Diarrhea in children: Difference between revisions
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==Overview== | ==Overview== | ||
Diarrhea defines as an increase in frequency or change in consistency of stool to become more liquid; which is different than normal for that person is called [[diarrhea]]. [[Causes]] include [[infections]], diet intolerance, malnutrition, etc. Diarrhea is usually self limited. Severe cases of dehydration may require treatment. | |||
==Historical Perspective== | ==Historical Perspective== | ||
*Hippocrates first coined the term diarrhea which was derived from the Greek word "diarrhoia", which translates into "flowing through". | *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. | *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. | ||
<ref name="urlAncient Origin of the Word Diarrhea and Other Common Medical Terms">{{cite web |url=http://www.todayifoundout.com/index.php/2014/01/ancient-origin-word-diarrhea-common-medical-terms/ |title=Ancient Origin of the Word 'Diarrhea' and Other Common Medical Terms |format= |work= |accessdate=}}</ref> | <ref name="urlAncient Origin of the Word Diarrhea and Other Common Medical Terms">{{cite web |url=http://www.todayifoundout.com/index.php/2014/01/ancient-origin-word-diarrhea-common-medical-terms/ |title=Ancient Origin of the Word 'Diarrhea' and Other Common Medical Terms |format= |work= |accessdate=}}</ref> | ||
| Line 19: | Line 17: | ||
==Classification and pathophysiology== | ==Classification and pathophysiology== | ||
*Chronic [[diarrhea]] in children may be classified according to the following subtypes/groups:<ref name="pmid29654747">{{cite journal |vauthors=Thiagarajah JR, Kamin DS, Acra S, Goldsmith JD, Roland JT, Lencer WI, Muise AM, Goldenring JR, Avitzur Y, Martín MG |title=Advances in Evaluation of Chronic Diarrhea in Infants |journal=Gastroenterology |volume=154 |issue=8 |pages=2045–2059.e6 |date=June 2018 |pmid=29654747 |pmc=6044208 |doi=10.1053/j.gastro.2018.03.067 |url=}}</ref> | *Chronic [[diarrhea]] in children may be classified according to the following subtypes/groups:<ref name="pmid29654747">{{cite journal |vauthors=Thiagarajah JR, Kamin DS, Acra S, Goldsmith JD, Roland JT, Lencer WI, Muise AM, Goldenring JR, Avitzur Y, Martín MG |title=Advances in Evaluation of Chronic Diarrhea in Infants |journal=Gastroenterology |volume=154 |issue=8 |pages=2045–2059.e6 |date=June 2018 |pmid=29654747 |pmc=6044208 |doi=10.1053/j.gastro.2018.03.067 |url=}}</ref> | ||
:*Osmotic: due to unabsorbed nutrients | :*Osmotic: due to unabsorbed nutrients | ||
:*Secretory: due to imbalances in ion secretion | :*Secretory: due to imbalances in ion secretion | ||
| Line 28: | Line 27: | ||
*Diarrhea in children can be divided into acute and chronic causes: <ref name="urlDiarrhea in Children - Pediatrics - MSD Manual Professional Edition">{{cite web |url=https://www.msdmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/diarrhea-in-children |title=Diarrhea in Children - Pediatrics - MSD Manual Professional Edition |format= |work= |accessdate=}}</ref> <ref name="urlDiarrhea in Children - American College of Gastroenterology">{{cite web |url=https://gi.org/topics/diarrhea-in-children/ |title=Diarrhea in Children - American College of Gastroenterology |format= |work= |accessdate=}}</ref> <ref name="pmid32278065">{{cite journal |vauthors=D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L |title=Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management |journal=Clin Gastroenterol Hepatol |volume=18 |issue=8 |pages=1663–1672 |date=July 2020 |pmid=32278065 |pmc=7141637 |doi=10.1016/j.cgh.2020.04.001 |url=}}</ref> | *Diarrhea in children can be divided into acute and chronic causes: <ref name="urlDiarrhea in Children - Pediatrics - MSD Manual Professional Edition">{{cite web |url=https://www.msdmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/diarrhea-in-children |title=Diarrhea in Children - Pediatrics - MSD Manual Professional Edition |format= |work= |accessdate=}}</ref> <ref name="urlDiarrhea in Children - American College of Gastroenterology">{{cite web |url=https://gi.org/topics/diarrhea-in-children/ |title=Diarrhea in Children - American College of Gastroenterology |format= |work= |accessdate=}}</ref> <ref name="pmid32278065">{{cite journal |vauthors=D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L |title=Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management |journal=Clin Gastroenterol Hepatol |volume=18 |issue=8 |pages=1663–1672 |date=July 2020 |pmid=32278065 |pmc=7141637 |doi=10.1016/j.cgh.2020.04.001 |url=}}</ref> | ||
