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The one Minute Counselor
;0
fhe .
,; Vo ne Minute o ~~ Counselor What Is Norman
Parents sometimes find it hard to know what should be going on where their children's bathroom habits are concerned. Commonly, newborn infants who are breast-fed can have soft bowel movements as many as 12 times a day-and this is normal. Yet, many older children have bowel movements as seldom as once every three or four days-and this is also normal. How can you decide when too many bowel movements mean that your child has diarrhea and when too few bowel movements mean that your child is constipated? If You Suspect Diarrhea
Diarrhea is more than just frequent bowel movements. If your child's bowel movements are consistently liquid and runny, it is diarrhea and needs your attention. Diarrhea that goes on too long-more than 24 hours for an infant and more than five days for an older c~d-is a serious problem. Prolonged diarrhea can lead to harmful imbalances of water and natural chemicals (called electrolytes) in your child's body. Watch for signs of dehydration. Call your doctor immediately if: • Your child's urine is dark yellow, or urination becomes less frequent (often seen in a decreased number of wet diapers per day). • Your child's skin changes--dehydrated skin is not as elastic as normal skin and can look like the skin of a very old person. • Your child cries without producing tears. • Your child has a dry mouth. • Your child's eyes look sunken. • Your child's bowel movements contain blood. Diarrhea can be caused by viral and bacterial infections, congenital disorders, intolerance to food or formula or even the antibiotics your child m~y be taking to treat another infection. Regardless of the cause, treatment consists of getting your child's fluid and electrolyte balances back to normal. For severe diarrhea, your child may need to be hospitalized and receive fluids intravenously. For mild or moderate diarrhea, you can restore
A Parent's Guide to Pediatric Diarrhea and Constipation your child's fluid balance at home. What to Do
Most of the time, diarrhea can be controlled by a change in your child's diet. Follow these instructions: • Give your child clear liquids to help replace fluids. Avoid juices or flat sodas-these may actually increase diarrhea in infants and young children. If you give your older child Gatorade or a similar sports-drink product, be sure to dilute it to half strength with water or to choose a "lite" or low-sugar product. • Give your child Pedialyte, Infalyte, Rehydralyte, or a similar product to help replace electrolytes. Your pharmacist can tell you what products are available and advise you about how to give them to your child. • Keep your child on a normal diet including dairy products. Continue t~ breast-feed. If your infant is not better by the end of the day or if your older child is not better after three days, call your doctor. What Not to Do
• Most doctors no longer recommend withholding food for 24 hours or switching to the so-called BRATCbananas, rice, applesauce, and toast) diet. • Antidiarrheal over-the-counter medicines (such as Imodium and Kaopectate) are not recommended for young children. How to Keep Diarrhea from Coming Back
Cleanliness is the best way to keep a diarrheal infection from spreading. Keep your child clean. Keep the bathroom clean. Wash your hands thor0ughly after changing diapers or cleaning up an older child. Be sure to have older children wash their hands appropriately. If You Suspect Constipation
Constipation is more than just infrequent bowel movements. If your child has very hard stools or is in pain when a stool is passed, it is constipation, and you can do several things to help. Watch for signs that constipation is more serious. Call your doctor if: • Your child is in severe pain while having a bowel movement.
Photocopy this page and give it to appropriate patients.
• Your child has not had a bowel movement for more than four days. • Your child has a crack or fissure on the rectum. • Your child's bowel movements contain blood. Constipation may be a side effect of other illnesses or drug therapy. In some children, constipation may have a psychological element-for example, during toilet training, a child may withhold bowel movements and start a bout of constipation. If you have reason to suspect an emotional element to your child's constipation, discuss the situation with your doctor. Regardless of the cause, treatment consists of softening the child's stools to make them easier to pass. What to Do
As with diarrhea, constipation can usually be controlled by changing your child's diet: • Make sure your child drinks plenty of water. • Allow your child to stay active; activity or exercise may encourage bowel movements. • Make sure your child eats highfiber foods. Fruits, vegetables, and high-fiber breads are usually the first line of treatment for constipation. • Fruit juices-especially prune, pear, and apple juice-are sometimes the only treatment you will need. What Not to Do
• Don't give your child a laxative, lubricant, stimulant, or cathartic unless told to do so by your doctor. Mineral oil-an old-fashioned remedy-iS especially dangerous for infants. If your baby breathes in mineral oil, pneumonia can result. • Don't use rectal stimulation. • Don't use glycerin suppositories unless told to do so by your doctor. • Don't give your child an enema. How to Keep Constipation from Coming Back
Regular exercise and regular bathroom habits will help ease the problem of constipation for most children. If the problem continues however consult your child's doct~r. '
© 1995 by the American Pharmaceutical Association . All rights reserved.
