Childhood diarrhea: what should you pay attention to?

“The diarrhea In early childhood they are among the 5 most frequent reasons for emergency consultation, and – depending on the time of year – they can even be the main reason for visiting the pediatrician; In fact, 1 in 5 children with diarrhea usually present with moderate or severe symptoms, which require a special approach. All this implies more visits to the guard, absenteeism from work for the parents and school absences for the child, altering the routine of the entire family,” said the Dr. Mabel Carosellapediatrician, Director Physician of the Belgrano R Pediatric Group.

Childhood diarrhea: what to take into account

He also added: “But diarrhea, worldwide, in developing countries is the second cause of hospitalization, dehydration and death, with a very high burden of disease.

Yesand it is well estimated that 8 out of 10 diarrheas have a viral origin, whatever the causewhich triggers It is an inflammatory intestinal process that manifests clinically with diarrhea, producing what we call ‘clinical intolerance’ to lactose.

“Young children with acute diarrhea are temporarily unable to digest lactose, the most common type of sugar in milk and other dairy products. The inability to digest and absorb lactose can make the diarrhea worse and last longer. Therefore, in cases that do not receive breast milk, lactose-reduced or lactose-free milk is recommended, depending on the clinical picture, to benefit the evolution and shorten the process, avoiding complications related to the osmotic effect of lactose due to secondary intolerance,” he stated. the Dr. Silvina Balbarreypediatrician and gastroenterologist.

The different types of diarrhea in children

Within the different types of diarrhea in young children, there are acute ones, which usually last between 7 and 10 days and are self-limiting. In these cases, the primary recommendation is always breastfeeding, but for those cases in which – for different reasons – the child is no longer breastfeeding, treatment includes changes in diet and lactose-free or lactose-reduced formula milk, with the aim of shortening the period, the frequency of bowel movements and their volume.

Then there are prolonged diarrheas, which last more than 14 days and require treatment and, finally, chronic diarrhea, which lasts up to 1 month and usually has an underlying cause, such as immunoglobulin A (IGA) immunodeficiency, which is very common in children. The deficit of IGA which is the first defense barrier in the digestive and respiratory mucosa, leads to recurrent infections, such as gastroenteritis.

“If the diarrhea is prolonged or even in cases of chronic diarrhea, as long as the child is not breastfed, what we pediatricians do, in addition to a dietary approach with a focus on guaranteeing good hydration for the child, is to replace the milk you are receiving for one with a lower lactose content or without lactose,” stated Dr. Carosella.

Dr. Burgos said that in the office we often see cases of children who, without presenting a specific case of acute diarrhea, may partially present clinical lactose intolerance, caused by changes in the microbiota, new foods or traveler’s diarrhea.

“Lactose-reduced or lactose-free medicated milks are formulated for this condition and should be indicated for short periods, while, for those with congenital lactose intolerance, which are rare cases and make up a special group of patients, the indication should be be for life,” he said.

Among other conditions, diarrhea is usually the result of an infection of the digestive tract, which can be caused by various bacterial, viral or parasitic organisms. The infection is transmitted through contaminated food or drinking water, or from one person to another as a result of poor hygiene. As for the symptoms, it generally presents with decreased appetite – which leads to weight loss -, weakness and lack of interest in food.

National law 27,305, passed in 2016, known as the ‘medicated milk law’, requires social and prepaid insurance companies to cover 100% of the consumption of medicated formula milk, among which are those lactose-reduced or lactose-free.

With a medical prescription issued by the pediatrician or pediatric gastroenterologist, the law guarantees access to this lactose-free medicinal formula at no cost. However, currently, the majority of families that need any of these medicinal formulas face difficulties, obstacles and delays in access.

In a similar way, it happens with the regulation of the so-called law of 1,000 days (27,611) that complements the guarantee of coverage of medicated milk. Although Resolution No. 409/2022 of the Ministry of Labor expressly contemplates the coverage of lactose-free formulas for cases of diagnosis of intestinal insufficiency/intestinal failure due to malabsorption (as occurs in the case of different types of diarrhea), several prepaid medicine and social works fail to comply with the regulations and do not provide effective coverage for these medicated milks.

“Pediatricians, when we indicate these medicated milks, do so by attaching the summary of the clinical history and protected by national law, which generates greater acceptance by social and prepaid health insurance companies,” clarified Dr. Burgos.

“Parents must go through a bureaucratic process to obtain coverage, which generally consists of completing a form given to them by the social work, presenting a summary of the medical history prepared by the pediatrician and waiting for the authorization process to complete; all of this process often takes longer than recommended for timely initiation of treatment,” concluded Dr. Carosella.

Scientific evidence

Various clinical studies reveal that the inclusion of lactose-free milk in infants and children with lactose intolerance due to diarrhea not only reduces its duration but also its severity. These benefits are attributed to the ease with which the body assimilates lactose-free milks, which provide a source of essential nutrients without triggering adverse gastrointestinal responses.

A review by Dr. MacGillivray S. and others, called ‘Lactose avoidance in young children with acute diarrhea’ concluded that in young children with acute diarrhea who are not predominantly breastfed, switching to a diet Lactose-free may result in earlier resolution of acute diarrhea and reduce treatment failure. The work arose from the analysis of 33 trials that included 2973 children with acute diarrhea.

Another study, led by Dr. Hossein Saneian and colleagues, indicated that early administration of lactose-free formula to formula-fed children with diarrhea may result in more rapid relief of acute diarrhea and, therefore, therefore, probably in lower mortality and morbidity rates.

While a meta-analysis, conducted by Dr. Nipat Simakachorn and others, concluded that lactose-free formula was shown to be effective in the dietary management of childhood diarrhea. The duration of diarrhea was shortened, weight gain was better, and stool frequency was lower compared to the lactose-containing formula.