*Acute: | *Acute: | ||
** | **Use of [[antibiotics]] | ||
**[[gastroenteritis]] | **G[[gastroenteritis|astroenteritis]] | ||
** | **[[Allergies]] | ||
** | **[[Food poisoning]] | ||
*Chronic: | *Chronic: | ||
** | **Diet-related | ||
** | **[[Infection|Infectious]] causes | ||
** | **Autoimmune such as [[celiac|celiac disease]] | ||
**[[inflammatory bowel disease]] | **I[[inflammatory bowel disease|nflammatory bowel disease]] | ||
*Few other causes of chronic diarrhea in children are: | *Few other causes of chronic diarrhea in children are: | ||
**[[lactose intolerance]] | **L[[lactose intolerance|actose intolerance]] | ||
**[[irritable bowel syndrome]] | **I[[irritable bowel syndrome]] | ||
** | **Non-specific: from consumption of artificially sweetened drinks in a large amount, eg: sports drinks, juice, etc. | ||
*[[Covid-19]] | *[[Covid-19]] | ||
| Line 54: | Line 53: | ||
*2-3 million deaths per year occur every year due to [[acute diarrhea]] especially in developing countries. | *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. | *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. | *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=== | ===Age=== | ||
| Line 83: | Line 82: | ||
Signs and symptoms that indicate severe disease: <ref name="urlGastroenteritis in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0201/p159.html |title=Gastroenteritis in Children - American Family Physician |format= |work= |accessdate=}}</ref> | Signs and symptoms that indicate severe disease: <ref name="urlGastroenteritis in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0201/p159.html |title=Gastroenteritis in Children - American Family Physician |format= |work= |accessdate=}}</ref> | ||
:*[[Altered mental status]] | :*[[Altered mental status]] | ||
:*Vomiting with bile or blood in it | :*Vomiting with bile or blood in it | ||
| Line 96: | Line 96: | ||
*Patients with severe diarrhea usually appear toxic. | *Patients with severe diarrhea usually appear toxic. | ||
*Physical examination may be remarkable for: <ref name="urlDiagnosis of Chronic Diarrhea in Children | NIDDK">{{cite web |url=https://www.niddk.nih.gov/health-information/digestive-diseases/chronic-diarrhea-children/diagnosis#:~:text=During%20a%20physical%20exam%2C%20a%20doctor%20typically.%20checks,find%20the%20cause%20of%20chronic%20diarrhea%20in%20children%3F |title=Diagnosis of Chronic Diarrhea in Children | NIDDK |format= |work= |accessdate=}}</ref> <ref name="urlDiagnosing and treating diarrhea in children">{{cite web |url=https://notes.childrenshospital.org/diarrhea-in-children/ |title=Diagnosing and treating diarrhea in children |format= |work= |accessdate=}}</ref> | *Physical examination may be remarkable for: <ref name="urlDiagnosis of Chronic Diarrhea in Children | NIDDK">{{cite web |url=https://www.niddk.nih.gov/health-information/digestive-diseases/chronic-diarrhea-children/diagnosis#:~:text=During%20a%20physical%20exam%2C%20a%20doctor%20typically.%20checks,find%20the%20cause%20of%20chronic%20diarrhea%20in%20children%3F |title=Diagnosis of Chronic Diarrhea in Children | NIDDK |format= |work= |accessdate=}}</ref> <ref name="urlDiagnosing and treating diarrhea in children">{{cite web |url=https://notes.childrenshospital.org/diarrhea-in-children/ |title=Diagnosing and treating diarrhea in children |format= |work= |accessdate=}}</ref> | ||
:*tenderness | :*tenderness | ||
:*[[low blood pressure]] | :*[[low blood pressure]] | ||
:*dry skin | :*dry skin | ||
:*history of [[constipation]] which may be leading to overflow diarrhea. | :*history of [[constipation]] which may be leading to overflow diarrhea. | ||
:*right lower abdominal quadrant tenderness caused by [[pseudoappendicitis]] can also be caused by causes like [[Yersinia enterocolitica]], [[intussusception]], [[hemolytic uremic syndrome]], etc. | :*right lower abdominal quadrant tenderness caused by [[pseudoappendicitis]] can also be caused by causes like [[Yersinia enterocolitica]], [[intussusception]], [[hemolytic uremic syndrome]], etc. | ||
| Line 105: | Line 106: | ||
