Persistent and chronic diarrhoea

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]

References12Show ledgerHide ledger

1. [1]Zella GC; Israel EJ Chronic diarrhea in children. Pediatr Rev, 2012.PMID 22550264
2. [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. [3]Field M Intestinal ion transport and the pathophysiology of diarrhea. J Clin Invest, 2003.PMID 12671039
4. [4]Kneepkens CM; Hoekstra JH Chronic nonspecific diarrhea of childhood: pathophysiology and management. Pediatr Clin North Am, 1996.PMID 8614606
5. [5]Dennison BA Fruit juice consumption by infants and children: a review. J Am Coll Nutr, 1996.PMID 8892177
6. [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. [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. [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. [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. [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. [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. [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