Diarrhea in children: Treatment overlooked


The World Health Organization and the United Nations Children's Fund have made a concerted effort to promote and make accessible an inexpensive, effective treatment for diarrhea. Oral rehydration solution sold over-the-counter at drug stores (e.g., Pedialyte, Rehydralyte) replaces the fluid and body salts lost when a child has persistent diarrhea. Rapid dehydration from diarrhea causes one million deaths per year worldwide and many more complications, such as stunted growth.

Surprisingly, children continue to die of diarrhea in Canada and the U.S. where these oral rehydration products are underutilized, wrote Mary E. Penny and Claudio F. Lanata, M.D., in a recent editorial in The New England Journal of Medicine (28 September 1995). Pediatricians in these countries are reluctant to change from the standard treatment of intravenous fluid replacement which often requires hospitalization. Oral rehydration has been shown in a clinical trial to be as safe and effective as intravenous rehydration (see HealthFacts, November 1991).

"In many cases, the death occurs even though the child is seen at a health care facility just hours before. Similarly, half the deaths due to diarrhea in North America occur after visits to a medical facility." Penny and Lanata raised questions about how mothers recognize severe illness, how and why they seek care, and their implementation of treatment advice.

But medical care may also be at fault: "Health care professionals, looking for remedies to stop diarrhea, resort too readily to inappropriate, costly, and ineffective prescription medicines instead of emphasizing oral rehydration therapy and nutrition advice."

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