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Pediatric Traveler's Diarrhea

Children represent a particular problem in overseas travel in underdeveloped countries, particularly in their susceptibility to dehydration from diarrhea diseases. Dehydration occurs more quickly because of decreased body size.

All efforts should be made to prevent diarrhea, especially in children. Select safe foods and water while traveling. Ensure food is cooked fully and avoid uncooked dishes such as salads, raw fruits, vegetables and dairy products. Fruits with a peel (like bananas or oranges) are considered safe. Use bottled water for drinking and brushing teeth. Do not ingest ice cubes.

Treatment of Pediatric Traveler’s Diarrhea

Recommendations for treating children with diarrhea have changed. The old concepts of giving clear fluids and “resting the gut” (no food) are counterproductive. Clear fluids fail to replace electrolytes lost via vomiting and diarrhea, further worsening the electrolyte imbalance and hastening dehydration. Food decreases the volume and frequency of diarrhea and speeds recovery. Even in severe diarrhea, the impaired intestinal wall continues to function sufficiently well to absorb needed electrolytes and calories.

Commercially prepared oral electrolyte solutions (OES) are best. Start giving OES with the first episode of diarrhea or vomiting, before it is evident whether the illness will be mild or severe. OES contain carbohydrates (glucose) and electrolytes in the proportions needed to replace fluids being lost and for optimum absorption from the impaired intestine.

FLUIDS FOR CHILDREN WITH DIARRHEA

 Product

CHO
G/L

 Na
mEq/L

 CHO/Na  K
mEq/L
 Base
HC03
 mOSM/L*
Oral Rehydrating Solutions - Acceptable
 Pedialyte  25  45  3:1  20  30 270
 WHO/ORS  25  90  1:2  20  30 310
Other Fluids - Unacceptable
 Cola  50-150  2  350  0.1  13 550
 Juice  100-150  3  250  20  0 700
 Broth  0  250  -  5  0  250
 Gatorade  45  20  13  3  3  330
 Tea  0  0  -  0  0  5
*More than 310 mOSM/L may cause osmotic diarrhea

While infectious diarrhea interferes with many of the systems that absorb and secrete nutrients across the intestinal wall, one system (the “co-transport” system) remains intact. This involves the absorption of one molecule of glucose linked to one molecule of sodium. The sodium takes water along.

Administering solutions that contain too much sugar (cola drinks or fruit juice, for example) creates an osmotic density in the intestine that draws fluid from the blood stream into the intestine, worsening diarrhea. Broth, on the other hand, contains much sodium but no glucose and will not be absorbed.
Recently developed cereal-based (CB) OES may have important advantages over those that are glucose-based. CB-OES contains cooked starches (usually rice) instead of glucose to cotransport the sodium. CB-OES provides 4 times more calories than glucose, without causing osmotic diarrhea, and supplying more calories helps speed recovery. In addition to OES or CBOES, offer children food to eat.

Food stimulates intestinal cell renewal and increases absorption of nutrients. Food is best avoided as long as vomiting continues; vomiting rarely lasts more that 12 hours. Infants can continue to breast feed or drink formula and regular milk. Infectious diarrhea almost never causes malabsorption problems, especially in the first few days. Older children can be given carbohydrates (starches) including rice, wheat, potatoes, cereal and bread. When OES is not available, various readily available solutions can be substituted: plain water with pretzels or salted crackers; plain water with mashed potatoes or banana flakes; and drinks made with pre-cooked infant rice cereal, unsweetened yogurt or vegetable juices.