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Suggest Treatment For Loose Stool In Child

Posted on Mon, 22 Sep 2014

Question: Hello,
This regarding my 5 month old daughter, shes exclusively breastfeeding. Its been 12 days now, that shes having diarrhea. Her stool contains mucus, some times green in colour. We consulted our pedi and he gave us Taxim-o 5ml daily twice a day. We did that for 6 days but her stool were consistent in terms of frequency i.e. 8/day. She simeed to have lost the fat, so we changed her pedi, new pedi advised us to give Zathrin 200 2.5ml once a day, Bezoylmetronidazole Oral Suspension IP 3ml thrice a day and vibact XXXXXXX thrice a day for 3 days. Its been 5 days now, theres no improvement in her bowel movement. she does it after each feeding. We had done her stool test which says
mucus present
Reaction (pH) Acidic
Octul Blood Positive
Reduction Substance Present (++++)
Red blood cell 4-6
Pus Cell 2-4 .
Is there any thing I can give my dauther so that she her bowel movement comes back to normal.

Answered by Dr. Irshad H Naqvi (51 minutes later)

Brief Answer:
Stomach infection with lactose intolerance.

Detailed Answer:
Hi Dear
Welcome to the HCM,

In exclusively breast fed child.The stomach infection possibilities are usually not frequent in breast fed children.
But at 5 months of age, babies do start putting fingers in their mouth. Leading to the GIT infection and diarrhea. Stool report is also pointing toward some infection.
Stool culture /sensitivity may give us the exact bug causing the problem, and also the exact drug effective to eradicate the infection.

At the same time stool report sent by you is showing the acidic stool and 4+reducing substance. This indicated that the baby has also developed Lactose Intolerance (as a consequence of GIT infection).
Such condition can be treated with by giving the lactose free milk or feeds.
So please discontinue the breast feed and other animal milk for some time (a week or so) which do contain some amount of Lactose.

Shift to Lactose free milk formula available with your near by chemist in the name of (Simyle MCT power/Lactonil/Neosobee etc). Taste of such lactose free power is little different form the normal milk, But gradually baby may start accepting it.
This milk can be given till the loose stools are stopped and baby is comfortable.

Since the baby is 5 month old, She can be introduced with some semisolid feed which are free of any sugar(Lactose) like ( dal rice soup, boiled meshed potatos, banana etc.
Nestum/ Easum are some semisolid commercial product available in the market.These can also be tried with good result.

Perianal and periurethral area of the baby might have also become red (inflammed) because of acidic nature of stools.This can be overcome by applying simple soothing cream like rash free etc.
Probiotics (vibact ) to be continued.

Hope the query is answered.
Please feel free for further clarification.
Thanks

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Irshad H Naqvi (1 hour later)

Hello Dr. Naqvi,
Thank you for the detailed explanation.
Is this a serious issue, I mean it has been 12 days now... should I take her to a big hospital like kokilaben ?

Should I do "Stool culture /sensitivity", also should I continue giving her the medicines i.e. Zathrin 200 2.5ml once a day, Bezoylmetronidazole Oral Suspension 3ml thrice a day, I was told to give Zathrin redymix for 6 days (I have given her thsi for last four days) ?

Regarding, lactose intolerance solution, is it a must? I say so because I am the father and I don't know how will my wife take it, on hearing that her milk is temporally not good for our daughter. Would there be an alternative to this..

Also, can I give her grype water, dabur janam ghutti ?

Thanks, XXXXXXX

Answered by Dr. Irshad H Naqvi (3 hours later)

Brief Answer:
No Ghuttee , No gripe water

Detailed Answer:
Hi
stool culture should be done to know exact drug required.
stool report shows the acidic stools and reducing substances are highly positive, So Lactose Intolerance can not be overlooked.

Better you consult your pediatrician for the treatment in this light. If mother is explained with little patience then I hope she will understand the things and will agree for the treatment of her baby.
So in nut shell the baby should be treated in both terms of infection and lactose intolerance simultaneously.
Start the semisolids supplementation as advised earlier ASAP.
Hope the baby should respond in 3 to 4 days with these measures.
Thanks

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Irshad H Naqvi (6 days later)

Hello Dr. Naqvi,
I did a stool culture test of my daugther. Please see the attached "stoolCulture.jpg".

her bowel movement is around 4 to 5 times per day now, it's still very watery and sometimes greenish in colour.

I am giving her Zinc Dry Powder for Suspension (0.5ml twice a day) , Flagyl 3ml once a day and Enterogermina Oral Suspension XXXXXXX bottle once a day.

Its been now three weeks, what should I do ? please, advise...

Thanks, XXXXXXX

Answered by Dr. Irshad H Naqvi (1 hour later)

Brief Answer:
lactose intolrance +,infection in stool

Detailed Answer:
Hi
Stool routine examination shows clear cut lactose intlorence, So has to be managed according to the case of Lactose intolerance as explained earlier ( diet changes etc)
Stool culture is inconclusive but showing mucus flakes. pus cells, red blood cells ,occult blood etc all show the evidence of infection in stomach. So we should also additionally treat the child imperically by adding (syrup zanocin50) about 3.5 ml 8 hourly for 5 to 8 days. I personally like to refrain from the taxim O because many times cefixime itself may cause loose stools.
Flagyl is not required as stool exam does not show any E Histolitica
Continue with zinc and enterogermina
Hope the query is answered and was of help to you.
Thanks

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Irshad H Naqvi (48 minutes later)

Hello Dr. Naqvi,
Thanks for the quick response.

What is syrup zanocin50 and enterogermina used for ? In how many days should I expect improvement ?

Also, can I give zinc and syrup zanocin50 together, not mixed but simultaneously ?

For how long should I continue the medications i.e. syrup zanocin50, zinc and enterogermina ?

Thanks, XXXXXXX

Answered by Dr. Irshad H Naqvi (14 minutes later)

Brief Answer:
zanocin is for infection

Detailed Answer:
Hi
Zanocin is (ofloxacin ) is an antibiotic being advised imprically with evidence of infection in the culture report though bacteria was not grown.
Zinc, enterogermina are the supportive medicines for stabilizing the disturbed intestine.
With management advised for the lactose intolerance and treatment of infection collectively, we should expect response with in three to 4 days.
Medicines can be mixed with other so that baby can accepts easily.
Hope the query is answered.
thanks

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj