From the Guidelines
Diarrhea in a child after surgery can be caused by several factors, including antibiotics, anesthesia medications, stress, dietary changes, and hospital-acquired infections like C. difficile, and management typically involves ensuring adequate hydration and possibly using probiotics to restore gut flora. The most common causes of diarrhea in children after surgery include antibiotics given during or after surgery, which can disrupt the normal gut bacteria balance; anesthesia medications that slow gut motility initially but can cause rebound diarrhea as they wear off; stress from the surgical experience; and dietary changes during hospitalization. Post-operative pain medications, especially opioids, can sometimes cause diarrhea as a side effect. Additionally, if the surgery involved the gastrointestinal tract, this direct manipulation can temporarily affect normal bowel function. Hospital-acquired infections like C. difficile can also cause diarrhea, particularly if the child received antibiotics 1.
According to the ESPEN expert group, probiotics have been shown to be useful in the treatment of gastrointestinal infections, for oral rehydration therapy in treating acute infectious diarrhea in children, and antibiotic-associated diarrhea in both children and adults 1. The 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea recommend reduced ORS as the first-line therapy of mild to moderate dehydration in infants, children, and adults with acute diarrhea from any cause 1.
Key points to consider in the management of diarrhea in children after surgery include:
- Ensuring adequate hydration with oral rehydration solutions like Pedialyte
- Gradually reintroducing a normal diet
- Possibly using probiotics to restore gut flora
- Monitoring for signs of severe diarrhea, such as blood, high fever, or persistence beyond a few days, which may indicate a more serious complication requiring specific treatment 1.
It is essential to note that the management of diarrhea in children after surgery should prioritize the prevention of dehydration and the restoration of normal gut flora, and that probiotics may be a useful adjunct in this management, as suggested by the ESPEN expert group 1.
From the Research
Causes of Diarrhea in Children Post-Operation
- Antibiotics prescribed to children can alter the microbial balance within the gastrointestinal tract, commonly resulting in antibiotic-associated diarrhea (AAD) 2
- Gastrointestinal infections, viral and bacterial, are primary causes of acute diarrhea in children 3
- Other factors such as alimentary intoxications can also contribute to diarrhea in children 3
Role of Probiotics in Preventing Diarrhea
- Probiotics may prevent AAD via restoration of the gut microflora 2
- Moderate quality evidence suggests a protective effect of probiotics in preventing AAD, with Lactobacillus rhamnosus or Saccharomyces boulardii being potentially effective strains 2, 4, 5
- Probiotics have been shown to reduce the duration of diarrhea in children with acute gastroenteritis 4
Other Factors to Consider
- Dehydration and negative nutritive balance are main complications of diarrhea in children, emphasizing the importance of fluid and dietary management 3
- Antiemetics, antidiarrhetics, and spasmolytics are not recommended for children with diarrhea due to potential risks 3
- Further research is needed to fully understand the efficacy and safety of probiotics in preventing and treating diarrhea in children, particularly in certain populations such as those with underlying medical conditions 2, 6, 5