What is Traveller's Diarrhoea?

Traveller's Diarrhoea (TD) is a prevalent health concern, particularly affecting children, and is defined as the passage of three or more loose or watery stools within 24 hours during or after travel.¹ The significance of addressing TD in children cannot be overstated. Children, due to their developing immune systems and smaller body size, are considerably more vulnerable to the effects of TD, facing a higher risk of dehydration and potential complications that can hold back their development.

Therefore, the implementation of proactive preventative measures and the provision of timely, appropriate treatment are essential to safeguarding their well-being during travel.

Causes of TD

The primary cause of TD is the ingestion of food or water contaminated with pathogenic microorganisms. Among these, bacterial pathogens play a significant role. Escherichia coli (E. coli), particularly enterotoxigenic E. coli (ETEC), stands out as the most common bacterial culprit, responsible for a substantial proportion of TD cases.² Other bacterial agents that can cause TD include Salmonella, Shigella, and Campylobacter, each posing a risk depending on the region and sanitary conditions.

Viral pathogens also contribute to the occurrence of TD, especially in younger children. Rotavirus, norovirus, and adenovirus are among the viruses that can cause gastrointestinal distress during travel.

Furthermore, parasitic organisms such as Giardia lamblia and Cryptosporidium can cause persistent diarrhoea, presenting a challenge in both diagnosis and treatment.

Beyond microbial causes, other factors such as poor hygiene practices, abrupt changes in diet, and exposure to unfamiliar environments can increase susceptibility to TD.⁵

Symptoms of TD

The symptoms of TD in children can vary, but the most common symptom is the frequent passage of loose, watery stools. This primary symptom is often accompanied by abdominal cramps, nausea, and vomiting, which can further contribute to discomfort and dehydration. In addition to these primary symptoms, secondary symptoms such as fever may manifest, indicating the body's response to infection. A significant concern is dehydration, which can be identified by signs such as dry mouth, decreased urination, and lethargy. In severe cases, the presence of blood in the stools may indicate a more serious infection that requires immediate medical attention.

How to prevent TD?

Preventing TD in children requires a multifaceted approach, with a strong emphasis on food and water safety. The proverb "boil it, cook it, peel it, or forget it" serves as a fundamental guideline for ensuring food safety.⁶

Drinking bottled or purified water is crucial, as tap water in many regions may be contaminated. Additionally, avoiding raw or undercooked foods, including unpasteurised dairy products, is essential to minimise the risk of infection.

When considering street food, taking caution is vital, as the sanitary conditions may be uncertain. Maintaining rigorous hygiene practices is equally important. Frequently washing hands with soap and water, especially before meals and after using the restroom, is critical. When soap and water are unavailable, the use of alcohol-based hand sanitiser is recommended.

The vaccinations play an important role in preventing certain causes of TD. Rotavirus vaccination is recommended for infants, protecting against a common viral cause of diarrhoea.⁷ Depending on the travel destination, other vaccines may be recommended. Therefore, consulting a healthcare provider is essential.

The use of probiotics has been suggested as a potential preventative measure, but it is advisable to consult a doctor before incorporating probiotics into a child's routine.⁸

How to treat TD?

When TD occurs, the primary focus of treatment is rehydration. Oral rehydration solutions (ORS) are the cornerstone of management, providing a balanced mix of electrolytes and fluids to replenish those lost due to diarrhoea ⁹. Administering small, frequent sips of ORS is more effective than giving large amounts at once. It is crucial to avoid sugary drinks, as they can exacerbate diarrhoea by drawing water into the intestines.

Dietary management is also important. The BRAT diet, consisting of Bananas, Rice, Applesauce, and Toast, is often recommended as it provides easily digestible foods that are gentle on the stomach. Avoiding dairy and fatty foods until symptoms subside is also advisable.

In some cases, medications may be necessary. Anti-diarrheal medications should only be used under a doctor's supervision in children, as inappropriate use can lead to complications.

It is crucial to seek medical attention when certain warning signs are present. Signs of severe dehydration, such as significant fatigue, decreased urination, and sunken eyes, indicate the need for immediate medical attention. The presence of blood in the stools, a high fever, persistent vomiting, or symptoms lasting longer than a few days are also indications that medical evaluation is necessary. 

FAQs

What exactly is Traveller's Diarrhoea (TD) in children? 

TD is defined as the passage of three or more loose or watery stools within 24 hours during or after travel. It's a common ailment, especially in children, due to their developing immune systems. 

What are the main causes of TD in children? 

The primary causes are bacteria (especially E. coli), viruses (such as rotavirus and norovirus), and parasites (such as Giardia). Contaminated food and water are the primary modes of transmission. 

What are the common symptoms of TD in children? 

Common symptoms include frequent loose, watery stools, abdominal cramps, nausea, vomiting, fever, and signs of dehydration (dry mouth, decreased urination, lethargy).

How can I prevent my child from getting TD while travelling? 

Preventative measures include: practising strict food and water safety; drinking bottled or purified water; maintaining good hygiene, especially frequent handwashing; ensuring appropriate vaccinations, such as the rotavirus vaccine for infants; and consulting a doctor about probiotics.

What should I do if my child gets TD while travelling? 

The primary treatment is rehydration with oral rehydration solutions (ORS). Follow the BRAT diet (bananas, rice, applesauce, toast) and avoid sugary, fatty, and dairy foods. Consult a doctor before using any medications.

When should I seek medical attention for my child with TD?

Seek medical attention immediately if your child shows signs of severe dehydration, has bloody stools, a high fever, persistent vomiting, or symptoms that last more than a few days. 

Is it safe to give my child anti-diarrheal medications? 

Anti-diarrheal medications should only be given to children under the supervision of a doctor, as inappropriate use can lead to complications.

Can vaccinations prevent TD? 

Yes, certain vaccinations, such as the rotavirus vaccine, can prevent specific causes of TD. Consult with a healthcare provider about recommended vaccinations based on your travel destination. 

Are probiotics helpful in preventing TD in children?

Probiotics may offer some protection, but it's essential to consult with a doctor before giving them to a child. 

What is the BRAT diet, and why is it recommended for children with TD? 

The BRAT diet (Bananas, Rice, Applesauce, Toast) consists of easily digestible foods that are gentle on the stomach. It helps to settle the digestive system during episodes of diarrhoea.

Why are children more vulnerable to TD than adults? 

Children have developing immune systems and smaller body sizes, making them more susceptible to infections and more vulnerable to dehydration, which can lead to serious complications. 

Summary

Traveller's diarrhoea is a common illness in children during or after travel, characterised by frequent loose stools. It's primarily caused by consuming contaminated food or water, with bacteria like E. coli being the most frequent culprits. Symptoms include diarrhoea, abdominal cramps, nausea, vomiting, and potential dehydration. Prevention focuses on food and water safety, hygiene, and vaccinations. Treatment emphasises rehydration with oral rehydration solutions and dietary management. Medical attention is necessary for severe symptoms like bloody stools or persistent vomiting.