Persistent Diarrhea with Mucus and Blood in Infants

Persistent diarrhea with mucus and streaks of blood?

The child is currently 8 months and 10 days old.
Since May 19, he has been experiencing diarrhea with mucus and blood-streaked stools.
At the clinic, the doctor diagnosed it as Salmonella infection.
After two weeks of medication, the doctor discontinued the treatment, and the child continued to take probiotics (益腹寧).
During the medication period, the stools only contained mucus.
However, two days after stopping the medication, on June 2, blood-streaked mucus stools reappeared.
A stool culture at Mackay Memorial Hospital showed no Salmonella.
The pediatrician mentioned that a small amount of blood-streaked stools is not a concern and that it might be the later stage of the infection where Salmonella is no longer detectable, indicating recovery.
The child continued taking probiotics, but during this period, the stools remained mucous.

Starting June 28, diarrhea with blood-streaked mucus occurred up to seven times a day, prompting a visit to the emergency department at Mackay, where the child was referred to pediatric gastroenterology.
Another stool culture was performed, again showing no Salmonella.
The doctor stated that since both cultures did not show Salmonella, it is likely resolved.
Mucus in the stool is acceptable as long as the child is in good spirits.
However, since June 28, the child has been experiencing diarrhea every time he eats, and new complementary foods seem to exacerbate the issue, resembling chronic diarrhea.
If the child has more than four bowel movements a day, he needs to take anti-diarrheal medication prescribed by the Mackay doctor.
During this time, the child has only been consuming breast milk, rice porridge, and some electrolyte solution (the child has been exclusively breastfed since birth; the gastroenterologist at Mackay advised against stopping breastfeeding, suggesting it would be beneficial for recovery).

However, today, July 15, blood-streaked mucus stools have reappeared.
The mother is concerned about why there is still mucus in the stools despite the absence of Salmonella.
Should they wait for natural recovery? What can be done to help the child recover quickly? (The child's weight has not increased during these two months.) The stools sometimes appear light yellow and watery with mucus, while other times they are greener.

Dora, 30~39 year old female. Ask Date: 2008/07/15

Dr. Pei Rensheng reply Pediatrics

Dear Dora,
Hello!
1.
If diarrhea lasts more than two weeks, it is classified as chronic diarrhea.
Conditions such as enteritis, food allergies, genetic factors, and immune issues can all contribute to chronic diarrhea.
Your baby is likely experiencing post-infectious diarrhea due to the intestinal mucosa or villi not fully recovering after the Salmonella enteritis.
2.
Please continue breastfeeding, as it contains antibodies and rich nutrients that are very beneficial for a baby with diarrhea.
3.
You may continue giving probiotics like Bifidobacterium, and it would be prudent to be conservative with food additives for now.
I believe your baby will soon have healthy stools and a robust gastrointestinal system.
Wishing you peace and health,
Dr.
Pei Ren-sheng
Director, Pediatric Department
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2008/07/15

More Info

Persistent diarrhea with mucus and blood in infants can be a concerning issue for parents, especially when it seems to persist despite medical intervention. In your case, your 8-month-old child has been experiencing diarrhea with mucus and blood since May, and it appears that the situation has not improved significantly even after treatment.
From the information provided, it seems that the initial diagnosis was a Salmonella infection, which can indeed cause gastrointestinal symptoms such as diarrhea, mucus, and blood in the stool. However, after two weeks of treatment, the stool cultures did not show any signs of Salmonella, which suggests that the infection may have resolved. The presence of mucus and blood in the stool can be indicative of several underlying issues, including inflammation of the intestinal lining, which can occur after an infection, or even food intolerances.

The fact that your child has been on a diet primarily consisting of breast milk and has recently started solid foods could also be a contributing factor. Introducing new foods can sometimes lead to gastrointestinal upset, especially if the infant has a sensitivity or intolerance to certain ingredients. Additionally, the use of probiotics like益腹寧乳酸菌 (Lactobacillus) is generally beneficial for gut health, but it may take time for the gut flora to stabilize after an infection.

The presence of blood in the stool, even if it is minimal, should always be taken seriously. While your pediatrician has indicated that a small amount of blood may not be a cause for alarm, it is essential to monitor your child closely. If the blood persists or increases in quantity, or if your child shows signs of dehydration, lethargy, or any other concerning symptoms, it is crucial to seek immediate medical attention.

Chronic diarrhea in infants can lead to malnutrition and failure to thrive, which is concerning given that you mentioned your child's weight has not increased during this period. It is vital to ensure that your child is receiving adequate nutrition and hydration. Continuing breastfeeding is beneficial, as breast milk provides essential nutrients and antibodies that can help support your child's recovery. However, if solid foods are being introduced, it may be worth consulting with a pediatric gastroenterologist to determine if there are specific foods that should be avoided or if a specialized diet is necessary.

In terms of management, here are some steps you can take to help your child recover:
1. Hydration: Ensure that your child is adequately hydrated. Oral rehydration solutions can be beneficial if diarrhea persists.

2. Dietary Adjustments: Consider a bland diet that is easy on the stomach. Foods like bananas, rice, applesauce, and toast (the BRAT diet) can be gentle on the digestive system. Avoid high-fiber foods, dairy, and sugary foods until the diarrhea resolves.

3. Probiotics: Continue with the probiotics as they can help restore the natural gut flora. However, consult your pediatrician about the appropriate strains and dosages.

4. Monitoring Symptoms: Keep a close eye on your child's symptoms, including the frequency and consistency of stools, any new symptoms, and overall behavior. If there are any changes or worsening of symptoms, seek medical advice promptly.

5. Follow-Up: Regular follow-ups with your pediatrician or a pediatric gastroenterologist are essential to monitor your child's progress and adjust treatment as necessary.

In conclusion, while it can be frustrating and worrisome to deal with persistent diarrhea in your infant, it is crucial to remain vigilant and proactive in seeking medical advice and support. With appropriate care and monitoring, many infants recover from these gastrointestinal issues and return to their normal health.

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