Jessi Howell’s motherly instincts kicked in when she noticed her 12-year-old son Shane wasn’t acting quite like himself.

 “I would like to share with everyone to never second guess their instincts,” she said to the Sentinel-Press via Messenger Friday. Shane is one of three Maquoketa children hospitalized at the University of Iowa Stead Family Children’s Hospital with complications from a rare strain of E. coli.

“We knew something wasn’t right. Shane doesn’t like to complain about anything and doesn’t like going to doctors for even simple routine visits. When he stopped being his normal 12-year-old self and didn’t have a football in his hands, we knew it was bad but we never could have dreamed of just how bad it was about to get,” she said.

His parents quickly got him medical attention. Shane is currently on dialysis as he battles Hemolytic Uremic Syndrome (HUS), a rare complication that can occur with a shiga toxin-producing Escherichia coli (STEC) infection. Briella Davis, 18 months, and Cal Notz, 2, both from Maquoketa, are also at the children’s hospital battling the same illness.

Listlessness and decreased activity can be a sign of a STEC infection, said Dr. Melanie Wellington, a pediatric infectious disease specialist and associate hospital epidemiologist with University of Iowa Health Care. Most STEC symptoms start three to four days after exposure to the bacterium. Other common symptoms include diarrhea (usually bloody), abdominal cramps, nausea, vomiting, and chills.

How people react to being infected with E.coli varies widely, Wellington said. People who are very young or very old can be more heavily impacted, although infection can occur in all age groups.

In the majority of cases, people will experience symptoms that go away after a few days, she said. However, in rare cases, HUS and other complications occur. Wellington spoke to the Sentinel-Press about E.coli and HUS in general to help educate the public and not specifically about the cases of the three local children.

The parents of the three hospitalized children have been keeping friends and family updated through Facebook posts, from which they gave the Sentinel-Press permission to share information. They also have shared information with the newspaper via texts, phone calls and messenger.

Briella is progressing well and her dialysis stopped earlier this week, said her mother, Maggie Ward, via text late Friday afternoon.

“She just got moved out of the Pediatric Intensive Care Unit to inpatient a few hours ago,” she wrote.

Howell reported Friday that Shane was still on dialysis and was able to take a small walk and about five laps around the children’s unit in a wheel chair. On Saturday morning she said she expected him to be moved from intensive care later in the day.

Cal’s condition is more serious, and he was in a medically induced coma due to seizures and receiving dialysis, his mother, Nichole Notz, reported. On Saturday morning, the family reported on the Facebook page Prayers for Cal that he had had a stable night with no seizures.

All three families are thankful for the community support and prayers, the mothers said.

Many E. coli strains are routinely found in the colons of humans and do not cause disease, Wellington said. However, unlike other E. coli strains, STEC produces a harmful toxin called “shiga toxin,” which is responsible for the bloody diarrhea, HUS, and other symptoms that occur with this infection, according to the Iowa Department of Public Health (IDPH).

Spread of the bacteria can occur through drinking water contaminated with human or animal feces containing the bacterium; eating undercooked contaminated ground beef or unpasteurized dairy products; drinking unpasteurized apple juice; cider; or dairy products; eating raw fruits and vegetables that have been contaminated with feces of infected animals; or person-to-person transmission.

Wellington said that if a child is sick, parents should watch for warning signs of dehydration, such as decreased wet diapers or decreased trips to the bathroom to urinate. If a child’s urine becomes the color of cola or tea, call the child’s primary care physician as that can be a strong indication of E.coli. The bacteria also can cause mucous or blood in the feces, which is not dangerous in and of itself, but can indicate a problem, she said.

 “What’s really clear is that getting really dehydrated is bad for you and your kidneys,” Wellington said.

She gave some guidance for parents whose children are ill.

 “If your kid gets diarrhea, do everything you can to keep them hydrated,” Wellington said. If a child has diarrhea and is vomiting it can be hard to keep up with enough hydration. If that’s the case or if parents have any concerns, they should call their pediatrician to discuss options, she said.

Wellington suggested the same measures promoted by the IDPH to combat communicable disease. People should wash their hands, practice safe food handling practices such as having separate plates and utensils for raw or cooked meat, and cleaning counters and surfaces with a 10% bleach solutions, letting it dry and cleaning with soap and water.