Pediatrics – Pediatric Diarrhea: By Jason Silverman M.D.

Pediatrics – Pediatric Diarrhea: By Jason Silverman M.D.


Diarrhea is a common problem in children. While many causes are self-limited and benign,
diarrhea can also be caused by serious conditions requiring investigation and treatment. Here are some important things to know. Diarrhea means having 3 or more liquid stools
per day. Acute diarrhea has been ongoing for less than
2 weeks, beyond that it is considered chronic. Acute diarrhea is most commonly infectious. Most often it is related to viral gastroenteritis
and does not require investigation. Care is supportive to ensure adequate hydration. Diarrhea can also be caused by bacteria or
parasites from contaminated food or water. Stool cultures or microscopic analysis for
parasites may be indicated. Some infections need to be reported to public
health. Diarrhea caused by C. difficile may be acute
or chronic. It usually starts as watery, but may progress
to containing blood. Ask about risk factors for C. difficile like
previous antibiotic use, hospitalization or PPI use. Testing is for the presence of C. difficile
toxin in stool, and is important as this requires treatment. Also look out for diarrhea caused by medications,
like antibiotics, laxatives and magnesium supplements. Removing these agents can resolve the diarrhea. While some infections cause chronic diarrhea,
other causes are more common. There are two conditions not to miss. Inflammatory bowel disease can present with
abdominal pain and watery or bloody diarrhea, depending on anatomy affected. Weight loss, growth failure, extraintestinal
manifestations (oral ulcers, joint pain, rashes) or a positive family history may suggest IBD
or celiac disease. Suspicion of either condition should lead
to prompt referral for further investigation so as not to delay necessary treatment. Of course, there are more benign causes of
chronic diarrhea in children that include dietary intolerance (like lactose) or functional
diarrhea (“toddler’s diarrhea”). These improve with dietary changes.

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