Messy nappies may be sign of severe intestinal infection

Sep 5 2006

Anyone who's ever cared for an infant or young child knows what it's like to change the occasional smelly, messy diaper.

While mild bouts of diarrhea aren't uncommon in young children, moderate to severe diarrhea, lasting several days, could be a sign a dangerous infection in the intestines known as rotavirus gastroenteritis.

So how can parents tell the difference between normal diarrhea and diarrhea caused by rotavirus, and know when to call their child's health care provider?

"Moderate to severe diarrhea, along with a persistently high fever, blood in the stool or vomiting, are some symptoms of rotavirus and should signal parents to seek medical attention for their child to prevent dehydration," explains Janet Gilsdorf, M.D., director of Pediatric Infectious Disease and Immunology in the Department of Pediatrics and Communicable Disease at the University of Michigan C.S. Mott Children's Hospital.

She continues: "But because there are so many other causes for diarrhea, parents shouldn't assume their child has rotavirus infection. The only way to diagnose rotavirus is through a test of your child's stool, conducted by his health care provider."

According to the Centers for Disease Control and Prevention, rotavirus is one of the most common causes of severe diarrhea in infants and young children in the United States, although it can occur in children of any age and even adults.

Cases of rotavirus increase each winter and spring, and the disease tends to begin with a fever, an upset stomach and vomiting, followed by watery diarrhea. Infected children also may have a runny nose and cough.

Rotavirus is transferred from person to person, though contact with contaminated diapers, hands, or surfaces. Children infected with the disease occasionally need to be hospitalized, and in rare cases some have died from severe dehydration.

Prevention

Fortunately, there are ways to protect your child against rotavirus infection. The U.S. Food and Drug Administration recently approved the new rotavirus vaccine Rotateg. The CDC's Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommend giving the vaccine to infants at two, four and six months of age.

"The vaccine is very effective in preventing rotavirus diarrhea," says Gilsdorf, who is a member of the CDC's ACIP. "It prevents 70 to 80 percent of rotavirus infections, and about 98 percent of severe rotavirus infections."

Since rotavirus usually is transferred via contaminated hands, simply washing your hands and your child's hands after each diaper changing can work to prevent the spread of disease.

"It only takes a few virus particles to spread rotavirus from one child to another," says Gilsdorf. "So it's very important for people who are changing nappies to use good hand washing practices. That includes using soap to work up a good lather, washing between your fingers and the backs of your hands, rinsing with warm water, and thoroughly drying your hands."

Treatment

With no antibiotics or anti-viral drugs to treat diarrhea caused by rotavirus, keeping children hydrated becomes vital to their care.

"Children quickly lose fluids and electrolytes during bouts of diarrhea and vomiting, and when they have a fever. To keep them hydrated, begin giving them extra fluids as early as possible in the illness," advises Gilsdorf.

Babies may be given breast milk, formula, or products containing electrolytes that are specifically made for infants, such as Pedialyte. However, unlike older children and adults with diarrhea, sick infants should not be given water alone, since the salts lost in diarrhea also need to be replaced.

As the disease progresses, parents should be on alert for the signs of severe dehydration – fewer wet nappies and crying with no tears – and contact their child's health care provider if dehydration continues for several hours.

Gilsdorf also recommends that parents avoid giving their infant any type of over-the-counter medication for diarrhea. "Some of those medications contain aspirin-like ingredients, which can be harmful in large doses. Other medications can slow down the motility of the intestine, which prevents diarrhea, and thus the body's ability to rid itself of toxic substances."