Diarrhea in children

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Debduti Mukhopadhyay, M.B.B.S[2]

Synonyms and keywords: Diarrhea in kids

Historical Perspective

• Hippocrates first coined the term diarrhea which was derived from the Greek word "diarrhoia", which translates into "flowing through".
• It was described as a symptom of a lot of conditions such as intestinal parasites, cholera, and in relation to improper water and food handling.

Classification

• Chronic diarrhea in children may be classified according to the following subtypes/groups:

• Osmotic: due to unabsorbed nutrients
• Secretory: due to imbalances in ion secretion
• Mixed: stool osmotic gap (50-100 mOsm)

Pathophysiology

• The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
• The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
• On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
• On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

• Diarrhea in children can be divided into acute and chronic causes:
• Acute:
  • use of antibiotics
  • gastroenteritis
  • allergies
  • food poisoning

• Chronic:
  • diet-related
  • infectious causes
  • autoimmune such as celiac
  • inflammatory bowel disease

• Few other causes of chronic diarrhea in children are:
  • lactose intolerance
  • irritable bowel syndrome
  • non-specific: from consumption of artificially sweetened drinks in a large amount, eg: sports drinks, juice, etc.

• Covid-19

Differentiating [disease name] from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

• In 2017, 8% of all deaths in children all over the world were due to diarrhea.
• 2-3 million deaths per year occur every year due to acute diarrhea especially in developing countries.
• 9% of all hospitalizations in the United States under the age of 5 are due to diarrhea.
• In the age group of less than 3 years the incidence of diarrhea is noted to be 1.3-2.3 episodes per child annually.

Age

• In one study conducted in Hanoi, Vietnam on children <5 years of age with diarrhea; it was found that 40.9% were 1 year and below and 71.0% were 2 years and below.

Gender

• Female gender has a lower risk of diarrheal disease.

Risk Factors

• Travel to countries with poor sanitary conditions, swimming, daycare, sick contacts at home and school, antibiotics usage. Autoimmune conditions such as celiac and inflammatory bowel disease.

Natural History, Complications and Prognosis

• The majority of patients with [disease name] remain asymptomatic for [duration/years].
• Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
• If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
• Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
• Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

• The diagnosis of diarrhea is made when either the frequency of bowel movements increases or the consistency of stools becomes looser than what is normal for that child.

• [criterion 1]
• [criterion 2]
• [criterion 3]
• [criterion 4]

Symptoms

Signs and symptoms that indicate severe disease:

• Altered mental status
• Vomiting with bile or blood in it
• Cyanosis
• Increased irritability and/or crying
• Rash
• Fast breathing
• Temperature of 104 F (40C) or more
• Age less than six months or baby with low body weight

Physical Examination

• Patients with [disease name] usually appear [general appearance].
• Physical examination may be remarkable for:

• [finding 1]
• [finding 2]
• [finding 3]
• [finding 4]
• [finding 5]
• [finding 6]

Laboratory Findings

• There are no specific laboratory findings associated with [disease name].

• A [positive/negative] [test name] is diagnostic of [disease name].
• An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
• Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

• [Disease name] may also be diagnosed using [diagnostic study name].
• Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

• There is no treatment for [disease name]; the mainstay of therapy is supportive care.

• The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
• [Medical therapy 1] acts by [mechanism of action 1].
• Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

• Surgery is the mainstay of therapy for [disease name].
• [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
• [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

• There are no primary preventive measures available for [disease name].

• Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

• Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].