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Discomfort while passing stools which is sbnormal. Treatment?

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My son who is 19 months old passed abnormal stools. He had discomfort while passing it.Frequency was 3-4 times.Consistency I have attached a picture .Kindly look into it

Category: Pediatrician

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Category: ICU/ Critical Care Specialist
 24 Doctors Online

Dear parent,
Thank you for your query at DoctorSpring.com

I can understand your concerns. I have examined the attached picture in detail.
Please help me understand your son's clinical condition better by answering a few queries:
1. How long has the child been passing such stools?
2. Do the stools contain blood or mucus? Do they have a foul odour?
2. Does he also have fever?
Regards
Dr. Saptharishi L G


Patient replied :

Hello Doctor, My son has been passing such stools since yesterday so 1 day over.. Slight mucus was seen..his body was slightly warm yesterday night. I gave him dolo and he was fine..but in the night and in the morning he has passed stools again.. But today the whitish Consistency was not seen it was just loose.. Also I would like to add that my son is underweight compared to his birth weight.. He was 3.5 when he was born.. Now he is only 8.3 ..he is weight gain is very slow.. Could the stools he passed sugest anything related to that. Usually his stools are pasty or really hard.. He is otherwise active..


Dear parent,
Thank you for answering my queries. I has definitely clarified things.
Your son has two distinct issues:
1. Failure to thrive
2. Acute gastroenteritis
The recent onset change in stool consistency with increase in frequency is suggestive of an acute viral infection of the food pipe (intestines). This may not be really worrisome and may require only rehydration with ORS ( oral rehydration solution) if the stools become more watery. This is likely to be a transient infection and is likely to subside by itself in a few days. You also need to start him on Syrup ZINC 5 ml once daily for a couple of weeks. No other drugs or medications are needed. No drug should be used to stop diarrhoea as this will cause complications.
Coming to the second part of the problem, Failure to thrive...
Your son's birth weight has been normal. Subsequently his weight gain is definitely poor. This requires a detailed evaluation, including measurement of length and head circumference. We need a detailed dietary history and calculate deficits in calorie and protein intake.
If despite improving the intake of calorie-protein, the weight gain does not improve, we need to evaluate him for malabsorption, chronic diseases, etc. This will require a personal visit to the nearest paediatrician.
Hoping that my explanation clarified your queries.


Patient replied :

Thank you doctor for the reply. My son passed stools today in the morning.. After that very little in the evening. I forgot to mention I gave him enterogermenia twice yesterday is that OK? Regarding his weight His height /head circumference as calculated when he was 18 months Height - 75cm HC - 46 cm Regarding his diet Morning - 1bread and cerelac Or1 boiled egg white andcerelac Or Idli/dosa and cerelac Afternoon- daliya khichdi with ghee or ragi 1/2 cup alternate days Sometimes little rice with fish curry Evening- boiled egg / juice/biscuits/fruit/cheese/toast Dinner - 1 methi Chapathi with ghee OrCerelac with milk He is still breastfeeding.. Doesn't drink other milk


Dear parent,
Thank you for the detailed reply. Now let us analyze the situation systematically.
1. Regarding the acute gastroenteritis,
Most therapies have no proven role except for ZINC and ORS. So enterogermina or any other probiotic may not be very useful for a child with acute diarrhoea. It has a proven role in only chronic diarrhoea, where diarrhoea lasts > 14 days
2. Regarding the failure to thrive,
The height and head circumference are lower than expected for a 18 month old. It is important to look at serial values of these growth parameters for any meaningful interpretation. We need to chart these values on a growth chart and see where the child has faltered. This can identify the approximate age at which the child has started having a fall in the growth curve.
The dietary history has been helpful. The calorie - protein content seems to be appropriate for age. So, despite taking adequate calories and protein, if the child is not thriving well, then your son needs to be evaluated for other causes that I had listed previously. There are multiple causes ranging from malabsorption, chronic kidney, liver or cardiac disease, etc.
There are limitations to consultation over the internet. You can obtain a direction or line of management. But, very specific treatment strategies are better advised after a detailed history evaluation, a through physical examination and a few laboratory investigations.
I urge you to meet a paediatrician in person with your child so that further decision making regarding failure to thrive can be taken. Wishing your son a rapid recovery.


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
Dr. Saptharishi L G and 4 other Medical Specialists are ready to help you

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