Tag: diarrhea

Understanding the Risks and Benefits of Drinking Raw Milk

Understand the many risks of drinking raw milk and don't be fooled by propaganda, such as that 'raw milk heals.'
Understand the many risks of drinking raw milk and don’t be fooled by propaganda, such as that ‘raw milk heals.’ (CC BY 2.0)

Surprisingly, more and more people are starting to drink raw, unpasteurized cow’s milk.

Or maybe that shouldn’t be too surprising as most people associate things that are raw or natural as being safer and healthier for them, often without understand the consequences.

Unfortunately, drinking raw milk can be dangerous, especially for young children.

There are plenty of risks and no real health benefits.

Drinking Raw Milk

Just as you would have thought, is basically “straight from the cow,” and hasn’t been processed or pasteurized.

Although most experts consider pasteurization to be one of the most important health advances of the last century, some people think that it removes nutrients and kills beneficial bacteria. They also claim that raw milk can taste better than pasteurized milk, which if you believe it, is really the only possible benefit of drinking raw milk.

It’s not even a good way to avoid growth hormones in milk, as most milk is now growth hormone free anyway and is labeled rBST-free.

Is raw milk healthier than pasteurized milk? There is no research to support that raw milk is healthier or, according to the FDA, that there is a “meaningful difference between the nutrient content of pasteurized and unpasteurized milk.”

In fact, the American Academy of Pediatrics states that “substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections.”

Dangers of Drinking Raw Milk

According to the FDA, raw milk can be contaminated with bacteria, including:

  • Brucella species
  • Campylobacter jejuni
  • Coxiella Burnetii
  • Escherichia coli
  • Enterotoxigenic Staphylococcus aureus
  • Listeria monocytogenes
  • Mycobacterium bovis
  • Mycobacterium tuberculosis
  • Salmonella species
  • Yersinia enterocolitica

These bacteria can cause people to get sick, leading to symptoms such as diarrhea, vomiting, fever, stomach cramps, and headaches. The Centers for Disease Control and Prevention reports that about 200 to 300 people get sick each year from drinking raw milk or eating cheese made from raw milk.

Another big danger of drinking raw milk that some people may overlook is that raw milk is very low in vitamin D. In addition to being pasteurized, processed milk that you routinely buy in a store is typically fortified with vitamin D, which is important to keep your bones strong.

Since young children are at big risk for getting sick from any bacteria that may be in raw milk and they need vitamin D, it is important that you not give your child raw, unpasteurized cow’s milk. In fact, the American Academy of Pediatrics states that “children should not consume unpasteurized milk or products made from unpasteurized milk, such as cheese and butter, from species including cows, sheep, and goats.”

We will have to add unpasteurized camel milk to the list, as that seems to be a thing now too.

Keep in mind that kids should also avoid unpasteurized fruit juices, including unpasteurized apple juice and apple cider.

Lastly, raw milk is about the same as whole milk in terms of fat content and calories. Experts recommend that children start drinking reduced fat milk, which has less fat and calories than whole milk, beginning at age two, you won’t be able to do that if your kids are drinking raw milk.

What To Know About Drinking Raw Milk

If you are still thinking of giving your child raw milk, keep in mind that “the AAP strongly supports the position of the FDA and other national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants, and children.”

And remember that you are basically giving raw milk to your kids because you think it tastes better, as it certainly isn’t better for them, is missing key nutrients, and it could be contaminated with dangerous bacteria.

More Information on Drinking Raw Milk:

What is Causing your Child’s Diarrhea?

Often described as the "cruise ship virus," you can get norovirus infections in daycare centers, schools, or after eating at a restaurant.
Often described as the “cruise ship virus,” you can get norovirus infections in daycare centers, schools, or after eating at a restaurant. (CC BY-SA 2.0)

Why does your child have diarrhea?

Could it be the “stomach flu,” food poisoning, or just an intolerance to something your child eat?

Common Causes of Diarrhea

While parents often quickly jump to the idea of “food poisoning,”  infections are typically the most common cause of diarrhea in kids.

These include:

  • viruses – rotavirus (a vaccine preventable disease), adenovirus, and norovirus
  • bacteria – C. diff, Salmonella, Shigella, E. coli, Campylobacter jejuni, Bacillus cereus, Listeria, Cholera
  • parasites – Cryptosporidium, Giardia, Cyclospora

Not all diarrhea is caused by infections though. If the diarrhea lingers for more than a few weeks or keeps coming and going, then you might consider that your child might have a lactose intolerance, irritable bowel syndrome, Celiac disease,  or other non-infectious cause.