*Measurement of serum bicarbonate concentration of more than 15mEq per L is the laboratory finding used to evaluate 5% or less dehydration. [[Hypernatremic dehydration]] can be confirmed by serum sodium levels. <ref name="urlGastroenteritis in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0201/p159.html#afp20190201p159-c1 |title=Gastroenteritis in Children - American Family Physician |format= |work= |accessdate=}}</ref> <ref name="urlDiarrhea in Children - American College of Gastroenterology">{{cite web |url=https://gi.org/topics/diarrhea-in-children/ |title=Diarrhea in Children - American College of Gastroenterology |format= |work= |accessdate=}}</ref> | *Measurement of serum bicarbonate concentration of more than 15mEq per L is the laboratory finding used to evaluate 5% or less dehydration. [[Hypernatremic dehydration]] can be confirmed by serum sodium levels. <ref name="urlGastroenteritis in Children - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2019/0201/p159.html#afp20190201p159-c1 |title=Gastroenteritis in Children - American Family Physician |format= |work= |accessdate=}}</ref> <ref name="urlDiarrhea in Children - American College of Gastroenterology">{{cite web |url=https://gi.org/topics/diarrhea-in-children/ |title=Diarrhea in Children - American College of Gastroenterology |format= |work= |accessdate=}}</ref> | ||
*If there is evidence of blood or [[mucus in stool]], or if the patient is immunocompromised, then stool microbiological tests can be done. They are however, not required in suspected viral cases. | *If there is evidence of blood or [[mucus in stool]], or if the patient is immunocompromised, then stool microbiological tests can be done. They are however, not required in suspected viral cases. | ||
*Stool culture results can sometimes become available only after 3-5 days, in some infectious causes, the organism is not visible even on stool testing. | *Stool culture results can sometimes become available only after 3-5 days, in some infectious causes, the organism is not visible even on stool testing. | ||
Revision as of 17:13, 23 February 2021
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
Overview
Diarrhea defines as an increase in frequency or change in consistency of stool to become more liquid; which is different than normal for that person is called diarrhea. Causes include infections, diet intolerance, malnutrition, etc. Diarrhea is usually self limited. Severe cases of dehydration may require treatment.
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 and pathophysiology
- Osmotic: due to unabsorbed nutrients
- Secretory: due to imbalances in ion secretion
- Mixed: stool osmotic gap (50-100 mOsm)
Causes
- Chronic:
- Diet-related
- Infectious causes
- Autoimmune such as celiac disease
- Inflammatory bowel disease
- Few other causes of chronic diarrhea in children are:
- Lactose intolerance
- Iirritable bowel syndrome
- Non-specific: from consumption of artificially sweetened drinks in a large amount, eg: sports drinks, juice, etc.
Differentiating Diarrhea in children 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. [6] [7]
- 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. [9]
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. [4]
Natural History, Complications and Prognosis
- Moderate to severe diarrhea can cause dehydration in children. Severe dehydration can cause seizures, dizziness, lack of energy, dry skin, etc. [10]
- Usually prognosis is good, and most cases resolve in a few days.
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. [4]
Symptoms
Signs and symptoms that indicate severe disease: [11]
- 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 severe diarrhea usually appear toxic.
- Physical examination may be remarkable for: [12] [13]
- tenderness
- low blood pressure
- dry skin
- history of constipation which may be leading to overflow diarrhea.
- right lower abdominal quadrant tenderness caused by pseudoappendicitis can also be caused by causes like Yersinia enterocolitica, intussusception, hemolytic uremic syndrome, etc.
Laboratory Findings
- Measurement of serum bicarbonate concentration of more than 15mEq per L is the laboratory finding used to evaluate 5% or less dehydration. Hypernatremic dehydration can be confirmed by serum sodium levels. [11] [4]
- If there is evidence of blood or mucus in stool, or if the patient is immunocompromised, then stool microbiological tests can be done. They are however, not required in suspected viral cases.