Summary
References
Although the 1993 CDC treatment guidelines for STDs contained relatively few changes from the 1989 guidelines, some recently marketed medications now appear in the list of recommended and alternative treatment regimens. Pharmacists must consider differences in dosage formulations (intramuscular verSUS oral), cost, and length of treatment when choosing the antibiotic or antiviral to be listed in a hospital or managed care formulary. Additionally, pharmacists should recognize that some SID therapies are now given once daily instead of in a 7-day course. When an antibiotic or antiviral prescription order is presented, pharmacists should determine why the patient is receiving this therapy. Verifying the disease process will help the pharmacist counsel the patient on the therapy. In some instances, therapy may be appropriately administered in the emergency room or the pharmacy, to ensure that the patient complies with the medication regimen. Verifying compliance will be especially important for patients who are expected to ingest only one dose, rather than a seven-day course of therapy. By initiating such programs, pharmacists can help prevent drug-resistance problems and ensure compliance. Maura A. Kraynak, PharmD, is assistant professor, Department a/Pharmacology, and assistant director, Drug Information Service, at the University of Texas Health Science Center at San Antonio and editor of the "Women 's Health" series. Leroy C Knodel, PharmD, is associate professor, Department of Pharmacology, and director, Drug Information Service, at the center.
1. Centers for Disease Control and Prevention. 1993 STD treatment guidelines. MMWR. 1993;44(R-14):22-66.
2. Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR. 1993;42(RR-12):1-39. 3. Goldberg LH, Kaufman R, Kurtz TO, et al. Long-term suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group. Arch Dermatol. 1993;129:582-7. 4.
Drugs for sexually transmitted diseases. Med Lett Drugs Ther. 1994;36(913): 1-6.
5.
Knodel Le, Roush MK. Sexually transmitted diseases. In: DiPiro JT, Talbert RL, Hayes PE, et aI., eds. Pharmacotherapy: A Pathophysiologic Approach. 2nd ed. Norwalk: Appleton & Lange; 1993.
Women's Health Series This article is part of American Pharmacy's series on women's health, guest edited by Maura A. Kraynak, PharmD, assistant professor, Department of Pharmacology, and assistant director, Drug Information Service, University of Texas Health Science Center at San Antonio. The series is supported by an educational grant from Wyeth-Ayerst Laboratories.
~a4' WYETH
'
® ~~ AYERST
System Requirements • • • • • • • •
PC with a 386DX processor or better 8 megabytes of RAM 3.5",1.44 megabyte diskette drive 10 megabytes of disk space on drive C VGA monitor or better Mouse or pointing device MS DOS version 5.0 or higher Microsoft®Windows™version 3.1 or higher
QARx®for Windows™, Version 4.0 includes software, user's manual, and 60 days free customer support (nominal fees will be charged for subsequent support).
Code T17-2 Single-user version dec:ei1;traliZ¢d data entry from T "'.
tlielrtWlpo'rteci'Jllto QARx® for Windows
• •
clibLicall ~tegl()rn~S: adVerse drUg rea~ons, clinical interventions, drug inforevaluation; and errors. Da'ta ... and r~rt generation in tliese categories available upon installatio~. ~ports on these topics can be generated by simply filling in a few blanks and press~g a button. Users can also .produce reports by outcomes, by intervention codes, and by phannaCls.t. . TIie re~rts create attractive graphs, bar charts, and pie charts, enhancing presentation at meetings.
Vol. NS35, No.4
Apri11995
APhA Member Price ....... $495 APhA-ASP Member Price . ... $395 Nonmember Price ........ $595
Network version available. For a quotation, call APhA's Marketing Division at 1-800-237-2742, ext. 7556.
MERI
PHARM Y
fhe .
