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Pediatrics - Pediatric Diarrhea
Whiteboard Animation Transcript
with Jason Silverman, MD
medskl.com/module/index/pedia...
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.