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Approach to diarrhea in children in resource-rich countries

Gary R Fleisher, MD
Section Editors
Stephen J Teach, MD, MPH
Teresa K Duryea, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 [1]. 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 [1]. However, watery and/or frequent stools may be the initial manifestation of a wide spectrum of other acute and chronic disorders (table 1) [2]. Norovirus has surpassed rotavirus as the most common pathogen in regions where vaccination against rotavirus has become routine [3].

Life-threatening conditions — A number of disorders causing diarrhea may be life threatening in children (table 1 and algorithm 1A) [4].

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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Literature review current through: Jul 2017. | This topic last updated: Nov 09, 2016.
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