Approach to diarrhea in children in resource-rich countries
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Section Editors
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will discuss the approach to diarrhea in children living in resource-rich countries. The approach to diarrhea in children living in resource-limited countries is discussed separately. (See "Approach to the child with acute diarrhea in resource-limited countries" and "Persistent diarrhea in children in resource-limited countries".)
Diarrhea refers to the passage of loose or watery stools. The World Health Organization (WHO) defines a case as the passage of three or more loose or watery stools per day . Nevertheless, absolute limits of normalcy are difficult to define; any deviation from the child's usual pattern should raise concern (particularly with ill appearance, the passage of blood or mucus, or dehydration) regardless of the actual number of stools or their water content.
Acute infectious gastroenteritis due to viruses accounts for most bouts of diarrhea in resource-rich countries, resulting in more than 1.5 million outpatient visits and 200,000 hospitalizations in the United States annually . However, watery and/or frequent stools may be the initial manifestation of a wide spectrum of other acute and chronic disorders (table 1) . Norovirus has surpassed rotavirus as the most common pathogen in regions where vaccination against rotavirus has become routine .
Sepsis — Diarrhea is commonly associated with sepsis caused by Salmonella spp and toxigenic strains of Staphylococcus aureus (staphylococcal toxic shock syndrome [TSS]):
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- Dutta P, Mitra U, Saha DR, et al. Mucoid presentation of acute enterocolitis in children: a hospital-based case-control study. Acta Paediatr 1999; 88:822.
- Issenman RM, Hewson S, Pirhonen D, et al. Are chronic digestive complaints the result of abnormal dietary patterns? Diet and digestive complaints in children at 22 and 40 months of age. Am J Dis Child 1987; 141:679.
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- Life-threatening conditions
- - Sepsis
- - Intussusception
- - Hemolytic uremic syndrome
- - Fulminant C. difficile colitis (pseudomembranous colitis)
- - Appendicitis
- - Toxic megacolon
- - Congenital secretory diarrheas
- Common conditions
- - Viral gastroenteritis
- - Bacterial enteritis
- - Extraintestinal infections
- - Antibiotic-associated diarrhea
- - Functional diarrhea
- - Starvation stools
- - Lactase deficiency
- Other conditions
- ACUTE DIARRHEA (DURATION <5 DAYS)
- Physical examination
- Laboratory testing and imaging
- Algorithmic approach to the patient
- - Febrile with non-bloody diarrhea
- - Afebrile with non-bloody diarrhea
- - Febrile with bloody diarrhea
- - Afebrile with bloody diarrhea
- Therapeutic interventions
- Persistent symptoms
- CHRONIC DIARRHEA (DURATION >1 MONTH)
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS