How to Get a Child to Cooperate in a Physical Exam

How to Get a Child to Cooperate in a Physical Exam Our next topic is diarrhea and vomiting a very, very common cause for this is toward pediatric office even probably more common for colds to a doctors’ office. Diarrhea and Vomiting obviously has many causes. The causes that we think of the most are those caused by bacteria or viruses many of which are food born and also parasitic infections. Parasitic infection usually don’t cause acute diarrhea, they usually cause a chronic diarrhea pattern that has to be considered among other organic causes of chronic diarrhea. The diarrhea we’re talking about is the acute onset gastroenteritis that all of us have had, all of have suffered from and will suffer many times more from. It is especially devastating in the children because of their smaller body mass, their decrease fluid volume and therefore their propensity to get dehydrated a lot quicker than an adult. Now one thing I want to stress is viral gastroenteritis is not a 24-hour illness not even in adults. The only exception is the Norwalk virus which is very common and may lasts for maybe three days tops. The Norwalk virus is a common virus that people think all diarrhea should dig in that wing get very upset when their child has Diarrhea’s five, six, seven eight days. But the rule of thumb basically is diarrhea is not a short illness that tends to lasts for reasonable length of time. Now there is immediate evaluation phenomenal with diarrhea. Let me give some of the reasons that a parent should immediately call their doctor and expect immediate evaluation. One is any child under six months with significant diarrhea probably should be seen the by physician and followed by the physician. Obviously, dehydration if is obvious isn’t called for immediate evaluation. Frequent vomiting would be of course since you can not get any fluids in and you can not correct the problem, loss of appetite for fluids on the child doesn’t take any fluids in or if your child is extremely thirsty, there’s a message that the child is getting dehydrated. Weight loss, bloody diarrhea, requires immediate access to the physician. Abdominal pain with diarrhea merits concern. It certainly is seen more with things like Salmonella and that and it should be probably be evaluated. Fever with diarrhea over a 102 again, not common with the viral diarrheas in the older children so when you get a temperature with it, it causes more concern. Diarrhea that’s one stool per hour for over 12-hours is a reason for immediate evaluation. Lethargy, irritability or if it’s connected with the ingestion of drugs or toxic substances there in an entity called C.Difficile that occurs with the child but it can be a very severe intestinal problem that is produced by a child taking long courses of antibiotics. Now, there are fluids that are not recommended in the treatment of diarrhea. Fluids are the main treatment but these fluids aren’t; tea, juices. Their high of sugar content, lack of electrolytes lead to low sodium and they also lead to further diarrhea because of the high- carbohydrate intake same as true of colas and soft drinks. Chicken broth is not a good idea for diarrhea. Boiled skimmed milk is a problem because it’s highly concentrated and you substitute high-sodium for sodium loss and you can get what’s called hypernatremic dehydration which is extremely severe because there are fluid shifts from the brain and there can be complications in re-hydrating the person. The other thing would be Sports Drinks and Kool-Aid. Kool-Aid is nothing but sugar water and will replenish none of the above. Pedialyte is of course and its related substances which are — World Health Organization recognize electrolyte solutions which have small amount of sugar and have in them electrolytes or the treatment of choice. So how do you care with a child for Diarrhea? You give liquids as soon as the diarrhea starts. A good rule of thumb for the whole maker is ½ cup that’s 4 ounces of re-hydrating solution for every stool the child has if the child’s younger than two. One and a half cup to one cup for every child over 2 re- hydrates the fluid loss from the stool. The modern thinking is not starvation. After you're re-hydrating or replaced or maintenancing the child with the fluids, you give food. You do not restrict food because many of the enzymes in the intestinal tract are inducible. And when you give food, they replenish the enzymes that are required for absorption correctly in the gut. If you delay food, you prolong the diarrhea and prolong recovery. No medicines are indicated for pediatric diarrhea that includes anti-diarrhea agents, they do not make the diarrhea last, they may make the stools less but the same but more fluids is actually are lost in the gut then you see come out with the infrequent stools so there’s really third spacing of fluids in the intestines and you're not accomplish in anything. The other thing with medicines is they can prolong cramping and in some scientific data with disease bacterial causes of gastroenteritis that you may make the disease worst because you prolong the contact time of the infecting agent with the intestine and there’s greater spreading of the disease. And in the case of E.Coli diarrhea, it may precipitate the Hemolytic Uremic Syndrome. And the main thing with this disease is you take steps to prevent with hand washing, food handling and alike.