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Ebook ABC of the first year (5/E): Part 2

Part 2 book “ABC of the first year” has contents: Diarrhoea, mother–infant attachment, growth and growth charts, failure to thrive, whooping cough, convulsions in the older infant, crying babies, non-accidental injury and selected drugs, and other contents. | 13 Diarrhoea Diarrhoea is the passage of loose stools more often than would be expected from the diet and age of the infant. It indicates a change in bowel habit. A stool should be examined personally. A rectal examination is often followed by a fresh stool, which can be examined. When diarrhoea is severe, the stools may be mistaken for urine. When this is a possibility, a urine bag should be placed in position and the infant nursed on a sheet of polyethylene. The stools of newborn infants vary with their diet. The normal stools of breastfed infants are never formed, may be passed at hourly intervals, may contain mucus, and may be green. When lactation becomes established between the third and fifth days intestinal hurry is common, resulting in frequent stools. Later the stools tend to become less frequent and more pasty and by the age of three weeks they may be passed once every two or three days. No treatment is needed. In contrast, the normal stools of bottlefed infants are formed and do not contain fluid or mucus. With certain cow’s milk preparations the stools may be dark green, but this has no sinister meaning. Figure 13.1 Stool of breastfed infant. Acute gastroenteritis Acute gastroenteritis is an acute infection mainly affecting the small intestine that causes diarrhoea with or without vomiting. The main danger is dehydration and electrolyte imbalance, which may develop rapidly, but the infant may also be very infectious for other infants in a ward or nursery. Gastroenteritis is particularly dangerous to infants aged under two years. The early signs of dehydration are often difficult to detect, but recent weight loss is often a valuable indicator. Sunken eyes, inelastic skin, and a dry tongue are late signs, but if the infant has not passed urine for several hours severe dehydration is probable. Clinical signs of dehydration are particularly difficult to detect in fat toddlers. The infant must be examined in detail to exclude any other acute .