Chronic Diarrhea

Objectives

After completing this article, readers should be able to:

1. Describe how to prevent intractable diarrhea of infancy.

2. Characterize the causes of chronic, acquired diarrhea.

3. Recognize and diagnose the severe, rare congenital diarrheas.

4. Discuss factitious diarrhea and its signs and symptoms.

Introduction

Although this review focuses primarily on issues that a pediatric practitioner in the United States or Canada may need to consider when faced with a patient who has protracted diarrhea, we should not ignore the role that North American pediatric practices play in world health. The harm done within and beyond our borders by the once common practices of withdrawing or diluting the feedings of infants who had diarrhea and overusing intravenous hydration and bottle-feeding have yet to be corrected fully. Implementation of the core concepts contained in the American Academy of Pediatrics (AAP) Practice Parameter for Acute Gastroenteritis (1996) is incomplete, although much progress has been made.

Recurrent, chronic, infantile diarrhea, acting in concert with malnutrition, causes the death of 4.6 million children globally each year. Prolonged diarrhea is a threat to life whenever or wherever safe food and water are not provided due to inadequate supply, ignorance, or malice. The near elimination of this lethal outcome of diarrhea in the United States and Canada is attributable, in part, to the successes of agriculture and public health measures in the 20th and 21st centuries that have made food abundant and safer. Also, in the last 25 years, the following specific preventive measures have reduced further the number of infants who have this condition: 1) renewed emphasis on breastfeeding, 2) reduction in the use of partial starvation regimens during diarrheal episodes, and 3) increased availability of age-appropriate infant food for children living in poverty (Special Supplemental Food Program for Women, Infants and Children) (WIC).

In the developing world, the downward …