Paeds · gastroenterology-hepatology-and-nutrition
Persistent and chronic diarrhoea
Also known as Persistent and chronic diarrhoea · Persistent diarrhoea in children · Chronic diarrhoea in children · Prolonged diarrhoea · Chronic nonspecific diarrhoea of childhood · Toddler's diarrhoea
Fellowship guide to persistent and chronic diarrhoea in children: the duration definitions that separate it from acute gastroenteritis, the osmotic, secretory, inflammatory and dysmotility mechanisms, the age-based causes from congenital diarrhoea and cow's milk protein allergy in infancy through toddler's diarrhoea to coeliac disease and inflammatory bowel disease in later childhood, the stool-osmotic-gap and fasting test, the coeliac serology and faecal calprotectin workup, and the management priorities of rehydration, nutritional rehabilitation, zinc and cause-specific therapy.
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Red flags
- Blood in the stool with chronic diarrhoea, weight loss and raised inflammatory markers in a school-age child or adolescent is inflammatory bowel disease until proven otherwise — arrange faecal calprotectin, inflammatory markers and paediatric gastroenterology referral for ileocolonoscopy
- Nocturnal diarrhoea that wakes the child, weight loss and faltering growth are organic red flags that exclude the benign diagnosis of toddler's diarrhoea and mandate investigation
- An infant with chronic watery diarrhoea from the first days of life, especially with a family history or consanguinity, has a congenital diarrhoeal disorder until proven otherwise and needs urgent electrolyte correction and specialist assessment before dehydration and acidosis become life-threatening
- Persistent diarrhoea with progressive weight loss and dehydration in a young child is a nutritional emergency — the mortality of persistent diarrhoea in the malnourished child is driven by the downward spiral of malabsorption, weight loss and infection, and it needs aggressive nutritional rehabilitation
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- Persistent and chronic diarrhoea
- Persistent and chronic diarrhoea: mechanism-based classification, age-specific causes, and management
- Persistent and chronic diarrhoea: the stepwise workup and the toddler's-diarrhoea-versus-organic distinction
- Short case: the toddler with loose stools and normal growth
- Long case: the child with chronic diarrhoea, weight loss, and a diagnosis of coeliac or inflammatory bowel disease
- Persistent and chronic diarrhoea: classification, pathophysiology, and management
- Gastroenterology: the child with chronic diarrhoea and faltering growth
- Gastroenterology: chronic diarrhoea in children
- Patient Care: persistent and chronic diarrhoea in children
- Medical Expert: persistent and chronic diarrhoea in children
Overview & Definition
Diarrhoea that will not settle is one of the commonest reasons a child is referred to a paediatrician, and the whole task is to separate the child who is thriving and needs reassurance from the child whose loose stools are the first sign of coeliac disease, inflammatory bowel disease, a food allergy or a congenital enteropathy. The clue that tells them apart is not the stool itself but the company it keeps — the growth, weight, blood and the timing. [1]
The starting point is time. Acute gastroenteritis resolves within a week or two; when watery stools continue past fourteen days the episode has become persistent diarrhoea, and when loose stools have run for four weeks or more the problem is chronic diarrhoea. The distinction matters because it changes the differential completely: a child who has had loose stools for three days almost always has a self-limiting infection, whereas a child who has had them for six weeks needs a structured search for an underlying cause. [1] [11]
References12ShowHide
- [1]Zella GC; Israel EJ Chronic diarrhea in children. Pediatr Rev, 2012.PMID 22550264
- [2]Thiagarajah JR; Kamin DS; Acra S; Goldsmith JD; Roland JT; Lencer WI Advances in Evaluation of Chronic Diarrhea in Infants. Gastroenterology, 2018.PMID 29654747
- [3]Field M Intestinal ion transport and the pathophysiology of diarrhea. J Clin Invest, 2003.PMID 12671039
- [4]Kneepkens CM; Hoekstra JH Chronic nonspecific diarrhea of childhood: pathophysiology and management. Pediatr Clin North Am, 1996.PMID 8614606
- [5]Dennison BA Fruit juice consumption by infants and children: a review. J Am Coll Nutr, 1996.PMID 8892177
- [6]Husby S; Koletzko S; Korponay-Szabó I; Kurppa K; Mearin ML; Ribes-Koninckx C European Society Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for Diagnosing Coeliac Disease 2020. J Pediatr Gastroenterol Nutr, 2020.PMID 31568151
- [7]Levine A; Koletzko S; Turner D; Escher JC; Cucchiara S; de Ridder L ESPGHAN revised porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr, 2014.PMID 24231644
- [8]Luyt D; Ball H; Makwana N; Green MR; Bravin K; Nasser SM BSACI guideline for the diagnosis and management of cow's milk allergy. Clin Exp Allergy, 2014.PMID 24588904
- [9]Keusch GT; Denno DM; Black RE; Duggan C; Guerrant RL; Lavery JV Environmental enteric dysfunction: pathogenesis, diagnosis, and clinical consequences. Clin Infect Dis, 2014.PMID 25305288
- [10]Berni Canani R; Terrin G; Cardillo G; Tomaiuolo R; Castaldo G Congenital diarrheal disorders: improved understanding of gene defects is leading to advances in intestinal physiology and clinical management. J Pediatr Gastroenterol Nutr, 2010.PMID 20216094
- [11]Lo Vecchio A; Quitadamo P; Poeta M; Buccigrossi V; Siani P; Cioffi V Aetiology, risk factors and microbiota composition in children with prolonged diarrhoea: A prospective case-controlled cohort study. Acta Paediatr, 2024.PMID 38129967
- [12]Ali AA; Naqvi SK; Hasnain Z; Zubairi MBA; Sharif A; Salam RA Zinc supplementation for acute and persistent watery diarrhoea in children: A systematic review and meta-analysis. J Glob Health, 2024.PMID 39641338