Diarrhea in internationally adopted children

Anna Banerji, MD
Focus on Adoption magazine

Some people consider diarrhea a right of passage. After all, almost all children around the world have been infected with diarrhea by age two.

Diarrhea: What it is
Diarrhea describes an increase in the frequency, fluidity, and volume of bowel movements (BMs). This assumes a change in the previous pattern, which is often difficult to know in newly adopted children. All children, like all adults, have their own rhythm of BMs. Some children have BMs several times a day, while others have BMs every few days.

Acute versus Chronic Diarrhea
Acute diarrhea is usually self-limited, lasting less than two weeks, while chronic diarrhea lasts longer than two weeks.Acute diarrhea is more likely than chronic diarrhea to be accompanied by vomiting, fever, or malaise. Most causes of acute diarrhea are infectious and may be caused by viruses, bacteria, and, to a lesser degree, parasites. This diarrhea can also be caused by non-infectious causes such as the ingestion of chemicals, dietary changes, and stress.

Chronic diarrhea has many causes, and many are infectious. Chronic diarrhea has a higher chance of being caused by parasites, such as giardia and cryptosporidium or bacteria than by viruses.

Diarrhea in adopted children
Diarrhea is common in young adopted children. Orphanages in developing countries are usually overcrowded and have poor hygiene standards. Young children often put objects in their mouths. As well, because many children are already infected with bowel parasites, this increases parasitic transmission between children, putting all children in the orphanage at a high risk of having diarrhea-causing parasites.

Upon arrival, most children come with a series of bowel infections and may arrive with post-infectious diarrhea where the infection has resolved, but the bowels remain irritated and need time to recover. This may result in temporary lactose intolerance.

Malnutrition, too, contributes to diarrhea. Conversely, children may get diarrhea as they adjust to a new diet and environment. Another common condition is Toddler’s Diarrhea, chronic diarrhea in an otherwise healthy child. This should improve with a reduction in fruit juices, and most children outgrow it. Rarer causes of diarrhea are a result of genetic conditions (cystic fibrosis, celiac disease, and enzyme deficiencies) or HIV.

When diarrhea is a concern
For acute diarrhea, the best treatment is adequate intake of fluids and salts. If a child loses fluids than are not being replaced, he or she risks dehydration and must be assessed by a doctor. Acute diarrhea accompanied by high fever or stools with blood or mucus should be checked by a doctor. The stools will likely be checked for bacterial or parasitic infections in a lab. Chronic diarrhea is a concern if the child is not gaining weight, or is losing weight. All children adopted from overseas should have stools checked for parasites or bacteria. If a child fails to grow, they may require a more extensive medical assessment. It’s reassuring if a child grows despite diarrhea.

The outcome
Because many of these children are malnourished, have had multiple bowel infections, and have recently started a new diet, they have an increased risk of developing diarrhea. However, once simple screening tests are done, and common things ruled out or treated, all that is required is a tincture of time and patience for the diarrhea to resolve itself and for the children to flourish.

Anna Banerji, MD, is the Director of the TMVC Tropical Disease Clinic. Toll-free at 1-888-288-8682 or locally at 681-5656