Hints of Diarrhea Causes and Risk Factors

To help figure out what might be causing your child’s diarrhea, consider these questions and share the answers with your pediatrician:

  • Does your child have bloody diarrhea (sometimes a sign of a bacterial infection)?
  • Is your child getting dehydrated? While that doesn’t tell you want is causing the diarrhea, it is a good sign that you need to seek medical attention.
  • Does your younger child (under age 2 to 4 years) have bloody diarrhea that is becoming jelly-like and episodes of severe, colicky abdominal pain (sign of intussusception)?
  • Is your child in daycare? Has anyone else recently been sick with diarrhea or vomiting?
  • Has your child recently been on antibiotics (a risk for C. diff)?
  • Does your toddler with diarrhea drink a lot of juice (Toddler’s diarrhea)?
  • Have you recently traveled out of the country (Traveler’s diarrhea)? Did your child get sick a few days later (could be a bacterial or viral cause) or a few weeks later (parasites have longer incubation periods)?
  • Has your child recently spent time on a lake or river and possibly drank untreated water (risk for Giardia infection)?
  • Do you have any high risk pets, including turtles, snakes, lizards (or other reptiles); frogs, salamanders, newts (or other amphibians); chicks, chickens, ducklings, ducks, geese, and turkeys (or other poultry); mice, rats, hamsters, and guinea pigs (or other rodents); or farm animals (all can be a risk for Salmonella)?
  • Have you recently visited a farm or petting zoo (risk for Salmonella and E. coli)?
  • Has your child recently visited a water park or public swimming pool (risk for Cryptosporidium)?
  • Does your child drink raw milk, unpasteurized juice, raw or undercooked eggs, or undercooked beef, pork, and poultry (risk for food poisoning)?
  • Has your child recently eaten leftover food that had been unrefrigerated for more than two hours (risk for food poisoning)?
  • Is the diarrhea worse after your child drinks a lot of milk or eats a lot of dairy (a sign of lactose intolerance)?
  • Does your child have alternating episodes of constipation and diarrhea (irritable bowel syndrome)?
  • In addition to chronic diarrhea, is your child irritable, with poor weight gain and other symptoms (a sign of Celiac disease)?
  • Does your child also have abdominal pain or just diarrhea?
  • Is your child taking any medications that might cause diarrhea as a side effect?

Once you have narrowed down the possibilities, blood and stool tests, including stool culture tests for bacteria, parasites, and viruses can sometimes help to figure out what is causing your child’s diarrhea. Keep in mind that these are usually reserved for diarrhea symptoms that are severe (bloody diarrhea, fever, weight loss, etc.)  or lingering for more than a few weeks.

And remember that the most common causes of diarrhea, including food poisoning and viral infections, typically go away on their own without treatment. In fact, you can make things worse if you treat some causes of diarrhea with antibiotics, including some Salmonella, Shigella, E. coli infections.

Still don’t know what is causing your child’s diarrhea? In addition to your pediatrician, a pediatric gastroenterologist can be helpful when your child has diarrhea.

What To Know About Diarrhea

While diarrhea is common in kids and we often don’t figure out the specific cause before it goes away on its own, there are clues that can help you figure out if your child’s diarrhea is caused by a virus, bacteria, parasite, or other condition.

For More Information on Diarrhea

Treating Hard to Control Vomiting and Diarrhea

Kids get vomiting and diarrhea for many reasons, but it is most often caused by a stomach virus.

Whatever the cause, even if it is something your child eat or food poisoning, you will want to know how to best manage your child’s symptoms to help them feel better quickly and prevent them from getting dehydrated.

Vomiting and Diarrhea

Although most people associate vomiting and diarrhea with the “stomach flu,” the flu virus doesn’t usually cause vomiting and diarrhea.

