in prone position and keep patting the back gently so that the baby passes off the flatus and gets relieved.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumanth Amperayani (1 hour later)
Thank you Doctor. She is eating and drinking in very small quantities as of now. Hence am just keeping my patience and awaiting full recovery. Hope she will not require any emergency hospitalization.
doctor
Answered by Dr. Sumanth Amperayani (8 hours later)
Brief Answer:
Hospitalization is required only if there's dehydration

Detailed Answer:
Hi....hospitalization is required only if there is dehydration. I feel she's on recovery path. so do not worry.

Dehydration signs include -

1. Sunken eyes
2. Dry tongue
3. Loss of skin turgor
4. Decreased urine output
5. Abdominal distension
6. Lethargy and loss of consciousness.
Hi...please do not give any laxative as she's recovering from viral diarrhea.

It is quite common to pass hard stools after recovering from diarrhea.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumanth Amperayani (4 days later)
Dear Dr., My daughter finally recovered from the viral gastritis last Saturday after 5 days. She is stable now and the only medication that she is taking now is Z&D Drops which was prescribed for 14 days.
The problem she is now having since last 2 days is constipation and hard stool. In fact on Monday & Tuesday, she has not had any proper bowel movements. With lot of difficulty, very little faecal matter came out.
Last time when she had such a problem, the doctor had given her Syrup Nulax. Am not sure whether I should give her the same again as she has just recovered from gastritis.
Thank you doctor. Any home remedy to soften her stools. Am worried if she is goes into constipation and hard stools which become painful later.
doctor
Answered by Dr. Sumanth Amperayani (43 minutes later)
Brief Answer:
Natural methods to avoid constipation

Detailed Answer:
Hi....
1. Papaya twice a day
2. Water 750-1000 ml per day
3. Milk maximum 300-400ml per day
4. If possible toilet training

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Deepak
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Follow up: Dr. Sumanth Amperayani (31 hours later)
Thank you. Very frequently I see my baby touching her vaginal area and making grunting sounds. Could it be due to some urinary tract infection or any other reason?
Her other issues of constipation have settled down now.
doctor
Answered by Dr. Sumanth Amperayani (10 minutes later)
Brief Answer:
It could be worm infestation

Detailed Answer:
Hi....it could be worm infestation. I suggest you use Albendazole.

I suggest you use Albendazole Suspension 200mg/5ml strength .... 5ml today and another 5ml after 10 days.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumanth Amperayani (16 hours later)
Thanks. Is the de worming medication necessary for children once a year or more frequently? Till what age?
doctor
Answered by Dr. Sumanth Amperayani (11 minutes later)
Brief Answer:
It's always symptomatic - no definite time period

Detailed Answer:
Hi...there is no specific time period or gap defined. Old thinking was that deworming has to be done every 6 months once. But now it is not so. We recommend deworming now only if there are symptoms.

Deworming can be done at any age if symptoms are there. Only thing is if decided to treat we need to treat all kids in the household.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sumanth Amperayani (22 hours later)
Dear Dr.,
My daughter is having almost no motion since the last 2 days. She has recovered from viral gastritis before 7 days. As advised by you, we are giving her papaya twice a day, adequate water and she also sits properly for passing motion. But whenever she has the urge to pass motion, only a small dark pellet falls. It is like a small ball like only. Please advise.
doctor
Answered by Dr. Sumanth Amperayani (6 hours later)
Brief Answer:
When she's recovering from diarrhea you can even wait 7 days

Detailed Answer:
Hi...at this age and especially when the kid is recovering from diarrhea we can even wait 7 deys before everything settles again.

I want you to understand that starting a medicine for softening the stools is easy...but if it becomes diarrhea again.... it will be again a suffering for the kid.

If she's eating appropriately and voiding well urine and active otherwise I suggest you wait for 3- 4 days more and continue the natural remedies I suggested please.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (11 hours later)
Thank you Dr. Is it ok to giver her orange juice and apple?
doctor
Answered by Dr. Sumanth Amperayani (5 minutes later)
Brief Answer:
You can give orange juice and Apple

Detailed Answer:
Hi....you can give orange juice and Apple. No problem.
Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (2 days later)
Thank you. As advised, I have given her 5 ml of Albendazole today. It was Syrup Zentel which came in a 10 ml bottle containing 400 mg. Do I need to give the remaining 5 ml dose after 10 days, as the bottle mentions Single Dose Pack
doctor
Answered by Dr. Sumanth Amperayani (3 hours later)
Brief Answer:
Yes...please give another 5ml after 10 days

Detailed Answer:
Hi....yes... I suggest you give another 5ml after 10 days.

The mention of single dose pack is fur kids above 3 years where 10ml is given after 10 days.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Sumanth Amperayani (3 hours later)
Thanks. Now she is taking calshine drops on a daily basis 0.5 ml. Does she need any other supplements or vitamins to be given? Anything in terms of iron drops?
doctor
Answered by Dr. Sumanth Amperayani (14 minutes later)
Brief Answer:
Please continue calshine in same dose

Detailed Answer:
Hi... you can continue calshine drops in the same dose which you are giving right now.

But regarding iron supplementation I cannot comment unless I see the kid directly or if possible let me know the recent hemoglobin of the kid if you have done any test recently. If it is low then I will suggest the appropriate iron supplementation.

When you get back to me kindly mention the weight of the kid also so that I can suggest appropriate formulation.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumanth Amperayani (12 days later)
My 17 month old daughter is since the last 2 days wanting to breastfeed continuously. At night in her sleep she wants to keep on sucking and even in the day time, when she is awake she just wants to breastfeed. Is not willing to eat solids voluntarily and has become fussy. Could it be due to teething or is it sign of some impending illness. Am just afraid as she has recovered from viral gastritis a month earlier. She was very much ok 3- 4 days earlier, but suddenly has become cranky and wanting to breastfeed only. Please advise.
doctor
Answered by Dr. Sumanth Amperayani (7 hours later)
Brief Answer:
This is a normal reaction - not a sign of impending illness

Detailed Answer:
Hi.... this is a normal phenomenon...nothing to worry about like this is a sign of impending illness. Please do not worry about it. This is called non nutritive sucking.

Some kids do this when they feel to be attached to the mother.

It might be due to teething also. But you need not give any medicines for this. Your daughter will settling down by herself.

Only thing is that... this continue breast feeding will be uncomfortable for the mother.

Regards - Dr. Sumanth


Above answer was peer-reviewed by : Dr. Deepak
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Follow up: Dr. Sumanth Amperayani (4 hours later)
Thank you doctor. Please help with the following queries:
1. What would be the right stage to start weaning? Do we need to initiate or let it happen naturally?
2. She does not want to drink milk or water from a bottle and chews the nipple only. She prefers to drink from a spoon. Should we train her to drink from a bottle to reduce dependence on breastfeeding?
3. Does breastfeeding beyond a certain age / limit have any adverse effect? Will she be actually getting any nutrition from breastfeeds beyond a certain age / limit?
doctor
Answered by Dr. Sumanth Amperayani (8 hours later)
Brief Answer:
Queries answered

Detailed Answer:
Hi... coming to your queries directly

1. Weaning should have been started at 6 months itself. Let it happen naturally.

2. Actually bottle feeding is not good. The best thing will be to give feeds by spoon or paladey or tumbler.

3. Breast feeding is not good beyond 2 years of age. There will not be any good nutrition by feeding by breast beyond 2 years of age.

If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. In this way even in health care magic you can follow up always with a single doctor who knows the history of your kid completely. Please find the link below -
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696


Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Sonia Raina
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Follow up: Dr. Sumanth Amperayani (50 minutes later)
Thank you Dr. What would be the best process of weaning so that the child and mother is not distressed. Any proactive steps that can be taken to facilitate weaning.
Also my daughter does not drink outside milk as it sometimes causes constipation. Can cow milk be started later at 3 or 4 years age. Will she have calcium deficiency if we do not give now? We give her ragi and barley almost daily as I have heard ragi has good calcium content.
doctor
Answered by Dr. Sumanth Amperayani (15 minutes later)
Brief Answer:
Suggestions on weaning

Detailed Answer:
Hi...these are my suggestions on weaning.

1. One of the proactive steps you can take is - using Femite lotion at the nipples. It will be bitter in taste and so the kid will gradually dislike breast feeding. But I do not advise it as it has got failure rate too. So what is suggest is to gradually reduce the breast feeding and still you have got time till 2 years of her age to do this.

2. Cow's milk can be started after 1 year of age itself if there is no cow's milk protein allergy.

3. You are right - Ragi is a good source of calcium. It will suffice and supplement for lack of cow's milk. so do not worry if your daughter is not accepting cow's milk.

