Update on Diarrhea

Nicholas J. CaJacob; Mitchell B. Cohen

doi:10.1542/pir.2015-0099

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Nicholas J. CaJacob, MD*,^†
Mitchell B. Cohen, MD*,^†

^*Departments of Pediatric Gastroenterology, Hepatology, and Nutrition and
^†Pediatrics, University of Alabama at Birmingham, Birmingham, AL.

AUTHOR DISCLOSURE
Drs CaJacob and Cohen have disclosed no financial relationships relevant to this article. This commentary does not contain discussion of an unapproved/investigative use of a commercial product/device.

Practice Gaps

The mainstay of management of infectious diarrheal illness in children remains supportive care with oral or intravenous rehydration. In the postvaccine era, norovirus has supplanted rotavirus as the leading cause of gastroenteritis presenting to medical facilities in the United States.

Objectives

After reading this article, the reader should be able to:

Recognize the common pathogens associated with infectious diarrhea and develop a management plan.
Identify the key differences between infectious and noninfectious causes of diarrhea.
Effectively treat a child with cow milk protein intolerance.
Recognize that antidiarrheal and antimotility agents are not indicated or recommended in the treatment of infectious diarrhea.
Understand the changing epidemiology of infectious diarrhea in the postvaccine era.

Introduction

Diarrhea is a worldwide problem that is frequently encountered in the practice of pediatric medicine. According to the World Health Organization, diarrheal illness is the second leading cause of death in children younger than age 5 years, accounting for 760,000 deaths per year in this age group. (1)

The overwhelming majority of diarrheal illnesses are due to acute infectious diarrhea, commonly referred to as acute gastroenteritis (AGE). The degree of dehydration, assessed by both history and physical examination, is the most important indicator of disease severity. However, most children who have infectious diarrhea are not dehydrated and can be successfully treated at home with replacement of ongoing fluid losses using oral rehydration solution (ORS).

The routine use of antibiotics and antidiarrheal agents is not recommended for treatment of acute diarrhea and may cause harm. Restrictive diets are not necessary; the adverse effects on nutritional status during diarrheal illness can be lessened or prevented by rapid reinstitution of a regular …