Instead, there are a number of other viruses, bacteria, and parasites that do, including:

  • rotavirus – a vaccine-preventable disease
  • norovirus – the “cruise ship virus,” but very common elsewhere too
  • Salmonella, Shigella, E. coli – food poisoning, animals
  • C. diff – associated with recent antibiotic use
  • Cryptosporidium – drinking contaminated water, swimming pools, water parks

If necessary, especially when diarrhea is associated with severe symptoms or is lingering, stool tests can be done to figure out the specific cause. Fortunately, diarrhea and vomiting often goes away on its own fairly quickly and these tests aren’t necessary. What will likely be necessary is keeping your child well hydrated until these symptoms stop.

Treating Vomiting and Diarrhea

For most kids with vomiting and diarrhea, you can:

  • continue breastfeeding on demand
  • continue their normal diet (feed through the diarrhea), including baby formula or milk, if they just have diarrhea and no vomiting or only occasional vomiting, giving extra fluids every time your child has diarrhea (about 3 ounces if your child is under 22 pounds and about 6 ounces if they are over 22 pounds)
  • forget about eating and concentrate on drinking if your child has a lot of vomiting, but start by offering very small amounts of fluid, perhaps starting with a teaspoon (5ml) every 5 or 10 minutes, and then slowly working your way up to a tablespoon (15ml) and than an ounce (30ml) or two over a few hours
  • take a break from drinking for 30 minutes if your child has a set back and begins vomiting again, and restart at 5ml, slowly working your way back up again as tolerated
  • watch closely for signs and symptoms of dehydration, including weight loss, decreased urine output (fewer wet diapers or going to the bathroom less often), no tears, or dry mouth with no saliva or spit, etc.

In general, when talking about fluids, we mean an oral rehydration solution, like Pedialyte. If your older child won’t drink Pedialyte, you can offer something like Gatorade, but keep in mind that sports drinks have more sugar, so can sometimes make diarrhea worse.

But do you really make your child eat and feed through the diarrhea if he doesn’t want to? Of course not. The idea is that you don’t restrict your child’s diet if they want to eat. If they are complaining of a stomach ache, just don’t feel good, or feeding them their regular diet makes the diarrhea or vomiting worse, then move to more bland food.

Treating Hard to Control Vomiting and Diarrhea

What if your child continues to have vomiting and diarrhea?

You should still avoid treating your younger child with over-the-counter remedies to stop diarrhea, including those with loperamine (Imodium) or bismuth subsalicylate (Kaopectate).

A prescription medication, Zofran (ondansetron), might be appropriate for some children with persistent vomiting who are at risk of getting dehydrated.

If your child has persistent vomiting and diarrhea, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any symptoms that might require immediate medical attention, such as high fever, bloody diarrhea, severe headache, severe abdominal pain, or signs of moderate to severe dehydration?
  • Has your child with chronic diarrhea (diarrhea for more than four weeks) been losing weight, had fever, or regular stomach pains?
  • Does your otherwise well toddler have chronic, watery diarrhea even though no one else has been sick, a possible sign of Toddler’s diarrhea?
  • Do you have any pets or contact with pets that could put your child at risk for a Salmonella infection, including turtles, lizards, snakes, and frogs?
  • Has your child visited a farm or petting zoo, which puts him at risk for a Salmonella or E. coli infection?
  • Did your child recently take an antibiotic, which puts him at risk for a C. diff infection?
  • Has your child been drinking raw milk or other high risk foods?
  • Has your child traveled recently, which puts him at risk for traveler’s diarrhea?
  • Did you put your child on the BRAT diet (bananas, rice, applesauce, and toast) even though they were eager to eat?
    Have you tried giving your child a probiotic?
  • Does your child now only have diarrhea after drinking milk, perhaps a sign of a temporary lactose deficiency?
  • Is your child better, with much less vomiting, but you are just frustrated that the diarrhea hasn’t gone away yet?
  • Is your child better, with much less vomiting, but you are just frustrated that she is still vomiting at least once each day?

While you should certainly call your pediatrician if your child’s symptoms are lingering, remember that almost everything about the idea of the “24 hour stomach flu” you have heard is probably wrong. In addition to the fact that it isn’t caused by the flu virus, the symptoms typically last more than 24 hours, at least in kids. The vomiting may get better in 24 hours, but diarrhea can easily linger for a week or two.

It is also important to keep in mind that most causes of vomiting and diarrhea are very contagious and can easily spread through the whole house if you aren’t careful. Remember to always wash hands, rinse fruits and vegetables, clean and disinfect contaminated surfaces, and don’t share food or drinks, etc. If you just do it when your kids are sick, it will be too late, as many illnesses are contagious even before you show symptoms.

What To Know About Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

More Information On Treating Hard to Control Vomiting and Diarrhea

Rotavirus Vaccines and Infections

Rotavirus is a now vaccine-preventable disease that can cause vomiting and diarrhea in young children.

While rotavirus isn’t the only cause of diarrhea in children, it was once the most common cause of severe diarrhea in young children.

Norovirus, several bacteria (Salmonella and Shigella), parasites, and other organisms still cause gastroenteritis (stomach flu) in children, but we don’t see rotavirus as much anymore. The National Respiratory and Enteric Virus Surveillance System (NREVSS) now reports low levels of rotavirus infection each year, with only about 5% of rotavirus tests now being positive during the peak of rotavirus season vs over 25% in the pre-vaccine era.

Rotavirus Infections

Children can develop symptoms of rotavirus symptoms about 1 to 3 days after being exposed to someone else who is sick with a rotavirus infections (the incubation period). These symptoms could include vomiting, watery diarrhea (without blood or mucus), fever, and abdominal pain. Although the fever and vomiting typically only last a few days, the diarrhea can often last at least 3 to 8 days or longer.

A rapid antigen stool test is available to test for rotavirus, but the diagnosis a typically made clinically, which means without testing and based on your child’s symptoms, especially if rotavirus infections are going around in your community.

Of course getting diagnosed with rotavirus is much less likely these days, now that we have a safe and effective vaccine.

While rotavirus was once the most common cause of severe diarrhea in children, leading to about 3 million cases of diarrhea, 55,000 hospitalizations, and 20 to 40 deaths in the United States each year, that has been greatly reduced in the post-vaccine era.

During the 2007-2008 rotavirus season, rotavirus activity decreased by more than 50% as compared to the 15 previous rotavirus seasons from 1991 to 2006. And during the 2010 to 2012 seasons, “the number of positive rotavirus tests declined 74%-90% compared with the pre-vaccine baseline and the total number of tests performed annually declined 28%-36%.”

Rotavirus Vaccines

The first rotavirus vaccine, Rotashield was quickly taken off the market in 1999 after it was found to be associated with an increased risk of intussusception, a type of bowel obstruction.

Newer rotavirus vaccines include:

  • RotaTeq – approved in 2006 and given to infants as a 3 dose vaccine series, it provides protection against five common strains of rotavirus, including serotypes G1, G2, G3, G4 and P1
  • Rotarix – approved in 2008 and given to infants as a 2 dose vaccine series, it provides protection against the most strain of rotavirus that most commonly gets kids sick

Both are live vaccines that are given orally and are thought to provide protection for at least two to three rotavirus seasons.

How good is that protection?

Completing either series of vaccines has been found to provide up to 98% protection against severe rotavirus gastroenteritis and up to 87% against any rotavirus gastroenteritis.

Infants should not get a rotavirus vaccine if they have had a severe allergic to a previous dose of the vaccine, to latex, if they have a history of intussusception, or if they have severe combined immunodeficiency (SCID).

They can usually get the rotavirus vaccine if they simply have some chronic stomach issues, like acid reflux or a milk intolerance, or if someone in the house has a problem with their immune system (just wash your hands after diaper changes). An immune system problem that is not SCID, an episode of acute, moderate or severe gastroenteritis, or other acute illness would be considered precautions to getting the rotavirus vaccine.

What To Know About Rotavirus

Rotavirus is a life-threatening disease that was once very common in childhood but can now be easily prevented with either the RotaTeq or Rotarix vaccines.

 

Sources:

American Academy of Pediatrics. Rotavirus infections. In:Pickering LK, Baker CJ, Long SS, eds. RedBook: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2015

Gershon: Krugman’s Infectious Diseases of Children, 11th ed.

Live attenuated human rotavirus vaccine, Rotarix. Bernstein DI – Semin Pediatr Infect Dis – 01-OCT-2006; 17(4): 188-94.

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact, Environmental Contamination, and Unknown Modes of Transmission — United States, 2009–2013. MMWR. December 11, 2015 / 64(SS12);1-16

Tate JE et al. Trends in national rotavirus activity before and after introduction of rotavirus vaccine into the national immunization program in the United States, 2000 to 2012. Pediatr Infect Dis J. 2013;32(7):741-744.