4. Milk consumption more than 400ml per day is a risk factor for constipation.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sumanth Amperayani (8 days later)
Dear Dr., My daughter has not had motions since the last 2 days (today being the 3rd day). She has been having normal food and water.But whenever she has the urge to pass motion, she grunts and tries but only a small little ball of faeces comes out. This happens almost 7 to 8 times a day. Am worried if she is constipated and how I can help? Was forced to give her Syrup Nulax to enable her to pass motion but it has not helped yet. Tomorrow would be the 4th day. Please advise how this can be resolved so that she passes motion and able to get relief.
doctor
Answered by Dr. Sumanth Amperayani (55 minutes later)
Brief Answer:
I have a few questions for you

Detailed Answer:
Hi.. .I have certain questions for you.

Questions:
1. Did your kid pass motion or meconium on day one of life?
2. Since how long is the kid constipated.. I mean has it been a long standing issue before diarrhea?
3. Does the kid have any bleeding along with hard stools?
4. How much milk does the kid consume per day?
5. Does the kid eat fruits and vegetables (fibre diet) appropriately?
6. How much water does she consume pee day on an average?

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Follow up: Dr. Sumanth Amperayani (27 minutes later)
Yes she had passed meconium on first day. Yes it has been an issue even before diarrhoea. She had bleeding once before but it was an external cut. She consumes about 150 ml of milk per day. Yes we give her all types of vegetables. She has apple mixed with dal rice for lunch and orange juice also after lunch. She also has beans, raw banana, papaya etc for lunch. She drinks about 1.25 litres of water per day.
doctor
Answered by Dr. Sumanth Amperayani (11 hours later)
Brief Answer:
Suggestions on constpation

Detailed Answer:
Hi...Suggestions:
1. Natural methods are the best to relieve constipation.
2. Constipation is a risk factor for UTI
3. Maximum milk consumption per day should not exceed 300-400ml
4. Minimum 3-4 cups of fruits and vegetables to be consumed per day
5. Toilet training - that is - sitting in XXXXXXX type of lavatory daily at the same time will help a lot.

You can use laxative which you are currently using at the dose of 10ml twice a day for 6-8 weeks. This is just to soften the stool and take off the fear factor form the kid. Toilet training comprises of 70% of the management strategy.

Regards - Dr. Sumanth MBBS., DCH., DNB (Paed).,
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Sumanth Amperayani (3 hours later)
Thanks. Hope 10 ml of laxative won't cause any complications.what would be the symptoms of UTI? Am giving her a cup of orange juice daily. Fruits and veggies are mashed in her food. Please advise.
doctor
Answered by Dr. Sumanth Amperayani (4 hours later)
Brief Answer:
Queries answered

Detailed Answer:
Hi...

1. At the most laxative can cause diarrhea. If she passes more than 10 times per day then stop the laxative.

2. Urinary infection symptoms include - high grade Fever, vomiting, pain in tummy, pain or burning sensation while passing urine.

3. Rather than juice which doesn't contain fibre, it is better to give fruit itself as fibre content will go in.

4. Mashed fruits and veggies are excellent fiber.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Deepak
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Follow up: Dr. Sumanth Amperayani (26 minutes later)
Thanks. Can we give sprouts to help ease constipation. Does it add protein content? I understand that toilet training will help in long run. But any foods I should permanently avoid for constipation for the baby?
doctor
Answered by Dr. Sumanth Amperayani (3 hours later)
Brief Answer:
Diet for constipation

Detailed Answer:
Hi....

1. Sprouts will add to protein content of food and also is good for constipation.

2. Just avoid excess milk intake.

Regards - Dr. Sumanth
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sumanth Amperayani

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Suggest treatment for viral diarrhea in children

Brief Answer: Looks like viral diarrhea - don't worry - food refusal is common in this age Detailed Answer: Hi....It seems your kid is having viral diarrhoea. Once it starts it will take 5-7 days to completely get better. Unless the kid's having low urine output or very dull or excessively sleepy or blood in motion or green bilious vomiting...you need not worry. I suggest you use zinc supplements (Z&D drops 1ml once daily for 14 days) & ORS (Each small packet mixed in 200ml of potable water and keep giving sip by sip) as hydration is very important and crucial part of treatment. If there is vomiting you can use Syrup Ondansetron (as prescribed by your paediatrician). Regarding diet - You can use cerelac...any flavour will do. Avoid fruit juices as they might aggravate diarrhea. You can give zinc supplements & ORS apart from normal vegetarian porridges & soups. Avoidance of solid food is quite common in this age group. Even the nausea and diarrhea will worsen the same. Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. If you do not have any clarifications, you can close the discussion and rate the answer. Wish your kid good health. Dr. Sumanth MBBS., DCH., DNB (Paed).,