Posted by: Chris | November 7, 2010

Rivers of Poo Are Not Trivial

One thing about becoming a new parent is you learn that babies and toddlers are messy. They excrete fluids in ways that a boggles the mind of any former young professional intelligent person. Often for no apparent reason. I learned early on to never, ever, and I mean never hold a baby or toddler above your head while laughing at cute kid smiles and laughter. It is not pleasant to get a mouthful of vomit.

Then “it” happened. First is was the kind of messy diaper, which had happened a few times but had resolved fairly quickly. Except this time it got worse. The diarrhea became more fluid and frequent.

The diapers leaked, and it was all over the place. I was using cloth diapers from a diaper service, and velcro diaper covers… which were obviously inadequate. So I got out the emergency supply of plastic diapers, but they were also inadequate. I then tried a cloth diaper covered with the plastic diaper, covered with another cloth diaper and topped it off it a pair of plastic pants (which I bought from the diaper service, they were nice because they had snaps on the side so I did not have to slip them down his leg). And still the poo leaked out.

AAAGH!

So I took him to the doctor. He told me that it happened, and since he was being smiley and happy it was a “minor” case of diarrhea. I also had to make sure he stayed hydrated with the electrolyte products for children sold at the drug store.

But he refused the drink the recommended stuff. So I took the advice of my “Natural Baby Care” book and gave him diluted apple juice.

Then I got it! Obviously dealing with that many dirty messy diapers I passed the infection to myself. I actually put the large toddler cloth diapers on before my undies so I didn’t make a mess on the way to the toilet.

So sometime within a week I took him to the doctor again. Again he was happy smiley toddler, it looked like he was on the mend. Hooray!

Uh, not quite.

The next evening he was being his sweet happy self, and then he collapsed on the floor in convulsions. The next moments seemed to drag on in a type of time warp. I know I screamed to my husband that BigBoy was having a seizure, and I leapt to the phone to dial 911… and got a busy signal. Aaah!

I dialed again and got a person. And in a few minutes three large firefighters were in our tiny house hovering over our tiny boy who was now unconscious. An ambulance was called, and I went into it carrying my little boy. I laid on the gurney with my son on my lap as we were driven to the children’s hospital.

At their emergency department it was determined he was severely dehydrated. This is not trivial. Dehydration can cause heat injury, cerebral endema, seizures, hypovolemic shock, kidney failure, coma and death. He was given IV fluids, and did get better. He did not have to be admitted to the hospital

I was also told that the worst thing to give a kid with diarrhea is diluted apple juice. Apples and apple sauce are included in the BRAT diet (bananas, rice, apples, toast) because they have pectin, the juice lacks the fiber and makes things worse. When we got home later that night, I took the “Natural Baby Care” book and put it into the fireplace where it was burned the next day.

The funny thing was that my symptoms completely disappeared starting with his seizure.

We also got a phone call home from his doctor asking about what happened. He had received a notice about BigBoy from the hospital. Yes, doctors are human and do react when they misjudge conditions. But how could you call it? BigBoy was dancing to music just a couple of hours before the seizure.

We will never know what caused over a week of diarrhea. A likely culprit is the rotavirus. According to the CDC Pink Book chapter on rotavirus it happened to almost every kid, and “the most common cause of severe diarrheal disease and account for a higher proportion of severe episodes leading to clinic or hospital visits.”

It continues with:

In the prevaccine era rotavirus infection was responsible for more than 400,000 physician visits, more than 200,000 emergency department (ED) visits, 55,000 to 70,000 hospitalizations each year, and 20 to 60 deaths. Annual direct and indirect costs were estimated at approximately $1 billion, primarily due to the cost of time lost from work to care for an ill child.

In early 1990 we accounted for two physician visits and one ED visit of the above statistics.

Fortunately there are two effective and safe vaccines for rotavirus.

There is often discussion about the original vaccine, RotaShield, causing intussusception. For some reason it is assume that because there was an issue for this vaccine, it also occurs in the others, which is false. Plus intussusception happened to only fifteen infants, and they all survived.

Think about it: a vaccine was removed from the market when it caused problems in fifteen infants due to normal post-license surveillance. This is for a condition that caused over fifty thousand hospitalizations and several dozen deaths per year.

For other more recent issues with the vaccine, please read this virology blog and listen to the podcast.

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Responses

  1. Rotavirus can be nasty. The only time my daughter needed IV fluids was during a rotavirus infection too at age almost 2. It seems almost a rite of passage, and I was grateful to have medical care and adequate safe fluids to give her. Curiously, at the pediatric hospital, they would mix 2/3 oral electrolyte solution with 1/3 apple juice to make the kids like it enough to drink it.

  2. My youngest was one of the first to get the rotavirus vaccine in our province. My middle didn’t get it. He got rotavirus — he’s an unusually robust two-year-old, and he still nurses and would take food that way, and it was gross and not frightening. The littlest was unaffected. I’m so grateful to Dr. Offit and the other researchers for sparing what would have been at the very best an extremely unhappy experience for such a small child.

  3. When my eldest got a nasty gastro-bug at age nearly 2.5yr, he was vomiting and had diarrhea. He couldn’t keep down solid food and luckily he didn’t have to drink electrolyte mixture because he was still breastfed. As a result he bounced right back after 3 days on nothing but breast milk.

    In my opinion, doctors should teach parents how to recognise the signs of dehydration (dark urine, pinched skin does not spring back etc.) the moment they bring in a child with vomiting or diarrhea.

    • You are lucky. Since my son was pretty much self-weaned at that time there was no way to produce that much breast milk (I was pregnant, plus I also had it… so was trying very hard to keep up my level of fluid). He would have required at least two liters a day (though I may exaggerate… it was lots).

      I did say rivers of poo.

    • In my opinion, doctors should teach parents how to recognise the signs of dehydration

      Also, remember I did bring the boy into the doctor the day before his seizure. I kind of wonder why the doctor did not notice it.

      Or perhaps, his seizures did not require that level of dehydration. Since he did not have dark urine (it was mostly poo) and the skin did spring back.

  4. That sounds awful! And it does sound like the rotovirus. Our daughter had that when she was about two years old only instead of the runs she threw up for a week. I thought she was dying! Luckily, we did not read the book you read and I just asked my mom-the-retired-nurse what to do and she said give her tiny sips every twenty minutes of 7-up or gatorade to get her sugars and electrolytes back up. But what is given for throwing up is not always what is given for diahhrea too. My first thought when I read that was “Oh, apple juice might make the runs worse.” Sorry you were led astray and I’m glad BigBoy is ok!

  5. As for myself, the toughest time is having “faith” in a newly potty trained youngster to properly wash their hands. I’m well past this stage with my guys but it still makes me cringe to think about it.

  6. As for myself, the toughest time is having “faith” in a newly potty trained youngster to properly wash their hands even after numerous rehearsals of using proper hand washing techniques. I’m well past this stage with my guys but it still makes me cringe to think about it.

    • Christopher, that is so very true. One of the most idiotic things we did in the design of our house was putting the powder room right next to the main living area. Though it was very fortunate to catch kids who did not wash their hands, with MathMan being the hardest to teach.

      Via the SkepticsNorth blog, an article explaining that thanks to the vaccine rotavirus has been virtually wiped out in the USA. Now much fewer children will have to deal with, from the article:

      Rotavirus is dangerous largely because it leads to dehydration, which can, in some cases, lead to blood poisoning, seizures, life-threatening drops in blood pressure and even death.


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