,; Vo ne Minute o ~~ Counselor What Is Norman
Parents sometimes find it hard to know what should be going on where their children's bathroom habits are concerned. Commonly, newborn infants who are breast-fed can have soft bowel movements as many as 12 times a day-and this is normal. Yet, many older children have bowel movements as seldom as once every three or four days-and this is also normal. How can you decide when too many bowel movements mean that your child has diarrhea and when too few bowel movements mean that your child is constipated? If You Suspect Diarrhea
Diarrhea is more than just frequent bowel movements. If your child's bowel movements are consistently liquid and runny, it is diarrhea and needs your attention. Diarrhea that goes on too long-more than 24 hours for an infant and more than five days for an older c~d-is a serious problem. Prolonged diarrhea can lead to harmful imbalances of water and natural chemicals (called electrolytes) in your child's body. Watch for signs of dehydration. Call your doctor immediately if: • Your child's urine is dark yellow, or urination becomes less frequent (often seen in a decreased number of wet diapers per day). • Your child's skin changes--dehydrated skin is not as elastic as normal skin and can look like the skin of a very old person. • Your child cries without producing tears. • Your child has a dry mouth. • Your child's eyes look sunken. • Your child's bowel movements contain blood. Diarrhea can be caused by viral and bacterial infections, congenital disorders, intolerance to food or formula or even the antibiotics your child m~y be taking to treat another infection. Regardless of the cause, treatment consists of getting your child's fluid and electrolyte balances back to normal. For severe diarrhea, your child may need to be hospitalized and receive fluids intravenously. For mild or moderate diarrhea, you can restore
A Parent's Guide to Pediatric Diarrhea and Constipation your child's fluid balance at home. What to Do
Most of the time, diarrhea can be controlled by a change in your child's diet. Follow these instructions: • Give your child clear liquids to help replace fluids. Avoid juices or flat sodas-these may actually increase diarrhea in infants and young children. If you give your older child Gatorade or a similar sports-drink product, be sure to dilute it to half strength with water or to choose a "lite" or low-sugar product. • Give your child Pedialyte, Infalyte, Rehydralyte, or a similar product to help replace electrolytes. Your pharmacist can tell you what products are available and advise you about how to give them to your child. • Keep your child on a normal diet including dairy products. Continue t~ breast-feed. If your infant is not better by the end of the day or if your older child is not better after three days, call your doctor. What Not to Do
• Most doctors no longer recommend withholding food for 24 hours or switching to the so-called BRATCbananas, rice, applesauce, and toast) diet. • Antidiarrheal over-the-counter medicines (such as Imodium and Kaopectate) are not recommended for young children. How to Keep Diarrhea from Coming Back
Cleanliness is the best way to keep a diarrheal infection from spreading. Keep your child clean. Keep the bathroom clean. Wash your hands thor0ughly after changing diapers or cleaning up an older child. Be sure to have older children wash their hands appropriately. If You Suspect Constipation
Constipation is more than just infrequent bowel movements. If your child has very hard stools or is in pain when a stool is passed, it is constipation, and you can do several things to help. Watch for signs that constipation is more serious. Call your doctor if: • Your child is in severe pain while having a bowel movement.
Photocopy this page and give it to appropriate patients.
• Your child has not had a bowel movement for more than four days. • Your child has a crack or fissure on the rectum. • Your child's bowel movements contain blood. Constipation may be a side effect of other illnesses or drug therapy. In some children, constipation may have a psychological element-for example, during toilet training, a child may withhold bowel movements and start a bout of constipation. If you have reason to suspect an emotional element to your child's constipation, discuss the situation with your doctor. Regardless of the cause, treatment consists of softening the child's stools to make them easier to pass. What to Do
As with diarrhea, constipation can usually be controlled by changing your child's diet: • Make sure your child drinks plenty of water. • Allow your child to stay active; activity or exercise may encourage bowel movements. • Make sure your child eats highfiber foods. Fruits, vegetables, and high-fiber breads are usually the first line of treatment for constipation. • Fruit juices-especially prune, pear, and apple juice-are sometimes the only treatment you will need. What Not to Do
• Don't give your child a laxative, lubricant, stimulant, or cathartic unless told to do so by your doctor. Mineral oil-an old-fashioned remedy-iS especially dangerous for infants. If your baby breathes in mineral oil, pneumonia can result. • Don't use rectal stimulation. • Don't use glycerin suppositories unless told to do so by your doctor. • Don't give your child an enema. How to Keep Constipation from Coming Back
Regular exercise and regular bathroom habits will help ease the problem of constipation for most children. If the problem continues however consult your child's doct~r. '
© 1995 by the American Pharmaceutical Association . All rights reserved.
