How to Restore Appetite in a 1.5-Year-Old After Salmonella Infection?

The child, aged 1.5 years, has been experiencing a Salmonella infection for 2 weeks and is showing a lack of appetite?

My daughter is 18 months old.
On the morning of November 16, she had a fever without any cold symptoms, and experienced her first febrile seizure, which led us to the emergency room.
Blood tests showed a white blood cell count of 27,000.
The doctor suspected a urinary tract infection and admitted her for observation, administering a 7-day course of antibiotics (she was hospitalized for a total of 7 days).
Starting on the third day, she began having 7-8 loose stools a day, which had a foul smell but no blood.
The doctor tested her stool, and on the seventh day, confirmed it was Salmonella.
Since she had completed the 7-day course of antibiotics, she was discharged.

After returning home, without IV fluids, my daughter has only been drinking a maximum of 350cc of milk per day for the past 6 days.
She shows no interest in any food and has no desire to drink water, only managing to sip a few spoonfuls of hot soup.
She continues to have diarrhea, which is non-bloody but thick and has a bad odor.
During her hospital stay, she caught a cold, and yesterday we visited a pediatrician who prescribed nasal and cough medication along with more antibiotics.

I am concerned whether the antibiotics are affecting the clearance of Salmonella.
What should I do to help my child regain her appetite (she has shown no interest in food for 15 days), and what further treatments should I consider? Thank you.
How long does Salmonella typically last?

Teresa, 30~39 year old female. Ask Date: 2020/11/28

Dr. Xiao Kaiwen reply Pediatrics

Although antibiotic treatment is not always necessary for Salmonella enteritis (as it may prolong the duration of bacterial shedding), it is still recommended for more severe infections.
Given that your child is younger and has significantly elevated white blood cell counts, antibiotic treatment is advisable.
After a severe gastroenteritis episode, the gastrointestinal tract is still in the recovery phase, and appetite may not return to normal immediately; it may take time to recover, and this cannot be forced.
It is more important to monitor for signs of dehydration (such as lethargy, not urinating for 8 hours, or reduced tears when crying, etc.).
If there are mild signs of dehydration, you can first try oral electrolyte solutions for rehydration.
If there is no improvement, hospitalization for intravenous fluid therapy may be necessary.
The duration of Salmonella enteritis can vary depending on individual immunity and the rate of bacterial clearance; generally, if there are no severe toxic symptoms, antibiotic treatment is not required.

Reply Date: 2020/11/28

More Info

Restoring appetite in a 1.5-year-old child after a Salmonella infection can be a challenging process, especially considering the potential complications and the child's previous hospitalization. Salmonella infections can lead to gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain, which can significantly affect a child's desire to eat and drink. Here are some strategies and considerations to help restore your child's appetite and overall health.

Understanding the Situation
After a Salmonella infection, it is common for children to experience a loss of appetite. The infection can cause inflammation in the gut, leading to discomfort and a decreased desire to eat. Additionally, the antibiotics used during the hospital stay can disrupt the natural gut flora, further complicating recovery. It is essential to ensure that your child is adequately hydrated, as dehydration can occur due to diarrhea and reduced fluid intake.

Steps to Restore Appetite
1. Hydration is Key: Since your child is only drinking a limited amount of milk and some soup, it is crucial to encourage fluid intake. Offer small sips of water, oral rehydration solutions, or diluted fruit juices to keep her hydrated. Avoid sugary drinks, as they can worsen diarrhea.

2. Small, Frequent Meals: Instead of trying to get your child to eat large meals, offer small, frequent meals throughout the day. This approach can be less overwhelming and may encourage her to eat more. Focus on nutrient-dense foods that are easy to digest, such as bananas, rice, applesauce, and toast (the BRAT diet).

3. Introduce Probiotics: Probiotics can help restore the balance of good bacteria in the gut, which may have been disrupted by the infection and antibiotics. Foods like yogurt (if tolerated) or probiotic supplements specifically designed for children can be beneficial. Always consult your pediatrician before introducing new supplements.

4. Appealing Foods: Make meals visually appealing and fun. Use cookie cutters to create shapes or involve her in the meal preparation process. Sometimes, children are more inclined to eat if they feel involved.

5. Avoid Force-Feeding: While it can be frustrating to see your child refuse food, forcing her to eat can create negative associations with mealtime. Instead, offer food without pressure and allow her to eat at her own pace.

6. Monitor Symptoms: Keep an eye on her diarrhea and any other symptoms. If diarrhea persists or worsens, or if she shows signs of dehydration (such as dry mouth, decreased urination, or lethargy), seek medical attention promptly.

7. Follow-Up with Healthcare Providers: Since your child has been prescribed additional medications for her cold, it’s essential to follow up with her pediatrician. Discuss her ongoing symptoms, appetite issues, and any concerns regarding the antibiotics and their impact on her recovery.

Duration of Salmonella Symptoms
The duration of Salmonella symptoms can vary. In many cases, gastrointestinal symptoms may last for several days to a week, but it can take longer for a child's appetite to return to normal. Some children may experience lingering effects, such as mild diarrhea or changes in appetite, for weeks after the initial infection.

Conclusion
Restoring appetite in a young child after a Salmonella infection requires patience and a gentle approach. Focus on hydration, small meals, and appealing food options while monitoring her symptoms closely. If her appetite does not improve or if you have concerns about her health, do not hesitate to reach out to her healthcare provider for further guidance. Remember, recovery can take time, and each child’s response to illness is unique.

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