- Stool culture results can sometimes become available only after 3-5 days, in some infectious causes, the organism is not visible even on stool testing.
Electrocardiogram
There are no ECG findings associated with diarrhea.
X-ray
- Usually not indicated but may be done to rule out structural anomalies of the digestive tract. [14]
Echocardiography or Ultrasound
- Severe dehydration in children caused by acute diarrhea can be measured by ultrasound evaluation of the ratio of aorta/inferior vena cava. [15]
CT scan
There are no CT scan findings associated with diarrhea in children.
MRI
There are no MRI findings associated with diarrhea in children.
Other Imaging Findings
There are no other imaging findings associated with diarrhea.
Other Diagnostic Studies
- Upper gastrointestinal endoscopy or colonoscopy may be done. [14]
Treatment
Medical Therapy
- Fluids to prevent dehydration, especially in babies under six months of age. Artificially sweetened drinks like fruit juices should be avoided as these can make it worse.
- Slow initiation of rehydration drinks which have a perfect mix of water and electrolytes. Feed normally, medications are usually not required. [16]
Prevention
- Mainstay is the maintenance of sanitary conditions. Caregivers should wash their own hands and encourage children to do so after changing diapers, before and after handling food, after having contact with pets, after spending time in the garden/ soil. [16]
References
- ↑ "Ancient Origin of the Word 'Diarrhea' and Other Common Medical Terms".
- ↑ Thiagarajah JR, Kamin DS, Acra S, Goldsmith JD, Roland JT, Lencer WI, Muise AM, Goldenring JR, Avitzur Y, Martín MG (June 2018). "Advances in Evaluation of Chronic Diarrhea in Infants". Gastroenterology. 154 (8): 2045–2059.e6. doi:10.1053/j.gastro.2018.03.067. PMC 6044208. PMID 29654747.
- ↑ "Diarrhea in Children - Pediatrics - MSD Manual Professional Edition".
- ↑ 4.0 4.1 4.2 4.3 "Diarrhea in Children - American College of Gastroenterology".
- ↑ D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L (July 2020). "Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management". Clin Gastroenterol Hepatol. 18 (8): 1663–1672. doi:10.1016/j.cgh.2020.04.001. PMC 7141637 Check
|pmc=value (help). PMID 32278065 Check|pmid=value (help). - ↑ "Diarrhoea - UNICEF DATA".
- ↑ Dennehy PH (September 2005). "Acute diarrheal disease in children: epidemiology, prevention, and treatment". Infect Dis Clin North Am. 19 (3): 585–602. doi:10.1016/j.idc.2005.05.003. PMID 16102650.
- ↑ Vu Nguyen T, Le Van P, Le Huy C, Nguyen Gia K, Weintraub A (July 2006). "Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam". Int J Infect Dis. 10 (4): 298–308. doi:10.1016/j.ijid.2005.05.009. PMID 16458564.
- ↑ Pinzón-Rondón ÁM, Zárate-Ardila C, Hoyos-Martínez A, Ruiz-Sternberg ÁM, Vélez-van-Meerbeke A (August 2015). "Country characteristics and acute diarrhea in children from developing nations: a multilevel study". BMC Public Health. 15: 811. doi:10.1186/s12889-015-2120-8. PMC 4546125. PMID 26293136.
- ↑ "Diarrhea in Children: Why It Happens & How To Stop It".
- ↑ 11.0 11.1 "Gastroenteritis in Children - American Family Physician".
- ↑ "Diagnosis of Chronic Diarrhea in Children | NIDDK".
- ↑ "Diagnosing and treating diarrhea in children".
- ↑ 14.0 14.1 "Chronic Diarrhea in Children - What You Need to Know".
- ↑ Levine AC, Shah SP, Umulisa I, Munyaneza RB, Dushimiyimana JM, Stegmann K, Musavuli J, Ngabitsinze P, Stulac S, Epino HM, Noble VE (October 2010). "Ultrasound assessment of severe dehydration in children with diarrhea and vomiting". Acad Emerg Med. 17 (10): 1035–41. doi:10.1111/j.1553-2712.2010.00830.x. PMID 21040103.
- ↑ 16.0 16.1 "Child Diarrhoea | Causes, Symptoms and Treatment | Patient".