Summary
References
Although the 1993 CDC treatment guidelines for STDs contained relatively few changes from the 1989 guidelines, some recently marketed medications now appear in the list of recommended and alternative treatment regimens. Pharmacists must consider differences in dosage formulations (intramuscular verSUS oral), cost, and length of treatment when choosing the antibiotic or antiviral to be listed in a hospital or managed care formulary. Additionally, pharmacists should recognize that some SID therapies are now given once daily instead of in a 7-day course. When an antibiotic or antiviral prescription order is presented, pharmacists should determine why the patient is receiving this therapy. Verifying the disease process will help the pharmacist counsel the patient on the therapy. In some instances, therapy may be appropriately administered in the emergency room or the pharmacy, to ensure that the patient complies with the medication regimen. Verifying compliance will be especially important for patients who are expected to ingest only one dose, rather than a seven-day course of therapy. By initiating such programs, pharmacists can help prevent drug-resistance problems and ensure compliance. Maura A. Kraynak, PharmD, is assistant professor, Department a/Pharmacology, and assistant director, Drug Information Service, at the University of Texas Health Science Center at San Antonio and editor of the "Women 's Health" series. Leroy C Knodel, PharmD, is associate professor, Department of Pharmacology, and director, Drug Information Service, at the center.
1. Centers for Disease Control and Prevention. 1993 STD treatment guidelines. MMWR. 1993;44(R-14):22-66.
2. Centers for Disease Control and Prevention. Recommendations for the prevention and management of Chlamydia trachomatis infections, 1993. MMWR. 1993;42(RR-12):1-39. 3. Goldberg LH, Kaufman R, Kurtz TO, et al. Long-term suppression of recurrent genital herpes with acyclovir. A 5-year benchmark. Acyclovir Study Group. Arch Dermatol. 1993;129:582-7. 4.
Drugs for sexually transmitted diseases. Med Lett Drugs Ther. 1994;36(913): 1-6.
5.
Knodel Le, Roush MK. Sexually transmitted diseases. In: DiPiro JT, Talbert RL, Hayes PE, et aI., eds. Pharmacotherapy: A Pathophysiologic Approach. 2nd ed. Norwalk: Appleton & Lange; 1993.
Women's Health Series This article is part of American Pharmacy's series on women's health, guest edited by Maura A. Kraynak, PharmD, assistant professor, Department of Pharmacology, and assistant director, Drug Information Service, University of Texas Health Science Center at San Antonio. The series is supported by an educational grant from Wyeth-Ayerst Laboratories.
~a4' WYETH
'
® ~~ AYERST
System Requirements • • • • • • • •
PC with a 386DX processor or better 8 megabytes of RAM 3.5",1.44 megabyte diskette drive 10 megabytes of disk space on drive C VGA monitor or better Mouse or pointing device MS DOS version 5.0 or higher Microsoft®Windows™version 3.1 or higher
QARx®for Windows™, Version 4.0 includes software, user's manual, and 60 days free customer support (nominal fees will be charged for subsequent support).
Code T17-2 Single-user version dec:ei1;traliZ¢d data entry from T "'.
tlielrtWlpo'rteci'Jllto QARx® for Windows
• •
clibLicall ~tegl()rn~S: adVerse drUg rea~ons, clinical interventions, drug inforevaluation; and errors. Da'ta ... and r~rt generation in tliese categories available upon installatio~. ~ports on these topics can be generated by simply filling in a few blanks and press~g a button. Users can also .produce reports by outcomes, by intervention codes, and by phannaCls.t. . TIie re~rts create attractive graphs, bar charts, and pie charts, enhancing presentation at meetings.
Vol. NS35, No.4
Apri11995
APhA Member Price ....... $495 APhA-ASP Member Price . ... $395 Nonmember Price ........ $595
Network version available. For a quotation, call APhA's Marketing Division at 1-800-237-2742, ext. 7556.
MERI
PHARM Y