'Hello, doctor, both my children have diarrhoea. Is there something going round?'
There are many causes of diarrhoea, some more sinister than others. The majority, like rotavirus, are infective. Dehydration is usually the most common consequence, which, if severe, may cause kidney failure, seizures and even death. While these consequences are rare, it is crucial to bear in mind the status of hydration in this scenario.
As its name suggests, rotavirus is a viral infection. It is the commonest cause of gastroenteritis in young children and it is likely that every child will suffer at least one episode by age five. Data from the Health Protection Agency suggests that approximately 18,000 children are admitted to hospital in England and Wales every year with rotavirus-related diseases. Outbreaks may occur at any time of year, although February to May is particularly high with March tending to be the time it is most prevalent.
It takes about 48 hours for symptoms to emerge after exposure. Rotavirus lives in the gut of humans but may be acquired by breathing in contaminated microscopic water droplets or ingesting the virus.
SYMPTOMS AND COMPLICATIONS
The symptoms of rotavirus infection vary from mild to severe and may include vomiting, diarrhoea and crampy abdominal pain. The presence of bloody diarrhoea is not consistent with rotavirus infection. Children may also suffer fever and general malaise. It takes just under a week for symptoms to resolve.
While unusual, complications from rotavirus may occur. These include dehydration, febrile convulsions and transient lactose intolerance. Dehydration is more likely if the affected child has vomiting as well as diarrhoea or if either one of these is severe. Infants are more susceptible to dehydration than older children. Symptoms and signs of dehydration include irritability, weakness, dry mouth, mottled skin, sunken eyes, cool hands and feet, a fast pulse and breathing rate and a reduction in urine production.
Lactose intolerance occurs when the production of the enzyme lactase is temporarily halted by the inflammation in the gut. As such, the gut cannot break down lactose into its constituent sugars glucose and galactose, which requires adequate levels of the enzyme lactase. Prolonged diarrhoea, abdominal pain and wind may then occur.
The treatment of rotavirus focuses on ensuring those affected do not become dehydrated and adequate hygiene measures are adhered to. Antibiotics do not work against rotavirus and may make the diarrhoea worse. Hydration usually takes the form of adding rehydration salts (available both on prescription and over the counter) to the current feeding regime. The salts, which usually come in a sachet that requires the addition of plain water, replace electrolytes such as sodium, potassium which are lost in the diarrhoea and vomit, and glucose, which aids the absorption of water through the bowel wall.
Breast-fed babies should be continued on breast milk but may need additional hydration drinks (also on prescription and over the counter). Similarly, bottle-fed babies should continue to have their milk and hydration drinks if required. For slightly older children, fluid replacement is far more important than food. However, if they are hungry, bland foods should be encouraged.
If children suffer significant dehydration, they may require hospitalisation for intravenous fluids and monitoring. Temporarily diluting milk will reduce the chances of prolonging the diarrhoea in children with gastroenteritis-induced lactose intolerance, but this should only be done after medical assessment.
A vaccination has been produced against rotavirus but as yet it is not available on the NHS.
Good hygienic practice is essential to minimising the risk of spread:
- Meticulous hand-washing by those affected and those caring for affected individuals are without doubt essential, though hand-washing is difficult to enforce in children.
- Closing the toilet lid before flushing reduces the risk of viral particles landing on toothbrushes or other surfaces.
- Soiled clothes should be washed in a hot wash as soon as practicable.
- Hot soapy water is sufficient to clean surfaces, door handles and so on.
- Toilets, potties and the like should also be cleaned more frequently than otherwise.
- Hand-washing before preparing or eating food is imperative.
- Ensuring children do not return to school or nursery until 48 hours have passed without symptoms will reduce the risk of a serious outbreak.
The messages here are to try to minimise the risk of spreading the virus, ensure the child is well hydrated and, if concerned, always seek medical advice.
Dr Raj Thakkar BSc(Hons) MBBS MRCGP MRCP(UK) is a full-time GP in Buckinghamshire.