Gut health in infants and young children is a critical aspect of their overall well-being. The gastrointestinal (GI) system plays a vital role in nutrient absorption, immune function, and maintaining body homeostasis. Among the common concerns parents face regarding their children’s gut health is diarrhoea, which can result from various causes, including infections, dietary factors, and even emotional distress. A day doesn’t go by where pharmacists do not encounter a worried parent with an unwell baby or child with symptoms of acute diarrhoea or upset gut. Pharmacists are in a unique position to offer valuable insights into managing these conditions, providing counselling on over-the-counter (OTC) therapies, probiotics, and addressing colic as well as reassurance and direction if the child needs to be referred.
Causes of Diarrhoea in Infants and Children
Diarrhoea is characterised by increased stool frequency and fluid content, and it can lead to dehydration and electrolyte imbalances, particularly in young children. Understanding the causes of diarrhoea is crucial for effective management.
Infections
Infections are among the most common causes of diarrhoea in children. Viruses like Norovirus and rotavirus are notorious for causing gastroenteritis, leading to fluid loss and discomfort. Norovirus is highly contagious and often spreads through contaminated food or surfaces, making it particularly relevant in settings such as creches or day-care. Bacterial infections—while less common— can also result from consuming contaminated food or water, with pathogens like E. coli and Salmonella being notable culprits.
Non-Infectious Causes
Apart from infections, diarrhoea can also be prompted by noninfectious factors. For instance, food allergies or intolerances can adversely affect gut health. Lactose intolerance, due to insufficient lactase enzyme production, is particularly common and can lead to abdominal pain and diarrhoea upon consuming dairy products.
The Role of Probiotics
Probiotics have gained attention in recent years for their potential to support gut health, especially in children. These live microorganisms can positively influence the gut microbiota, which is essential for digestion and immune function.
Research indicates that certain strains of probiotics may help reduce the duration and severity of diarrhoea caused by infections, including rotavirus. In cases of antibiotic-associated diarrhoea, probiotics can help restore the balance of gut flora compromised by antibiotic therapy. Pharmacists should consider advising parents on the use of age-appropriate probiotic supplements during episodes of diarrhoea or following antibiotic treatment to promote a healthier gut environment.
Choosing the Right Probiotics
When recommending probiotics, it is essential to select products that have been clinically validated with specific strains shown to provide therapeutic benefits. A product available in Ireland is Colief® Multibiotic Drops. Research suggests that good bacteria, such as those found in Colief Multibiotic Drops, can promote a healthy gut microbiome, which contributes to health during childhood and into adulthood.
Recent research for baby probiotics suggests that certain strains of beneficial bacteria particularly Bifidobacterium, have been shown to help support digestive health and reduce symptoms often associated with colic.
Oral Rehydration Solutions (ORS)
The cornerstone of diarrhoea management is rehydration. ORS are specially formulated to replace lost fluids and electrolytes. Simple solutions can be made at home with water, salt, and sugar, but commercially available ORS provide an effective means for rehydration. It may be helpful to provide an oral syringe for ease of administration or alternatively give the solution on a teaspoon or medicine spoon or in a feeding bottle with a low flow teat. Pharmacists should educate parents on recognising the signs of dehydration and the importance of maintaining hydration during a diarrhoeal episode.
Over-the-Counter Therapies for Diarrhoea
Pharmacists are often the first point of contact for parents seeking advice on managing diarrhoea. OTC therapies can be effective tools in addressing symptoms and preventing dehydration. If the child is less than 6 months old and symptoms have been present for more than 24 hours in duration they should be referred immediately and oral rehydration salts should be provided as soon as possible. Likewise if the child is older than six months and has had symptoms for longer than 48 hours in duration I would treat that as a red-flag symptom and refer immediately.
Anti-Diarrheal Medications
While anti-diarrhoeal medications like loperamide are available for adults they are not available in liquid formulation in Ireland, instead as tablet and capsule presentations. Most paediatric patients, especially those under the age of two, should not use these medications without consulting a healthcare professional. The primary objective in managing diarrhoea should be rehydration and protecting the child from dehydration.
Products available in Ireland include Tasectan® AF. Clinical trials have demonstrated that Tasectan AF® is a fast-acting, efficacious, and safe therapy for the treatment of acute diarrhoea, reducing the frequency and duration of diarrhoea episodes. Children under 3 years should be given a sachet every 8 hours and those over 3 years can be given 1-2 sachets every 6-8 hours.
Addressing Colic
Colic, characterised by excessive crying and apparent discomfort in infants, can also impact gut health. Although the exact cause remains unclear, it may be related to GI immaturity or food sensitivities. Pharmacists can offer guidance about soothing strategies or dietary adjustments that may alleviate symptoms. For example, some parents have found success using specific probiotic strains that may decrease colic symptoms. In 40% of colicky babies, colic may be linked to Temporary Lactose Intolerance, where the digestive system lacks enough lactase to break down lactose in milk. Colief Infant Drops help by providing lactase to break down lactose into simpler sugars, making milk easier to digest and reducing discomfort.
The Role of Counseling
Pharmacists play an essential role beyond product recommendations. Providing thorough counseling can ensure that parents understand the underlying issues related to their child’s gut health. The following points will guide and reassure anxious parents:
1. Provide lots of fluids such as water or squash – take small sips if you feel sick.
2. Give paracetamol if the child is in discomfort.
3. Carry on breast or bottle feeding your baby – if they are being sick, try giving small feeds more often than usual. Prepare formula at its usual strength, no need to make it weaker.
4. Give babies on formula or solid foods small sips of water between feeds.
Conclusion
The management of gut health in babies and children, particularly in relation to diarrhoea, is a multifaceted challenge for caregivers. As pharmacists, leveraging our expertise to provide education, recommend appropriate OTC therapies, and highlight the benefits of probiotics can significantly contribute to improving pediatric health outcomes. Ultimately, fostering a collaborative relationship with parents empowers them to make informed decisions for their children’s health. By prioritising gut health from a young age, we can promote a lifetime of well-being.
Written by Tomas Conefrey, Conefrey’s CarePlus Pharmacy
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